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Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan
Open accessAbstract
Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.
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“it is unclear whether the prevalence of adult ADHD changes with age.”
From The decreasing prevalence of ADHD across the adult lifespan confirmed (2022) · cites this paper as [5]
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“compared to childhood ADHD, adult ADHD has received far less research attention”
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“adult ADHD definitions strongly varying between studies”
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“few large population-based data sets spanning the full adult lifespan available [4-7]”
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Attention-deficit hyperactivity disorder
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Self-citationADHD: Current Concepts and Treatments in Children and Adolescents
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Self-citationAnnual Research Review: Perspectives on progress in ADHD science – from characterization to cause
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“While the onset of such symptoms occurs before the age of 12, they tend to persist in adulthood, often in comorbidity with anxiety disorders, depression, or substance abuse [234,235].”
BackgroundShared genetic background between children and adults with attention deficit/hyperactivity disorder
Rovira, P., Demontis, D., Sánchez-Mora, C., Zayats, T., Klein, M., Mota, N. R., Weber, H., Garcia-Martínez, I., Pagerols, M., Vilar-Ribó, L., et al. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-0664-5 · Cited by 111
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“…by core symptoms of age-inappropriate inattention, impulsivity, and/or hyperactivity (American Psychiatric Association, 2013), the clinical presentation of which typically changes over the lifespan (Biederman et al., 2000; Franke et al., 2018; Turgay et al., 2012; G. Weiss & Hechtman, 1993).”
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Using the tools of genetic epidemiology to understand sex differences in neuropsychiatric disorders
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“Additionally, ADHD is associated with lower educational or occupational achievement, reduced social functioning (Costa Dias et al., 2013; Franke et al., 2018), and increased risk of mortality driven by unnatural causes such as accidents (Dalsgaard et al.”
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“remit in puberty but persists into adolescence and adulthood [2].”
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“As reported previously, in observational studies (6, 20, 43), ADHD has been associated with unhealthy lifestyle and risk behaviors.”
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“Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a childhood-onset and a childhood prevalence of ~3–5% [1, 2], with the rate of persistence into adulthood estimated at 15–65% [3].”
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Self-citationSocial cognition in autism and ADHD
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“Attention-deficit/hyperactivity disorder (ADHD) is a common and persistent neurodevelopmental disorder that is associated with adverse psychosocial, educational, occupational and health-related outcomes throughout life.(1,2) ADHD affects approximately 6.”
BackgroundSelf-citationTypes of Adult Attention-Deficit/Hyperactivity Disorder: A Replication Analysis.
Reimherr, F., Roesler, M., Marchant, B. K., Gift, T., Retz, W., Philipp-Wiegmann, F., & Reimherr, M. (2020) · Journal of Clinical Psychiatry · doi:10.4088/jcp.19m13077 · Cited by 40
Du Rietz, E., Jangmo, A., Kuja‐Halkola, R., Chang, Z., D'Onofrio, B. M., Ahnemark, E., Werner‐Kiechle, T., & Larsson, H. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13206 · Cited by 39
“Despite a growing interest into the persistence and remittance of ADHD in adulthood (Franke et al., 2018), there is a lack of knowledge of the patterns of healthcare utilization and economic burden in ADHD persisters and remitters.”
BackgroundSelf-citationSexuality in Adults With ADHD: Results of an Online Survey
Hertz, P. G., Turner, D., Barra, S., Biedermann, L., Retz-Junginger, P., Schöttle, D., & Retz, W. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.868278 · Cited by 39
Carucci, S., Narducci, C., Bazzoni, M., Balia, C., Donno, F., Gagliano, A., & Zuddas, A. (2022) · Journal of Neuroscience Research · doi:10.1002/jnr.25038 · Cited by 53
Leo, K., Kewitz, S., Wartberg, L., & Lindenberg, K. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.787162 · Cited by 39
Vos, M., Rommelse, N. N. J., Franke, B., Oosterlaan, J., Heslenfeld, D. J., Hoekstra, P. J., Klein, M., Faraone, S. V., Buitelaar, J. K., & Hartman, C. A. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01764-z · Cited by 45
Self-citationLi, L., Sujan, A. C., Butwicka, A., Chang, Z., Cortese, S., Quinn, P. D., Viktorin, A., Öberg, A. S., D'Onofrio, B. M., & Larsson, H. (2020) · CNS Drugs · doi:10.1007/s40263-020-00728-2 · Cited by 45
Self-citationMota, N. R., Poelmans, G., Klein, M., Torrico, B., Fernàndez‐Castillo, N., Cormand, B., Reif, A., Franke, B., & Vásquez, A. A. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-019-0592-4 · Cited by 43
“These comorbidities include both psychiatric and non-psychiatric (somatic) diseases and traits [5].”
