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Cited by 10Attention Deficit Hyperactivity DisorderDementia and Cognitive Impairment ResearchAutism Spectrum Disorder Research

ADHD and associated psychopathology in older adults in a German community sample

Open access
Müller, Marcus, Turner, Daniel, Barra, Steffen, Rösler, Michael, Retz, Wolfgang·2023·Journal of Neural Transmission
DOI 10.1007/s00702-022-02584-4PMC PMC10033550
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Abstract

Attention deficit hyperactivity disorder (ADHD) is still a neglected disorder in older adults. The aim of the present study was to examine the prevalence and symptomatology of ADHD and associated psychopathology in adults aged 40–80 years in a German community sample. We examined 539 participants in two age groups: (1) 40–59 years old ( n = 256) and (2) 60–80 years old ( n = 283). To assess ADHD in both childhood and adulthood as well as current psychopathological impairments, we used self-report instruments and corresponding observer reports. We examined group differences between age groups and between ADHD and non-ADHD groups. The prevalence of ADHD in the total sample was 2.6% with no significant differences between the two age groups (40–59 years: 3.1% vs. 60–80 years: 2.1%). Although differences emerged in impulsivity/emotional lability and self-concept problems, overall ADHD symptom ratings did not differ between the age groups. The ADHD group showed more psychopathological peculiarities compared to individuals without ADHD with medium-to-large effect sizes. Self-reports and observer reports showed good concordance in the assessment of ADHD and comorbid psychopathological symptoms. Regarding current ADHD symptomatology, in 92.1%, self-report was corroborated by observer's information. Our findings underline that ADHD symptoms are relevant across the lifespan. Augmenting self-reports with observer reports could increase the assessment quality of ADHD. For successful treatment, clinicians should also focus on additional psychopathological impairments and comorbidities in older adults with ADHD.

AI snapshot

Written from the paper’s full text.

TL;DR

In a German community sample of 539 adults aged 40–80, clinically relevant ADHD in both childhood and adulthood was reported by 2.6%, with no significant difference between the 40–59 and 60–80 age groups. ADHD was associated with substantially more psychopathological symptoms, and self-reports showed good concordance with observer reports.

Key findings

  • Prevalence of self-reported clinically relevant ADHD symptoms was 8.9% in childhood (WURS-K ≥ 30), 7.4% in adulthood (CAARS-S:S ADHD-Index T ≥ 65), and 2.6% in both childhood and adulthood; the 40–59 vs. 60–80 age groups did not differ significantly (3.1% vs. 2.1% for both childhood and adulthood).
  • The ADHD groups showed more psychopathological impairments than non-ADHD participants with medium-to-large effect sizes; for adult ADHD, the general psychopathology score was nearly two standard deviations higher than in the non-ADHD group (Cohen’s d = −2.13).
  • Self- and observer reports showed good concordance: in 92.1% of 466 dyads, they agreed on whether clinically relevant current ADHD symptomatology was present; total-sample correlations ranged from r = 0.39 to 0.49 across CAARS scales.
  • Gender effects were mostly nonsignificant overall, but in the 60–80 group, 8.9% of females vs. 3% of males reported current clinically relevant ADHD symptoms (χ²(1) = 5.29, p = 0.02, V = 0.14).

Methods

  • Population-based, non-clinical sample from the Gutenberg Brain Study in Mainz, Germany; 2,342 invited, 539 participants aged 40–80 included (53.1% female), divided into 40–59 years (n = 256) and 60–80 years (n = 283); participation rate 23.0%.
  • ADHD was assessed with self-report WURS-K for childhood symptoms and CAARS-S:S plus corresponding observer CAARS-O:S for current symptoms; psychopathology was assessed with ASR (18–59 years) or OASR (60+ years).
  • Analyses used SPSS 26.0, χ² tests with Cramér’s V, t tests with Cohen’s d, Pearson correlations, and False Discovery Rate correction for multiple testing.

Limitations

  • The paper states that retrospective childhood ADHD assessment relies on self-report and may be affected by recall bias, especially in older adults, and that the diagnosis did not exist in many participants’ childhoods.
  • The paper states that clinician-administered diagnoses were not included, the design was cross-sectional rather than prospective longitudinal, the sample was not representative, and the ADHD group was relatively small, limiting some comparisons.
  • The paper notes possible selection bias because participants had expressed interest in brain-health research and then mental-health questionnaires, which may have overestimated psychopathological abnormalities; it also states that findings may not generalize to other societies without limitations.

