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Cited by 459Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentAutism Spectrum Disorder Research

Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood

Open access
Agnew-Blais, Jessica C., Polanczyk, Guilherme V., Danese, Andrea, Wertz, Jasmin, Moffitt, Terrie E., Arseneault, Louise·2016·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2016.0465PMC PMC5475268
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Abstract

IMPORTANCE: Attention-deficit/hyperactivity disorder (ADHD) is now recognized to occur in adulthood and is associated with a range of negative outcomes. However, less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence, and the possibility of its emergence in young adulthood in nonclinical populations. OBJECTIVE: To investigate childhood risk factors and young adult functioning of individuals with persistent, remitted, and late-onset young adult ADHD. DESIGN, SETTING, AND PARTICIPANTS: The study sample was the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins born in England and Wales from January 1, 1994, to December 4, 1995. Evaluation of childhood ADHD (ages 5, 7, 10, and 12 years) included prenatal and perinatal factors, clinical characteristics, and aspects of the family environment. Among participants aged 18 years, ADHD symptoms and associated impairment, overall functioning, and other mental health disorders were examined. Data analysis was conducted from February 19 to September 10, 2015. MAIN OUTCOMES AND MEASURES: Attention-deficit/hyperactivity disorder according to DSM-IV diagnostic criteria in childhood and DSM-5 diagnostic criteria in young adulthood. RESULTS: Of 2232 participants in the E-Risk Study, 2040 were included in the present analysis. In total, 247 individuals met diagnostic criteria for childhood ADHD; of these, 54 (21.9%) also met diagnostic criteria for the disorder at age 18 years. Persistence was associated with more symptoms (odds ratio [OR], 1.11 [95% CI, 1.04-1.19]) and lower IQ (OR, 0.98 [95% CI, 0.95-1.00]). At age 18 years, individuals with persistent ADHD had more functional impairment (school/work: OR, 3.30 [95% CI, 2.18-5.00], home/with friends: OR, 6.26 [95% CI, 3.07-12.76]), generalized anxiety disorder (OR, 5.19 [95% CI, 2.01-13.38]), conduct disorder (OR, 2.03 [95% CI, 1.03-3.99]), and marijuana dependence (OR, 2.88 [95% CI, 1.07-7.71]) compared with those whose ADHD remitted. Among 166 individuals with adult ADHD, 112 (67.5%) did not meet criteria for ADHD at any assessment in childhood. Results from logistic regressions indicated that individuals with late-onset ADHD showed fewer externalizing problems (OR, 0.93 [95% CI, 0.91-0.96]) and higher IQ (OR, 1.04 [95% CI, 1.02-1.07]) in childhood compared with the persistent group. However, at age 18 years, those with late-onset ADHD demonstrated comparable ADHD symptoms and impairment as well as similarly elevated rates of mental health disorders. CONCLUSIONS AND RELEVANCE: We identified heterogeneity in the DSM-5 young adult ADHD population such that this group consisted of a large, late-onset ADHD group with no childhood diagnosis, and a smaller group with persistent ADHD. The extent to which childhood-onset and late-onset adult ADHD may reflect different causes has implications for genetic studies and treatment of ADHD.

AI snapshot

Written from the paper’s full text.

TL;DR

In the E-Risk longitudinal twin cohort, 21.1% of individuals with childhood ADHD still met criteria at age 18, while 67.9% of those with adult ADHD had no childhood diagnosis. Late-onset and persistent ADHD groups showed comparable age-18 ADHD symptoms, impairment, and psychiatric comorbidity, challenging the view of adult ADHD as solely a childhood-onset neurodevelopmental disorder.