BackgroundSelf-citationBasta, M., Micheli, K., Koutra, K., Fountoulaki, M., Dafermos, V., Drakaki, M., Faloutsos, K., Soumaki, E., Anagnostopoulos, D., Papadakis, N., et al. (2022) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2022.100334 · Cited by 38
Novel pharmacological targets for GABAergic dysfunction in ADHD
Ferranti, A. S., Luessen, D. J., & Niswender, C. M. (2024) · Neuropharmacology · doi:10.1016/j.neuropharm.2024.109897 · Cited by 48
“…for children aged 5 years and younger and approximately 30% of ADHD patients do not respond to stimulant treatments; progress towards developing pharmacological treatments beyond targeting dopaminergic and noradrenergic systems has also been stagnant (Faraone et al., 2015; Franke et al., 2018).”
How do adolescents with ADHD perceive and experience stress? An interview study
Öster, C., Ramklint, M., Meyer, J., & Isaksson, J. (2020) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2019.1677771 · Cited by 38
“Accordingly, fatigue syndrome [18], depression, anxiety disorders, substance abuse and sleep disorders are regarded as a common clinical feature of ADHD [19].”
BackgroundResultThe association between ADHD and physical health: a co-twin control study
Pan, P.-Y., & Bölte, S. (2020) · Scientific Reports · doi:10.1038/s41598-020-78627-1 · Cited by 37
Comparelli, A., Polidori, L., Sarli, G., Pistollato, A., & Pompili, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.949375 · Cited by 38
“Many children are diagnosed with comorbid ADHD and PBD; comorbidity rates are estimated to be around 20% (1, 4), and children with ADHD are more likely to be diagnosed with BD later in life (4).”
BackgroundCognitive mechanisms underlying depressive disorders in ADHD: A systematic review
Mayer, J. S., Bernhard, A., Fann, N., Boxhoorn, S., Hartman, C. A., Reif, A., & Freitag, C. M. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.12.018 · Cited by 48
Self-citationPrisco, M. D., Oliva, V., Fico, G., Raduà, J., Grande, I., Roberto, N., Anmella, G., Hidalgo‐Mazzei, D., Fornaro, M., de Bartolomeis, A., et al. (2023) · Psychological Medicine · doi:10.1017/s003329172300243x · Cited by 52
“Despite no available evidence allowing us to explore this comparison in adult life, varying clinical course and high rates of psychiatric comorbidities (Franke et al., 2018) could worsen the intensity and presentation of ED in ADHD patients.”
BackgroundBisset, M., Brown, L. E., Bhide, S., Patel, P., Zendarski, N. J., Coghill, D., Payne, L., Bellgrove, M. A., Middeldorp, C. M., & Sciberras, E. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13752 · Cited by 53
“…impact on an individual’s social and emotional wellbeing, inter-personal relationships, academic and career outcomes, physical and mental health, quality of life and life expectancy (Costello & Maughan, 2015; Franke et al., 2018; Lawrence et al., 2015; Sciberras et al., 2020; Shaw et al., 2012).”
BackgroundPrice, A., Newlove‐Delgado, T., Eke, H., Paul, M., Young, S., Ford, T. J., & Janssens, A. I. W. A. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2284-3 · Cited by 48
Prevalence of ADHD among Black Youth Compared to White, Latino and Asian Youth: A Meta-Analysis
Cénat, J. M., Kokou‐Kpolou, C. K., Blais-Rochette, C., Morse, C., Vandette, M.-P., Dalexis, R. D., Darius, W. P., Noorishad, P., Labelle, P., & Kogan, C. S. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2022.2051524 · Cited by 48
“Age and gender would have been particularly important to include as moderators given the evidence that prevalence rates, symptom presentations, severity and impairment vary across the lifespan and by gender (see review by Franke et al., 2018).”
BackgroundMachine Learning and MRI-based Diagnostic Models for ADHD: Are We There Yet?
Zhang‐James, Y., Razavi, A. S., Hoogman, M., Franke, B., & Faraone, S. V. (2023) · Journal of Attention Disorders · doi:10.1177/10870547221146256 · Cited by 41
“…diagnosed with the disorder will continue to have impaired functioning leading to increased risks for other health and social problems (Dalsgaard, Ostergaard, Leckman, Mortensen, & Pedersen, 2015; Franke et al., 2018; Lambert & Hartsough, 1998; Lichtenstein et al., 2012; Reiersen & Todorov, 2013).”