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

Integrity signals

Registry

Crossref · 10.1007/s00702-022-02584-4

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

17 of 53 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    Consistent with other research findings, the results showed a slight trend indicating that more men reported clinically relevant ADHD symptoms in childhood than women.

    “Consistent with other research findings (Loyer Carbonneau et al. 2021; Dalsgaard et al. 2015), our results showed a slight trend indicating that more men reporting clinically relevant ADHD symptoms in childhood than women.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Loyer Carbonneau et al. 2021 source
    • cites Dalsgaard et al. 2015 source

      The indexed Methods and Findings passages describe a Danish cohort and compare ADHD-related mortality by sex and age at diagnosis. They do not report whether more men than women had clinically relevant ADHD symptoms in childhood. Searches for a childhood male–female symptom or diagnosis comparison found no passage addressing that point. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
  • Findingown data

    In the 60-80 year old group, the prevalence rate found (2.1%) is 2.5 times higher than the 0.8% found in the meta-analysis of 40 studies by Song et al. (2021).

    “However, looking specifically at the group of the 60–80 years old, the rate we found (2.1%) is 2.5 times higher than the 0.8% found in the meta-analysis of 40 studies by Song et al. (2021) in this age group.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Song et al. (2021) source

      The Results’ study-selection section reports 40 included articles, and Table 2 estimates persistent adult ADHD prevalence at 0.77% (approximately 0.8%) for adults aged 60 and over. It does not give that estimate specifically for ages 60–80; nor were all 40 articles used to provide age-specific prevalence. The 2.1% rate is the citing authors’ own result, not a finding attributed to Song et al. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data

    The prevalence of self-reported clinically relevant ADHD symptoms in childhood (WURS-K score ≥ 30) was 8.9% (95% CI 6.5-11.5).

    “In the total sample (N = 539), the prevalence of self-reported clinically relevant ADHD symptoms in childhood (WURS-K score ≥ 30) was 8.9% (95% CI 6.5%–11.5%).”
    • Also stated in: § Prevalence of ADHD symptomatology in the two age groups · plain
      “ADHD in childhood (WURS-K ≥ 30) | 48 | 8.9 (6.5–11.5)”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the total sample of 539 adults aged 40-80 years, the prevalence of self-reported clinically relevant ADHD symptoms in both childhood and adulthood was 2.6% (95% CI 1.3-3.9).

    “Considerably less individuals reported about ADHD symptomatology in both childhood and adulthood (2.6%, 95% CI 1.3%–3.9%).”
    • Also stated in: § Abstract · plain
      “The prevalence of ADHD in the total sample was 2.6%”
    • Also stated in: § Prevalence of ADHD symptomatology in the two age groups · plain
      “WURS-K & ADHD-Index | 14 | 2.6 (1.3–3.9)”
    Quote in the paperSubstantial claim
  • Findingown data

    The prevalence of ADHD did not differ significantly between the 40-59 and 60-80 age groups (3.1% vs 2.1%).

    “The prevalence of ADHD in the total sample was 2.6% with no significant differences between the two age groups (40–59 years: 3.1% vs. 60–80 years: 2.1%).”
    • Also stated in: § Prevalence of ADHD symptomatology in the two age groups · plain
      “WURS-K & ADHD-Index | 14 | 2.6 (1.3–3.9) | 8 | 3.1 (1.2–5.5) | 6 | 2.1 (0.7–3.9) | 0.54 | 0.46 | 0.03”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 23
  • May combine two claims. 35
  • The quote only partly states this claim. 3

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

    Premisecitation

    About 15% of childhood ADHD cases show full symptomatology in adulthood, and in more than every second case, there are at least some continuing ADHD symptoms.

    “About 15% of childhood ADHD cases show full symptomatology in adulthood, and in more than every second case, there are at least some continuing ADHD symptoms (Fayyad et al. 2007; Faraone et al. 2006).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Fayyad et al. 2007 source

      The introduction (p. 1) says that children with ADHD often continue to have symptoms in adulthood, supporting the general persistence claim. Neither that passage nor the paper’s description of its childhood-ADHD assessment (Adult ADHD, p. 2) gives the claimed figures of about 15% with full symptoms or more than half with some symptoms. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Faraone et al. 2006 source

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

    Premisecitation

    Most previous research has not found any decline of prevalence estimates with increasing age within adulthood, and ADHD prevalence in older adults (e.g., above 50 years) was estimated to be around 3%.