Key findings

  • Among 247 individuals with childhood ADHD, 21.1% met diagnostic criteria at age 18; persistence was associated with more childhood ADHD symptoms and lower performance IQ, while most family-environment factors did not distinguish persistence from remission.
  • Among 162 individuals with adult ADHD, 67.9% were late-onset (no ADHD diagnosis at or before age 12); late-onset individuals were less likely to be male and had fewer childhood behavior problems and less cognitive impairment than persistent individuals.
  • At age 18, late-onset and persistent ADHD groups had similar ADHD symptoms, functional impairment, and elevated rates of generalized anxiety disorder, conduct disorder, and marijuana dependence; late-onset individuals had significantly elevated alcohol dependence compared with persistent individuals.
  • Remitted individuals still showed impairment versus controls at age 18, including more self-rated ADHD symptoms and impairment, lower life satisfaction and job preparedness, and higher rates of major depression and conduct disorder.

Methods

  • The study used the Environmental Risk (E-Risk) Longitudinal Twin Study, a UK nationally representative birth cohort of 2,232 twins born in England and Wales in 1994–1995, assessed at ages 5, 7, 10, 12, and 18; age-18 interviews included 2,066 participants, with analyses restricted to 2,040 with childhood and adult ADHD information.
  • Childhood ADHD was assessed at ages 5, 7, 10, or 12 using DSM-IV mother and teacher reports; adult ADHD was assessed at age 18 using DSM-5 self-interviews with impairment/pervasiveness criteria and required at least two childhood ADHD symptoms.
  • Participants were classified as persistent ADHD (n=52, 2.5%), remitted ADHD (n=195, 9.6%), late-onset ADHD (n=110, 5.4%), or never ADHD (n=1,683, 82.5%); logistic regressions compared groups, with sandwich variance estimator in Stata version 11 to correct for twin non-independence.

Limitations

  • The paper states that age-18 self-reports are a limitation, though adult self-reports have been found valid and co-informant ratings corroborated self-reports for the persistent group.
  • The paper states that requiring at least two childhood symptoms for adult ADHD is both a limitation and a strength: it may define late-onset as young-adult onset of the syndrome rather than symptoms, but it ensures the adult ADHD group meets DSM-5 criteria.
  • The paper states that the twin sample may not generalize to singletons, and that childhood ADHD prevalence (12%) was higher than previous estimates (3.4–11%), possibly because ADHD was assessed at four childhood ages; evident from the text, the observational design cannot establish causal direction for associations such as maternal warmth/depression and remission.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2016.0465

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 16 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The E-Risk sample represented the full range of socioeconomic conditions in the UK at follow-up.

    “At follow up, the study sample represented the full range of socioeconomic conditions in the UK.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] Odgers C Caspi A Russell M Sampson R Arseneault L Moffit T Supportive parenting mediates neighborhood socioeconomic disparities in children’s antisocial behavior from ages 5 to 12 Devel Psychopathol 2012 24 3 705 721 22781850 PMC3551477 source
  • Premisecitation

    Findings from the Dunedin Study found that 90% of the individuals with adult ADHD at age 38 did not meet diagnostic criteria for the disorder in childhood.

    “findings from the Dunedin Study found that 90% of the individuals with adult ADHD at age 38 did not met diagnostic criteria for the disorder in childhood.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Moffitt TE Houts R Asherson P Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study Am J Psychiatry 2015 Epub head of print PMC4591104 25998281 source
  • Findingown data

    Already by age 18, late-onset individuals constitute a large proportion of adult ADHD.

    “We found that already by age 18 late-onset individuals constitute a large proportion of adult ADHD.”
    Quote in the paperSubstantial claim
  • Findingown data

    In total, 247 participants (12.1%) met criteria for ADHD in childhood.

    “In total, 247 participants (12.1%) met criteria for ADHD in childhood.”
    Quote in the paperSubstantial claim
  • Findingown data

    Late-onset and persistent ADHD individuals were similar on age-18 psychiatric comorbidity: both had elevated rates of generalized anxiety disorder, conduct disorder, and marijuana dependence.

    “Late-onset and persistent ADHD individuals were also similar on age-18 psychiatric comorbidity: both had elevated rates of generalized anxiety disorder, conduct disorder, and marijuana dependence.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 4

  • May combine two claims.

    Premisecitation

    Childhood risk factors associated with a more persistent course of ADHD include higher levels of symptoms, comorbid oppositional-defiant disorder (ODD), lower IQ, and family socioeconomic disadvantage.