BackgroundSelf-citationGrimmsmann, T., & Himmel, W. (2020) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-020-02948-3 · Cited by 48
Perugi, G., Pallucchini, A., Rizzato, S., Rossi, P. D., Sani, G., Maremmani, A. G. I., Pinzone, V., & Maremmani, I. (2018) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2018.1551878 · Cited by 38
“authors suggested that cases of apparent adult-onset ADHD may have had undiagnosed ADHD or subthreshold ADHD in youth [4].”
BackgroundThe decreasing prevalence of ADHD across the adult lifespan confirmed
Vos, M., & Hartman, C. A. (2022) · Journal of Global Health · doi:10.7189/jogh.12.03024 · Cited by 33
Age-related clinical characteristics of children and adolescents with ADHD
Rossi, P. D., D’Aiello, B., Pretelli, I., Menghini, D., Vara, S. D., & Vicari, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1069934 · Cited by 45
“In this context, ADHD-specific symptoms during the transition to adolescence and young adulthood might be “masked” or changed but not really reduced, as confirmed by longitudinal data (23).”
BackgroundResultInsights into attention-deficit/hyperactivity disorder from recent genetic studies
Brikell, I., Burton, C. L., Mota, N. R., & Martin, J. (2021) · Psychological Medicine · doi:10.1017/s0033291721000982 · Cited by 37
“…childhood-onset psychiatric comorbidities are other NDDs, such as autism spectrum disorders (ASD) and learning disorders, as well as externalizing conditions including oppositional defiant disorder (ODD) and conduct disorder (CD) (Franke et al., 2018; Giacobini et al., 2018; Taurines et al., 2010).”
BackgroundInfluentialHess, J., Radonjić, N. V., Patak, J., Glatt, S. J., & Faraone, S. V. (2020) · Molecular Psychiatry · doi:10.1038/s41380-020-00974-2 · Cited by 37
Self-citationEmotion Dysregulation in ADHD and Other Neurodevelopmental Conditions: A Co-Twin Control Study
Astenvald, R., Frick, M. A., Neufeld, J., Bölte, S., & Isaksson, J. (2022) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-022-00528-0 · Cited by 32
“ADHD is defined by symptoms of inattention and/or hyperactivity/impulsivity [2], which often persist into adulthood and are associated with work-related, academic and social challenges, as well as increased risk for other psychiatric problems [3].”
BackgroundHalmøy, A., Ring, A. E., Gjestad, R., Møller, M., Ubostad, B., Lien, T., Munkhaugen, E. K., & Fredriksen, M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04356-6 · Cited by 47
“Background Attention-Deficit/Hyperactivity Disorder (ADHD) is a common, life-spanning, neurodevelopmental disorder [1] with prevalence estimates around 3% in adults [2].”
BackgroundArtigas, M. S., Sánchez‐Mora, C., Rovira, P., Vilar‐Ribó, L., Ramos‐Quiroga, J. A., & Marta Ribasés, A. (2022) · International Journal of Epidemiology · doi:10.1093/ije/dyac128 · Cited by 32
“with higher risks for poor educational achievement, unemployment or criminality, among others.(7) Most studies undertaken to date have reported association between ADHD and comorbid traits, but inferring”
BackgroundInfluentialSelf-citationGenetics in the ADHD Clinic: How Can Genetic Testing Support the Current Clinical Practice?
Balogh, L., Pulay, A. J., & Réthelyi, J. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.751041 · Cited by 37
Self-citationKantak, K. M. (2022) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2022.173378 · Cited by 36
A Review of Working Memory Training in the Management of Attention Deficit Hyperactivity Disorder
Al-Saad, M. S. H., Al-Jabri, B. A., & Almarzouki, A. F. (2021) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2021.686873 · Cited by 45
van Oort, J., Kohn, N., Vrijsen, J. N., Collard, R. M., Duyser, F. A., Brolsma, S. C. A., Fernández, G., Schene, A. H., Tendolkar, I., & van Eijndhoven, P. (2020) · NeuroImage Clinical · doi:10.1016/j.nicl.2020.102176 · Cited by 36
Cross-species models of attention-deficit/hyperactivity disorder and autism spectrum disorder
Vecchia, E. D., Mortimer, N., Palladino, V. S., Kittel‐Schneider, S., Lesch, K., Reif, A., Schenck, A., & Norton, W. (2018) · Psychiatric Genetics · doi:10.1097/ypg.0000000000000211 · Cited by 36
“4, although this may be an underestimation owing to the self-rating system commonly used in these studies (Franke et al., 2018).”