    “Most previous research has not found any decline of prevalence estimates with increasing age within adulthood, and just as throughout adulthood in general, the ADHD prevalence in older adults (e.g., above 50 years of age) was estimated to be around 3% (Dobrosavljevic et al. 2020; Goodman et al. 2016; Guldberg-Kjar and Johansson 2009; Kooij et al. 2016; Michielsen et al. 2012; Sharma et al. 2021; T”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Dobrosavljevic et al. 2020 source

      The Discussion reports an adjusted prevalence of 2.8% in one study of adults aged 60 and older, lending some support to the approximate 3% figure. But the paper’s pooled research-diagnosis estimate is 2.18%, with much lower estimates for clinical diagnosis and treatment. The Discussion also says its lower estimate for older adults is consistent with an age-related decline, contrary to the claim that previous research generally found no decline. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites Goodman et al. 2016 source
    • cites Guldberg-Kjar and Johansson 2009 source

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

    Premisecitation

    Recent longitudinal studies have found evidence for an adult-onset ADHD type.

    “Moreover, recent longitudinal studies have found evidence for an adult-onset ADHD type; meaning individuals with adult ADHD who have never been diagnosed with ADHD during childhood (Moffitt et al. 2015; Agnew-Blais et al. 2016; Caye et al. 2016).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites Moffitt et al. 2015 source
    • cites Agnew-Blais et al. 2016 source
    • cites Caye et al. 2016 source

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

    Premisecitation

    In adults, research has suggested a nearly balanced gender ratio for ADHD.

    “In adults, research has suggested a nearly balanced gender ratio, which accounts for adult ADHD in general and for older ADHD patients in particular (Dobrosavljevic et al. 2020; Michielsen et al. 2012; Song et al. 2021).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites Dobrosavljevic et al. 2020 source

      The Limitations and future lines of research section (page unavailable) says the authors could not estimate ADHD prevalence by sex in older adults because most included studies did not report it. Searches for a balanced gender or sex ratio found no passage establishing a nearly balanced ratio among adults with ADHD; the unequal female-to-male distribution noted there concerns study samples, not ADHD cases. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites Michielsen et al. 2012 source
    • cites Song et al. 2021 source

      The Results section’s sex-stratified analyses report similar male and female prevalence for both persistent adult ADHD (4.99% vs 4.49%) and symptomatic adult ADHD (8.05% vs 7.76%), supporting a nearly balanced ratio in adults generally. The age-specific Results report prevalence among adults aged 60 and over but do not give a sex ratio for that group, so this source does not establish the citing sentence’s older-patient qualification. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

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

    Premisecitation

    ADHD is mostly conceptualized as a neurodevelopmental disorder with early onset that can persist into adulthood with both psychopathological symptoms and functional impairments.

    “however, meanwhile, it is mostly conceptualized as a neurodevelopmental disorder with early onset that can persist into adulthood with both psychopathological symptoms and functional impairments (Faraone et al. 2021).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Faraone et al. 2021 source

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

    Premisecitation

    The rate of adult ADHD is around 3%.

    “The rate of adult ADHD is lower with around 3% (Fayyad et al. 2007; Kessler et al. 2006; Simon et al. 2009; Song et al. 2021).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Fayyad et al. 2007 source
    • cites Kessler et al. 2006 source
    • cites Simon et al. 2009 source

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

    Premisecitation

    A recent global systematic review and meta-analysis found a decline in ADHD prevalence during adulthood and a prevalence of only 0.8% in the age group 60 and above.

    “However, a recent global systematic review and meta-analysis questioned this view, finding a decline in ADHD prevalence during adulthood irrespective of childhood or adulthood onset and a prevalence of only 0.8% in the age group 60 and above (Song et al. 2021).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Song et al. 2021 source

      The Results section reports that both persistent and symptomatic adult ADHD decrease with age. For adults aged 60 and above, however, the approximately 0.8% estimate (0.77%) applies only to persistent ADHD with childhood onset; the estimate for symptomatic ADHD, regardless of childhood onset, is 4.51%. The paper does not separately estimate ADHD with adulthood onset. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    The rate of both childhood and adulthood ADHD symptoms (2.6%) is consistent with current empirical knowledge and confirms the hypothesis of a continuous decrease of ADHD symptomatology with increasing age.