    “These studies have identified childhood risk factors associated with a more persistent course, including higher levels of symptoms, comorbid oppositional-defiant disorder (ODD), lower IQ, and family socioeconomic disadvantage.”
    Quote in the paperNot a substantial claim4 of 5 sources checked
    • cites [11] Molina B Hinshaw S Swanson J The MTA Study at 8 years: prospective follow-up of children treated for combined type ADHD in a multisite study J Am Acad Child Adolesc Psychiatry 2009 48 5 484 500 19318991 PMC3063150 source

      The Discussion (page unavailable) links greater childhood ADHD symptom severity, lower IQ, conduct problems, and less socioeconomic advantage with poorer adolescent functioning; it also describes the more favorable baseline profile of children whose ADHD symptoms improved most durably. It does not specifically identify comorbid ODD as a childhood predictor, and its stated prediction concerns later functioning rather than ADHD persistence alone. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [12] Biederman J Petty C Clarke A Lomedico A Faraone S Predictors of persistent ADHD: an 11-year follow-up study J Psychiatric Res 2011 45 150 155 PMC3068747 20656298 source

      The Results (§3.3; page unavailable) associate baseline ODD with persistent ADHD, and the Discussion (§4) identifies it as a predictor. But §4 says the number or type of ADHD symptoms did not distinguish persistent from remittent cases; Results §§3.1 and 3.4 report no significant difference in family socioeconomic status or baseline IQ between those groups. The paper supports ODD, not the full list of risk factors. (LLM, conf=0.91)

      Experimental — accuracy not yet measured
    • cites [13] Barkley R Fischer M Smallish L Fletcher K The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder J Abnorm Psychol 2002 111 2 279 289 12003449 source
    • cites [14] Kessler RC Alder LA Barkley R Patterns and predictors of attention-deficit/hyperactivity disorder persistence to adulthood: results from the National Comorbidity Survey Replication Biol Psychiatry 2005 57 1442 1451 15950019 PMC2847347 source

      The Results (Childhood ADHD severity; page not specified) associate more severe childhood symptom profiles with persistence into adulthood. But the Results (Comorbid DSM-IV disorders and Childhood adversities; pages not specified) find no significant association of early-onset comorbid disorders or assessed childhood adversities with persistence. The passages do not establish lower IQ or family socioeconomic disadvantage as predictors. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [15] Cheung CHM Rijsdijk F McLoughlin G Cognitive and neurophysiological markers of ADHD persistence and remission Br J Psychiatry 2015 62 92 100 PMC4887724 26250744 source

      The Discussion (page unavailable) says childhood IQ predicted later ADHD outcome in this sample and identifies low IQ as a potential risk for poor outcome. The passages do not identify higher childhood symptom levels, comorbid ODD, or family socioeconomic disadvantage as predictors of persistence. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The vast majority of follow-up studies of children with ADHD have been conducted with clinical samples, which may not represent the overall ADHD population.

    “However, the vast majority of follow-up studies of children with ADHD have been conducted with clinical samples, which may not represent the overall ADHD population.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [16] Holbrook J Cuffe S Cai B Persistence of parent-reported ADHD symptoms from childhood through adolescence in a community sample J Atten Disord 2014 Epub ahead of print 1 10 PMC4474771 24994874 source

  • May combine two claims.

    Study design and conductcitation

    There were no differences between those who did and did not take part at age 18 in socioeconomic status when the cohort was initially defined, or age 5 IQ, internalizing or externalizing problems.

    “There were no differences between those who did and did not take part at age 18 in socioeconomic status when the cohort was initially defined, or age 5 IQ, internalizing or externalizing problems.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] Goldman-Mellor S Caspi A Arseneault L Committed to work but vulnerable: self-perceptions and mental health in NEET 18-year olds from a contemporary British cohort J Child Psychol Psychiatry 2015 EPub ahead of print PMC4789764 26791344 source

  • May combine two claims.