    “Both, clinically relevant symptoms in childhood as well as in adulthood were reported by 2.6% of our sample, a rate which goes well with the current empirical knowledge about the course of ADHD along the lifespan and confirms our hypothesis of a continuous decrease of ADHD symptomatology with increasing age (Wootton et al. 2022).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Wootton et al. 2022 source

      The Introduction gives a 2.6% estimated prevalence for adults, not for people reporting clinically relevant symptoms in both childhood and adulthood. The Discussion reports an overall decrease in ADHD traits with age, but the Results describe a small increase in measured scores from ages 17 to 21, so the paper does not establish a strictly continuous decrease. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Adult ADHD does rarely occur without other comorbid psychiatric symptoms and most adults with ADHD suffer from additional psychiatric disorders during their lifetime.

    “Furthermore, adult ADHD does rarely occur without other comorbid psychiatric symptoms and most adults with ADHD suffer from additional psychiatric disorders during their lifetime (Simon et al. 2009; de Zwaan et al. 2012).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Simon et al. 2009 source

      The Abstract (page not specified in our copy) describes ADHD as a serious risk factor for comorbid psychiatric disorders. It does not say that ADHD rarely occurs without them or that most adults with ADHD have an additional psychiatric disorder during their lifetime. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites de Zwaan et al. 2012 source

  • May combine two claims.

    Premisecitation

    There is considerable concern about the ability of adults to accurately recall childhood conditions, and there is a risk to under- or overestimate symptoms.

    “There is considerable concern about the ability of adults to accurately recall childhood conditions (Fayyad et al. 2007; Kessler et al. 2006) and there is a risk to under- or overestimate symptoms.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Fayyad et al. 2007 source

      The Adult ADHD section (p. 2) says childhood symptoms were assessed retrospectively, and the Discussion (p. 6) identifies reliance on adult self-reports as a limitation. These passages support a general concern about assessment accuracy, but they do not specifically discuss adults’ ability to recall childhood conditions or a risk of both under- and overestimating symptoms. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites Kessler et al. 2006 source

  • May combine two claims.

    Findingown data

    There was no significant gender difference in the prevalence of both childhood and adulthood ADHD.

    “Both ADHD symptomatology in childhood and adulthood have been found in 2.4% of the examined women and 2.8% of the men; again, differences were not statistically significant (χ2(1) = 0.05, p = 0.82, V = 0.01).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Observer reports suggested lower rates of adult ADHD in both age groups (40-59: 5.4%; 60-80: 2.7%) compared to self-reports.

    “Finally, the observer’s reports (CAARS-O:S) suggested somewhat lower rates of adult ADHD in both age groups [40–59 years: 5.4% (95% CI 2.5–8.3%); 60–80 years: 2.7% (95% CI 0.9–4.9%)], but again no significant differences.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the 60-80 age group, the gender ratio for both childhood and adulthood ADHD differed significantly, with women (3.8%) higher than men (0.0%).

    “In the group of the 60–80 year old adults, the gender ratio also differed significantly (χ2(1) = 4.92, p = 0.03, V = 0.13) and the proportion of women who met the criteria (3.8%) was higher than the proportion of men (0.0%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the 40-59 age group, 6.2% of females vs 11.8% of males reported current clinically relevant ADHD symptoms, with no significant gender difference.

    “With regard to adult ADHD, 6.2% females versus 11.8% males of the 40–59 year old adults reported current clinical relevant ADHD symptoms, with no significant gender difference (χ2(1) = 2.46, p = 0.12, V = 0.10).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    More participants in the younger age group reported clinically relevant difficulties including impulsive acts, low frustration tolerance, quick and frequent mood changes, and feeling easily angered and irritated by people.

    “Thus, more participants reported clinically relevant difficulties including impulsive acts, low frustration tolerance, quick and frequent mood changes, and feeling easily angered and irritated by people in the younger age group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Adults with ADHD symptomatology reported fewer personal strengths, meaning less resources and protective factors against the development or maintenance of comorbidities.

    “At the same time, adults with ADHD symptomatology reported fewer personal strengths, what means less resources and protective factors against the development or the maintenance of comorbidities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the childhood ADHD group, the general psychopathology score was one standard deviation higher than in the non-ADHD group; in the adult ADHD group, the difference was nearly two standard deviations.

    “In the childhood ADHD group, the general psychopathology score was one standard deviation higher than in the non-ADHD group. In the adult ADHD group, the difference was even nearly two standard deviations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The study found only small age effects in ADHD core symptoms, and after adjusting p values for multiple testing the significant differences disappeared.

    “With regard to the changes in ADHD core symptoms, however, it must be pointed out that we only found small age effects and after adjusting the p values for multiple testing the significant differences disappeared.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    In adulthood, the gender ratio adjusted and there was no longer a clear gender effect in both age groups.

    “In adulthood, the ratio adjusted and there was no longer a clear gender effect in both age groups, which also fits well with the previous research findings (Dobrosavljevic et al. 2020; Song et al. 2021).”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In this sample, the childhood ADHD group (n = 48) had significantly higher ASR/OASR total problems and all included subscale scores than the non-ADHD childhood group (n = 491), with medium to large effect sizes.

    “We found a statistically significant difference between the ASR/OASR total problems score (general psychopathology) and on all included subscales between the childhood ADHD group (n = 48) and the non-ADHD childhood group (n = 491) (see Table 4).”
    • Also stated in: § Differences between ADHD and non-ADHD participants concerning comorbid psychopathological symptoms · plain
      “Participants who reported about an ADHD symptomatology in childhood had significantly more psychopathological symptoms during adulthood than those participants who did not report about ADHD symptomatology in childhood. Effect sizes were medium to large.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Regarding every measured core symptom scale, there were somewhat higher correlations in the younger age group than in the older age group, but only minor differences in r coefficients.

    “Regarding every measured core symptom scale, we found somewhat higher correlations in the younger age group than in the older age group. However, there were only minor differences in the r coefficients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants who met criteria for clinically relevant childhood or adult ADHD symptoms reported significantly more current depressive, anxiety, psychosomatic symptoms, and more thought problems.

    “Participants who met the criteria for clinically relevant childhood or adult ADHD symptoms additionally reported significantly more current depressive, anxiety, psychosomatic symptoms, and more thought problems.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the case of current and symptomatic ADHD, the scores were higher and in the borderline range between absence and presence of clinical relevance.

    “In contrast, in case of current and symptomatic ADHD, the scores were higher and in the borderline range between absence and presence of clinical relevance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In comparison to participants without ADHD, the psychosocial functioning of older adults with ADHD is reduced, but the impairments are comparable to those found in younger adults with ADHD.

    “In comparison to participants without ADHD, the psychosocial functioning of older adults with ADHD is reduced as well, but the impairments are comparable to those found in younger adults with ADHD (Philipp-Wiegmann et al. 2016; Thorell et al. 2019).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Philipp-Wiegmann et al. 2016 source
    • cites Thorell et al. 2019 source

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

    Premisecitation

    Untreated ADHD often leads to severe and chronic functional impairments in major life domains.

    “Especially, untreated ADHD often leads to severe and chronic functional impairments in major life domains, e.g., education, work, relationships, friendships, and leisure activities (Able et al. 2007; Arnold et al. 2020; Barkley 2006; Fayyad et al. 2007; Halmøy et al. 2009; Holst and Thorell 2020).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Able et al. 2007 source
    • cites Arnold et al. 2020 source
    • cites Barkley 2006 source

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

    Premisecitation

    In both men and women, hyperactivity and impulsivity decline in adulthood, whereas inattention remains nearly unchanged.

    “In both men and women, hyperactivity and impulsivity decline in adulthood, whereas inattention remains nearly unchanged (Callahan & Plamondon 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Callahan & Plamondon 2019 source

  • May combine two claims.

    Premisecitation

    Older adults with ADHD report more partnership problems, higher rates of being divorced or never married, more emotional and social loneliness, more financial problems and lower lifetime productivity, as well as reduced health-related quality of life and reduced satisfaction with life compared to older individuals without ADHD.

    “For example, older adults with ADHD report about more partnership problems, higher rates of being divorced or never being married, more emotional and social loneliness, more financial problems and lower lifetime productivity, as well as a reduced health-related quality of life and reduced satisfaction with life compared to older individuals without ADHD (Michielsen et al. 2015; Brod et al. 2012; L”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Michielsen et al. 2015 source
    • cites Brod et al. 2012 source
    • cites Lensing et al. 2015 source

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

    Premisecitation

    Prevalence estimations for childhood ADHD average around 7%.