    Findingown data

    At age 18, co-informants rated individuals with persistent ADHD as having more symptoms compared to remitted individuals, and interviewers rated them as less conscientious, diligent and persevering than remitted peers.

    “At age 18, co-informants rated individuals with persistent ADHD as having more symptoms compared to remitted individuals, and interviewers rated them as less conscientious, diligent and persevering than remitted peers (Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Compared to controls, individuals with remitted ADHD had more self-rated ADHD symptoms and impairment at home and with friends, more ADHD symptoms as rated by co-informant, lower life satisfaction and job preparedness, and higher rates of major depression and conduct disorder.

    “However, compared to controls, individuals with remitted ADHD had more self-rated ADHD symptoms and impairment at home and with friends, more ADHD symptoms as rated by co-informant, lower life satisfaction and job preparedness, and higher rates of major depression and conduct disorder.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Co-informants rated ADHD symptoms as lower for the late-onset than the persistent group, and interviewers rated them as more conscientious, diligent and persevering.

    “Co-informants rated symptoms as lower for the late-onset than the persistent group, and interviewers rated them as more conscientious, diligent and persevering.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The majority of individuals with ADHD in childhood no longer met criteria at age 18; however, while remitted individuals showed better functioning than those with persistent ADHD, they remained impaired.

    “The majority of individuals with ADHD in childhood no longer met criteria at age 18; however, while remitted individuals showed better functioning than those with persistent ADHD, they remained impaired.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At age 18, individuals with late-onset ADHD showed comparable ADHD symptoms and impairment and similarly elevated rates of mental health disorders compared to the persistent group.

    “at age 18, they showed comparable ADHD symptoms and impairment and similarly elevated rates of mental health disorders compared to the persistent group.”
    • Also stated in: § Young adult functioning of late-onset versus persistent ADHD · plain
      “persistent and late-onset ADHD groups were similar on levels of ADHD symptoms and functional impairment, life satisfaction, job preparedness, and rates of being in formal education.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In childhood, individuals with late-onset ADHD showed fewer behavior problems and higher IQ compared to the persistent group.

    “In childhood, individuals with late-onset ADHD showed fewer behavior problems and higher IQ compared to the persistent group;”
    • Also stated in: § Childhood characteristics of late-onset versus persistent ADHD · plain
      “late-onset individuals were less likely to be male and, controlling for gender, had fewer childhood behavioral problems and less cognitive impairment than persistent individuals”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    While most pre-/perinatal and family environment factors were associated with the incidence of ADHD in childhood, overall they were not associated with its persistence into adulthood.

    “While most pre-/perinatal and family environment factors were associated with the incidence of ADHD in childhood, overall they were not associated with its persistence into adulthood.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Characteristics of the family environment did not distinguish individuals who persisted from those who remitted, except that families of persistent individuals had comparatively higher maternal warmth and less maternal depression.

    “Overall, characteristics of the family environment did not distinguish individuals who persisted from those who remitted, except that families of persistent individuals had comparatively higher maternal warmth and less maternal depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among individuals who met diagnostic criteria for ADHD in childhood, persistent individuals had more symptoms across childhood and lower performance IQ compared to those who remitted.

    “persistent individuals had more symptoms across childhood and lower performance IQ compared to those who remitted.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Persistent individuals had lower IQ and life satisfaction than remitted individuals, but these differences were marginally significant.

    “While persistent individuals had lower IQ and life satisfaction than remitted individuals, these differences were marginally significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants who met diagnostic criteria for ADHD in childhood and those who met diagnostic criteria for ADHD in adulthood both differed from controls on pre/perinatal factors, clinical features and family environment.

    “Participants who met diagnostic criteria for ADHD in childhood and those who met diagnostic criteria for ADHD in adulthood both differed from controls on pre/perinatal factors, clinical features and family environment (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Persistent individuals had elevated rates of generalized anxiety disorder, conduct disorder and marijuana dependence compared to those who remitted.