    “Prevalence estimations for childhood ADHD average around 7% (Thomas et al. 2015; Polanczyk et al. 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Thomas et al. 2015 source
    • cites Polanczyk et al. 2015 source

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

    Premisecitation

    Previous meta-analyses found prevalence rates for childhood ADHD around 7%.

    “Previous meta-analyses have found prevalence rates for childhood ADHD around 7% (Thomas et al. 2015; Polanczyk et al. 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Thomas et al. 2015 source
    • cites Polanczyk et al. 2015 source

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

    Interpretationreasoning

    The difference between the 2.1% prevalence in the 60-80 group and the 0.8% from Song et al. could be due to differing assessment methods.

    “This difference could be due to differing assessment methods.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The recruitment from subjects interested in studying brain health, and only those also interested in mental health completing questionnaires, may have introduced bias and likely overestimated psychopathological abnormalities in the sample.

    “We recruited our sample from subjects who had given their interest in studying brain health. This may influence the results. Of these subjects, only those who also had an interest in studying mental health completed our questionnaires, which may have introduced further bias. Considering this, it is more likely that psychopathological abnormalities were overestimated in our sample.”
    Quote in the paperNot a substantial claim

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

    Interpretationcitation

    This finding of good concordance fits well with correlation coefficients found in the validation study of the German version of the CAARS, which were also medium to large.

    “This finding fits well to correlation coefficients found in the validation study of the German version of the CAARS (Christiansen et al. 2014) which were also medium to large.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Christiansen et al. 2014

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

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

    Study design and conductcitation

    The level of significance was adjusted for accumulation of type-I error using the False Discovery Rate (FDR).

    “The level of significance was adjusted for accumulation of type-I error using the False Discovery Rate (FDR) (Benjamini and Hochberg 1995).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Benjamini and Hochberg 1995 source

  • May combine two claims.

    Study design and conductreasoning

    The study was not administered specifically to participants with clinical adult ADHD, so the ADHD group is relatively small and the interpretation of the comparison of the ADHD versus the non-ADHD group is limited.

    “The study was not administered specifically to participants with clinical adult ADHD, so the ADHD group is relatively small and so the interpretation of the comparison of the ADHD versus the non-ADHD group is limited.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The community-based sample in Germany was quite large but still too small to be representative, and it is not possible to generalize the outcomes into other societies without limitations.

    “We collected data from a community-based sample in Germany, which was quite large, but still too small to be a representative. It is not possible to generalize the outcomes into other societies without limitations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    A prospective longitudinal design from childhood to old age would have allowed statements about the development of ADHD across the lifespan and into old age.

    “A prospective longitudinal design from childhood to old age would have allowed statements about the development of ADHD across the lifespan and into old age.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Adult ADHD is often accompanied by mood disorders, anxiety disorders, substance use disorders, autism spectrum disorder, post-traumatic stress disorder, and personality disorders.

    “Thereby, adult ADHD is often accompanied by mood disorders (depression, bipolar disorder), anxiety disorders, substance use disorders, autism spectrum disorder, post-traumatic stress disorder, and personality disorders (Bramhan et al. 2012; Michielsen et al. 2013; Sobanski et al. 2007; Young and Cocallis 2021).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Bramhan et al. 2012

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

    • cites Michielsen et al. 2013 source
    • cites Sobanski et al. 2007 source

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

    Study design and conductcitation

    The WURS-K has good psychometric properties, including internal consistency Cronbach's α = 0.91 and test-retest reliability r = 0.90.

    “Good psychometric properties were proven for the WURS-K, e.g., an internal consistency of Cronbach’s α = 0.91 (Stieglitz 2000) and a test–retest reliability of r = 0.90 (Rösler et al. 2008).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Stieglitz 2000

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

    • cites Rösler et al. 2008

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

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationown data

    The results show that ADHD is a neurodevelopmental disorder that can negatively influence an individual's further development with unfavorable impact in nearly all areas of life.

    “Eventually, our results show that ADHD is a neurodevelopmental disorder that can negatively influence an individual’s further development with unfavorable impact in nearly all areas of life.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    The ASR has mean test-retest reliability r = 0.83 for DSM-oriented scales and r = 0.88 for empirically based scales; mean internal consistency α = 0.83 for empirically based scales and α = 0.78 for DSM-oriented scales.

    “For the DSM-oriented scales, the mean test–retest reliability was r = 0.83, and for the empirically based scales, it was r = 0.88 (Achenbach and Rescorla 2003). The mean internal consistency of the empirically based scales was good with Cronbach`s α = 0.83 and consistency score of the DSM-oriented scales was Cronbach`s α = 0.78 (Achenbach and Rescorla 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Achenbach and Rescorla 2003

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

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

    Study design and conductreasoning

    Including clinician-administered diagnoses would have increased the quality of the assessment of ADHD symptoms and comorbidities, but this was not possible in the present study.

    “To assess current and clinically relevant ADHD, we used self-reports and additional observer reports, however, including clinician-administered diagnoses would have increased the quality of the assessment of ADHD symptoms and comorbidities, which was, however, not possible in the present study.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The ethics committee at the Rhineland-Palatinate state chamber of physicians approved the study protocol.

    “The ethics committee at the Rhineland-Palatinate state chamber of physicians approved our study protocol (No 837.128.17–10,962).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The WURS-K is an adequate and practical instrument for the retrospective estimation of ADHD symptoms in childhood, with an 85-93% sensitivity and a 76-92% specificity for childhood ADHD.

    “We used the WURS-K as an adequate and practical instrument for the retrospective estimation of ADHD symptoms in childhood with an 85–93% sensitivity and a 76–92% specificity for childhood ADHD (Retz-Junginger et al. 2003).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Retz-Junginger et al. 2003 source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    There could be a self-report bias because the symptoms are so far in the past, especially for older adults.

    “There could be a self-report bias, because the symptoms are so far in the past, especially for older adults.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Assessments for clinical and research purposes benefit by augmenting self-ratings with observer ratings.

    “As information from different people displays different perspectives, assessments for clinical and research purposes benefit by augmenting self-ratings with observer ratings (Achenbach et al. 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Achenbach et al. 2005 source

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

    Study design and conductcitation

    The CAARS short forms have internal consistency ranging from Cronbach's α = 0.80 to 0.85 for self-rating and α = 0.83 to 0.89 for observer report, and test-retest reliability r = 0.85 to 0.91.

    “The internal consistency ranged from Cronbach`s α = 0.80 to 0.85 for the self-rating form and from α = 0.83 to 0.89 for the observer’s report. Test–retest reliability ranged from r = 0.85 to 0.91 (Christiansen et al. 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Christiansen et al. 2014

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

  • May combine two claims.

    Interpretationreasoning

    The prevalence rate of clinically relevant ADHD symptoms in childhood found in this study (8.9%) is slightly higher but comparable to previously found numbers.

    “We found a prevalence rate of clinically relevant ADHD symptoms in childhood of 8.9%, which is slightly higher but still comparable to previously found numbers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    ADHD is often accompanied by additional psychopathological symptoms and life impairments.

    “ADHD is often accompanied by additional psychopathological symptoms and life impairments.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Between elderly and middle-aged adults, there are more similarities than differences in the symptomatology of ADHD, with no significant gender effects.

    “Between elderly and middle-aged adults, there are more similarities than differences in the symptomatology of ADHD with no significant gender effects.”
    Quote in the paperSubstantial claim
49 of 49

  • The paper relies on this without support.

    A knowledge gap remains in research focusing on older adults with ADHD.

    “Although there are a growing number of older adults (40 years and older) diagnosed with ADHD, a knowledge gap remains in the research focusing on this population.”

  • The paper relies on this without support.

    The diagnosis of mental disorders is subject to a self-report bias, especially when limited to self-report questionnaires.

    “The diagnosis of mental disorders is subject to a self-report bias, especially when limited to self-report questionnaires.”

  • The paper relies on this without support.

    In mental illnesses in general and ADHD in particular, symptoms often only become apparent in interpersonal contact and are often not seen as problematic by the affected persons themselves.

    “In the case of mental illnesses in general and ADHD in particular, symptoms often only become apparent in interpersonal contact and are often not seen as problematic by the affected persons themselves.”

  • The paper relies on this without support.

    Information from close persons who know the assessed person well is often only collected if self-ratings are questionable.