    “Persistent individuals had elevated rates of generalized anxiety disorder, conduct disorder and marijuana dependence compared those who remitted.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among individuals who met diagnostic criteria for ADHD in childhood or adulthood, 52 (2.5%) had persistent ADHD, 195 (9.6%) had remitted ADHD, and 110 (5.4%) had late-onset ADHD; 1,683 (82.5%) never met criteria.

    “individuals with persistent ADHD who met diagnostic criteria both in childhood and at age 18 (n=52, 2.5% of the total sample); individuals with remitted ADHD who met diagnostic criteria in childhood but not at age 18 (n=195, 9.6%); and individuals with late-onset ADHD who did not meet diagnostic criteria in childhood but did at age 18 (n=110, 5.4%). A total of 1,683 (82.5%) participants did not me”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Persistence of ADHD was associated with higher levels of ADHD symptoms and lower IQ in childhood.

    “Persistence was associated with higher levels of symptoms and lower IQ in childhood.”
    • Also stated in: § Childhood characteristics of persistent versus remitted ADHD · plain
      “persistent individuals had more symptoms across childhood and lower performance IQ compared to those who remitted.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Persistent individuals had more functional impairment and higher rates of other mental health disorders at age 18 compared to those who remitted.

    “Persistent individuals had more functional impairment and higher rates of other mental health disorders at age 18 compared to those who remitted.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The gender distribution differed between ADHD groups: males were overrepresented in the childhood ADHD group, while the gender ratio was nearly equal in the adult ADHD group.

    “However, the gender distribution differed between ADHD groups: males were overrepresented in the childhood ADHD group, while the gender ratio was nearly equal in the adult ADHD group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Controlling for gender, late-onset individuals had fewer childhood behavioral problems and less cognitive impairment than persistent individuals.

    “late-onset individuals were less likely to be male and, controlling for gender, had fewer childhood behavioral problems and less cognitive impairment than persistent individuals (Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Late-onset individuals exhibit elevated rates of anxiety, depression, marijuana dependence and alcohol dependence.

    “We found that late-onset individuals exhibit elevated rates of anxiety, depression, marijuana dependence and alcohol dependence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The requirement of at least 2 symptoms in childhood does not identify a group with subthreshold ADHD in childhood; exhibiting at least 2 symptoms in childhood was quite normative, as 80% of the study population falls into this category.

    “Our requirement of at least 2 symptoms in childhood does not identify a group with subthreshold ADHD in childhood; exhibiting at least 2 symptoms in childhood was quite normative, as 80% of our study population falls into this category.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The late-onset group showed significant levels of ADHD symptoms and impairment, as well as poor functioning and high rates of psychiatric comorbidity.

    “we found this group showed significant levels of ADHD symptoms and impairment, as well as poor functioning and high rates of psychiatric comorbidity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous study in this cohort identified a heritability of ADHD symptoms at age 5 of 74%.

    “A previous study in this cohort identified a heritability of ADHD symptoms at age 5 of 74%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Kuntsi J Eley TC Taylor A Co-occurrence of ADHD and low IQ has genetic origins Am J Med Genet Part B (Neuropsychiatric Genetics) 2004 124B 41 47 14681911 source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Analyses were corrected for the non-independence of twin observations with tests using the sandwich variance estimator in Stata version 11.

    “Analyses were corrected for the non-independence of twin observations with tests using the sandwich variance estimator in Stata version 11.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] STATA [computer program]. Version 11 College Station, TX StataCorp LP 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Prospective follow-up studies of clinic-referred children with ADHD indicate that approximately 15% will continue to meet diagnostic criteria, and 65% will continue to have impairing ADHD symptoms as young adults.

    “prospective follow-up studies of clinic-referred children with ADHD indicate that approximately 15% will continue to meet diagnostic criteria, and 65% will continue to have impairing ADHD symptoms as young adults.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Faraone S Biederman J Mick E The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies Psychol Med 2006 36 2 159 165 16420712 source

  • May combine two claims.

    Study design and conductown data

    Co-informants rated the persistent group as having more symptoms than the remitted group, corroborating self-reports.

    “also our co-informants rated the persistent group as having more symptoms than the remitted group, corroborating self-reports.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The adult ADHD population is heterogeneous, consisting of a large late-onset group with no childhood diagnosis and minimal neuropsychological impairment, and a smaller persistent group with associated neuropsychological impairment.

    “we identified heterogeneity in the adult ADHD population such that this group consisted of a large late-onset ADHD group with no childhood diagnosis and minimal neuropsychological impairment, and a smaller group with persistent ADHD and associated neuropsychological impairment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    The sample comprised twins, so results may not generalize to singletons.

    “Third, the sample comprised twins, so results may not generalize to singletons.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The prevalence of childhood ADHD of 12% was higher than the 3.4-11% estimated previously, possibly because the study captured more cases by assessing ADHD at four ages across childhood.

    “Our prevalence of childhood ADHD of 12% was higher than the 3.4–11% estimated previously,32,33 possibly because we are capturing more cases by assessing ADHD at four ages across childhood.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [32] Polanczyk GV Salum GA Sugaya LS Caye A Rohde LA Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents J Child Psychol Psychiatry 2015 56 3 345 365 25649325 source
    • cites [33] Centers for Disease Control and Prevention Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children -- United States, 2003 and 2007 MMWR Morbidity and Mortality Weekly Report 2010 59 44 1439 1443 21063274 source

  • May combine two claims.

    Interpretationreasoning

    The rate of persistence of 21.1% is slightly higher than found in a meta-analysis; given the young age of the cohort, this is not unexpected.

    “However, our rate of persistence of 21.1% is slightly higher than found in a meta-analysis;10 given the young age of our cohort, this is not unexpected.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Faraone S Biederman J Mick E The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies Psychol Med 2006 36 2 159 165 16420712 source
31 of 31

  • The authors state this as an assumption.

    Less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence past childhood, and the possibility of its emergence in young adulthood in non-clinical populations.

    “However, less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence past childhood, and the possibility of its emergence in young adulthood in non-clinical populations.”

  • The authors state this as an assumption.

    Adult ADHD has been conceptualized as a continuation of childhood ADHD.

    “To date, adult ADHD has been conceptualized as a continuation of childhood ADHD.”

  • The paper relies on this without support.

    Individuals who do not meet diagnostic criteria for ADHD in childhood are generally not included in studies following children with ADHD.

    “Additionally, individuals who do not meet diagnostic criteria in childhood are generally not included in studies following children with ADHD, resulting in a limited understanding of the potential emergence of the disorder in later life.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • More than two-thirds of people with adult ADHD have ever had childhood ADHD.

    “several prospective longitudinal studies have revealed that more than two-thirds of people with adult ADHD have ever had childhood ADHD [7-9].”

    From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [8]

    The Abstract Results report that 67.9% of participants with ADHD at age 18 did not meet ADHD criteria at any childhood assessment through age 12. Thus, in this cohort, only 32.1% had a childhood ADHD diagnosis—the opposite of the proportion attributed to this source. (LLM, conf=0.95)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Children with ADHD do not outgrow the disorder when they reach adulthood.

    “Recent evidence supports the view that children with ADHD do not “outgrow” the disorder when they reach adulthood”

    From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [13]

    The Discussion section, under “Most children with ADHD will remit by age 18 but impairment remains,” says the majority of children with ADHD no longer met diagnostic criteria at 18. Although those who remitted remained impaired, the paper contradicts the unqualified claim that children with ADHD do not outgrow the disorder. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • A recent longitudinal study found that 2.5%-10.7% of subjects with ADHD first emerge in adolescence or adulthood, with the majority of adults with ADHD (67.5%-90.0%) not experiencing symptoms in childhood.

    “A recent longitudinal study found that 2.5%–10.7% of subjects with ADHD first emerge in adolescence or adulthood, with the majority of adults with ADHD (67.5%–90.0%) not experiencing symptoms in childhood (Agnew-Blais et al., 2016).”