    “Information from close persons who know the assessed person well is often only collected if self-ratings are questionable, e.g., in cases of severe psychiatric disorders like psychosis, cognitive limitations, or if the assessed person is interested in distorting the information, e.g., in forensic contexts.”
4 of 4

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(1) = 1.4reported p = .24 · recomputed p = .237

    “χ2(1) = 1.40, p = .24”

  • Consistentχ²(1) = 1.48reported p = .22 · recomputed p = .224

    “χ2(1) = 1.48, p = .22”

  • Consistentχ²(1) = 5.42reported p = .02 · recomputed p = .020

    “χ2(1) = 5.42, p = .02”

  • Consistentχ²(1) = 2.78reported p = .1 · recomputed p = .095

    “χ2(1) = 2.78, p = .10”

  • Consistentχ²(1) = 0.07reported p = .8 · recomputed p = .791

    “χ2(1) = 0.07, p = .80”

  • Consistentχ²(1) = 0.05reported p = .82 · recomputed p = .823

    “χ2(1) = 0.05, p = .82”

  • Consistentχ²(1) = 5.99reported p = .01 · recomputed p = .014

    “χ2(1) = 5.99, p = .01”

  • Consistentχ²(1) = 0.18reported p = .67 · recomputed p = .671

    “χ2(1) = 0.18, p = .67”

  • Consistentχ²(1) = 2.46reported p = .12 · recomputed p = .117

    “χ2(1) = 2.46, p = .12”

  • Consistentχ²(1) = 5.29reported p = .02 · recomputed p = .021

    “χ2(1) = 5.29, p = .02”

  • Consistentχ²(1) = 4.74reported p = .03 · recomputed p = .029

    “χ2(1) = 4.74, p = .03”

  • Consistentχ²(1) = 4.92reported p = .03 · recomputed p = .027

    “χ2(1) = 4.92, p = .03”

12 of 12

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Partnership percentage assigned to the wrong age range

    Minor

    The text assigns the 83.2% partnership figure to ages 40-49, while Table 1 assigns it to ages 40-59.

  • Reported correlation range omits a larger correlation

    Minor

    The stated total-sample range ends at 0.44, but Table 3 reports a total-sample correlation of 0.49 for problems with self-concept.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Achenbach TM, Rescorla LA (2003) Manual for the ASEBA Adult Forms & Profiles. University of Vermont Research Center for Children, Youth and Families, Vermont
  2. Achenbach TM, Newhouse PA, Rescorla LA (2004) Manual for the ASEBA Older Adult Forms & Profiles. In: Din M (ed) University of Vermont Research Center for Children, Youth, and Families. Vermont
  3. Christiansen H, Hirsch O, Abdel-Hamid M, Kis B (2014) CAARRS – conners skalen zu aufmerksamkeit und verhalten für erwachsene: deutschsprachige adaption der conners‘ adult adhd rating scales (CAARS). Verlag Hans Huber, Bern
  4. Rösler M, Retz-Junginger P, Retz W, Stieglitz R (2008) HASE – Homburger ADHS Skalen für Erwachsene (Homburg ADHD Scales for Adults). Hogrefe, Goettingen
  5. Stieglitz RD (2000) Diagnostik und Klassifikation psychischer Störungen: konzeptuelle und methodische Beiträge zur Evaluierung psychiatrischer Diagnostikansätze. Hogrefe, Göttingen

Cited by

Still being checked.

Related

Authors
Müller, M., Turner, D., Barra, S., Rösler, M., & Retz, W.
Affiliations
  • Johannes Gutenberg University Mainz (DE)
  • University Medical Center of the Johannes Gutenberg University Mainz (DE)
  • Saarland University (DE)
Corresponding author
Müller, Marcus
ORCID
Venue
Journal of Neural Transmission
Publisher
Springer Science and Business Media LLC
Published
2023-01-08
Volume
130
Issue
3
Pages
313-323
ISSN
  • 0300-9564 (ISSN-L)
  • 1435-1463
DOI
10.1007/s00702-022-02584-4
PMC
PMC10033550
OpenAlex
W4313750174
Semantic Scholar
af70e8d86862e516c3e710b9589494f5dd541c6d
Cited by
10
References
55
Citations by year
2026: 4 · 2025: 1 · 2024: 3 · 2023: 2
FWCI
1.79
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Neural Transmission (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
Universitätsmedizin der Johannes Gutenberg-Universität Mainz
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
adult ADHD, older adults, ADHD prevalence, comorbid psychopathology, impulsivity, emotional lability, community sample
MeSH terms
Adult, Affective Symptoms, Aged, Aged, 80 and over, Attention Deficit Disorder with Hyperactivity, Child, Humans, Impulsive Behavior, Middle Aged, Comorbidity, Self Report

About these checks

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-23.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-23.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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