    From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Agnew-Blais et al., 2016

    The Abstract Results report that 67.9% of participants with ADHD at age 18 had not met diagnostic criteria by age 12, supporting the claim that a majority lacked a childhood diagnosis. But the Discussion’s Limitations section says the adult ADHD group had at least two childhood symptoms, so ‘not experiencing symptoms in childhood’ is inaccurate. The paper does not report the attributed 2.5%–10.7% emergence range. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Most ADHD longitudinal studies simply define remission as failing to meet DSM criteria, with few attempts to identify or define distinct subtypes and patterns of remission.

    “Most ADHD longitudinal studies simply define remission as “failing to meet DSM criteria,” with few attempts to identify/define distinct subtypes and patterns of remission.”

    From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [4]

    The Methods section (‘Persistent, remitted, and late-onset ADHD groups’; page unavailable) defines remission in this study as meeting ADHD diagnostic criteria in childhood but not at age 18. The paper does not establish that most longitudinal studies use this definition or that few distinguish subtypes or patterns of remission. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Recent evidence has demonstrated that ADHD does not necessarily begin in childhood.

    “Although ADHD has been traditionally under the umbrella of neurodevelopmental disorder, recent evidence has demonstrated that ADHD does not necessarily begin in childhood [7-9].”

    From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [8]

    The Discussion reports that 70% of individuals with adult ADHD had never had a childhood diagnosis, supporting the possibility of later emergence. But the Introduction says ADHD *may* not arise until adolescence or adulthood, and the Discussion considers whether it was present but not apparent in childhood. The paper therefore does not demonstrate that ADHD itself began after childhood. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. [28]Brown T A new understanding of ADHD in childhood and adults: Executive function impairments New York and London Routledge Taylor & Francis Group 2013
  2. [35]Maughan B Taylor A Caspi A Moffitt TE Prenatal smoking and child antisocial behaviour: testing genetic and environmental confounds Arch Gen Psychiatry 2004 61 836 843 15289282
  3. [42]Baddeley AD Working Memory Oxford, England Oxford University Press 1986
  4. [54]Wechsler D Wechsler Adult Intelligence Scale--Fourth Edition San Antonio, TX Pearson 20078

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Related

Authors
Agnew-Blais, J. C., Polanczyk, G. V., Danese, A., Wertz, J., Moffitt, T. E., & Arseneault, L.
Affiliations
  • Medical Research Council Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
  • Universidade de São Paulo (BR)
  • National Health Service (GB)
  • King's College London (GB)
  • Duke University (US)
Corresponding author
Arseneault, Louise
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2016-07-01
Volume
73
Issue
7
Pages
713
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2016.0465
PMC
PMC5475268
OpenAlex
W2399153035
Semantic Scholar
a3442905ee60ab2c74b60e9efe98638a8df269ac
Cited by
459
References
48
Citations by year
2026: 29 · 2025: 43 · 2024: 41 · 2023: 44 · 2022: 44 · 2021: 49 · 2020: 49 · 2019: 40 · 2018: 52 · 2017: 48 · 2016: 16 · 2012: 1
FWCI
46.21
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
Funders
  • South London and Maudsley NHS Foundation Trust
  • National Institute for Health and Care Research
  • King's College London
  • Jacobs Foundation (G1002190)
  • Medical Research Council (G1002190)
  • Economic and Social Research Council (ES/P010113/1, RES‐177‐25‐0013)
  • National Institute on Aging (P30AG034424)
  • National Institute of Child Health and Human Development (G1002190, HD061298)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD077482, R01HD061298)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
attention deficit hyperactivity disorder, adult ADHD, late-onset ADHD, early adulthood, childhood risk factors, prenatal and perinatal factors, family environment, functional disability, psychiatric comorbidity, generalized anxiety disorder, conduct disorder, environmental risk, twin cohort, IQ, ADHD symptoms, Environmental Risk Longitudinal Twin Study
MeSH terms
Late Onset Disorders, Adolescent, Age Factors, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, England, Female, Humans, Longitudinal Studies, Male, Remission, Spontaneous, Risk Factors, Cohort Studies, Young Adult

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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