MethodSelf-citationADHD and Academic Performance in College Students: A Systematic Review
Pagespetit, È., Pagerols, M., Barrés, N., Prat, R., Martínez, L., Andreu, M., Prat, G., Casas, M., & Bosch, R. (2024) · Journal of Attention Disorders · doi:10.1177/10870547241306554 · Cited by 46
“However, two-thirds of individuals with ADHD in childhood continue to meet diagnostic criteria in adolescence and early adulthood (Franke et al., 2018), and some longitudinal studies, like van Lieshout et al. (2016), estimate that more than 80% continue to meet full diagnostic criteria for ADHD,…”
Somatic burden of attention‐deficit/hyperactivity disorder across the lifecourse
Libutzki, B., Neukirch, B., Reif, A., & Hartman, C. A. (2024) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13694 · Cited by 33
Self-citationThe diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults
Dobrosavljevic, M., Larsson, H., & Cortese, S. (2023) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2023.2250913 · Cited by 39
“On the other hand, the focus on safety should be paramount, given the possible adverse effects of the pharmacological treatment of ADHD, and the increased risk of psychiatric and physical multimorbidity in older adults [10–13].”
BackgroundInfluentialSelf-citationKenter, R. M. F., Gjestad, R., Lundervold, A. J., & Nordgreen, T. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100614 · Cited by 30
“When diagnosed with ADHD in adulthood, psychological treatments are commonly not available, even though the disorder is associated with a wide range of challenges affecting daily life functioning (Franke et al., 2018).”
BackgroundSchena, A., Garotti, R., D’Alise, D., Giugliano, S., Polizzi, M., Trabucco, V., Riccio, M. P., & Bravaccio, C. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043414 · Cited by 38
“, oppositional defiant disorder, conduct disorder, substance abuse disorder) [8].”
BackgroundAdolescents With Attention-Deficit/Hyperactivity Disorder: Adverse Behaviors and Comorbidity
Sultan, R. S., Liu, S.-M., Hacker, K. A., & Olfson, M. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2020.09.036 · Cited by 36
In utero exposure to ADHD medication and long-term offspring outcomes
Madsen, K. B., Robakis, T. K., Liu, X., Momen, N. C., Larsson, H., Dreier, J. W., Kildegaard, H., Groth, J. B., Newcorn, J. H., Thomsen, P. H., et al. (2023) · Molecular Psychiatry · doi:10.1038/s41380-023-01992-6 · Cited by 38
“INTRODUCTION Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder affecting individuals across the lifespan [1].”
BackgroundSelf-citationDo we over‐diagnose ADHD in North America? A critical review and clinical recommendations
Gascon, A., Gamache, D., St‐Laurent, D., & Stipanicic, A. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23348 · Cited by 53
Metadata
- Authors
- Franke, B., Michelini, G., Asherson, P., Banaschewski, T., Bilbow, A., Buitelaar, J. K., Cormand, B., Faraone, S. V., Ginsberg, Y., Haavik, J., Kuntsi, J., Larsson, H., Lesch, K.-P., Ramos-Quiroga, J. A., Réthelyi, J. M., Ribases, M., & Reif, A.
- Affiliations
- Radboud University Nijmegen (NL)
- King's College London (GB)
- Heidelberg University (DE)
- Radboud University Medical Center (NL)
- Instituto de Salud Carlos III (ES)
- SUNY Upstate Medical University (US)
- Karolinska Institutet (SE)
- Haukeland University Hospital (NO)
- Sechenov University (RU)
- Semmelweis University (HU)
- University Hospital Frankfurt (DE)
- Corresponding author
- Franke, Barbara
- ORCID
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 28
- Issue
- 10
- Pages
- 1059-1088
- ISSN
- 0924-977X (ISSN-L)
- PMC
- PMC6379245
- OpenAlex
- W2891070637
- Cited by
- 643
- References
- 285
- Citations by year
- 2026: 73 · 2025: 88 · 2024: 92 · 2023: 91 · 2022: 86 · 2021: 90 · 2020: 81 · 2019: 37 · 2018: 2
- FWCI
- 7.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Neuropsychopharmacology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, cc-by)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by-nc-nd)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Online Publication Service of Würzburg University (Würzburg University) (submittedVersion, cc-by)
- Publication Server of Goethe University Frankfurt am Main (Goethe University Frankfurt) (submittedVersion, cc-by)
- Semmelweis University Repository (Semmelweis University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- European Community's Seventh Framework Programme (n° 602805 (AGGRESSOTYPE), 603016 (MATRICS), 278948 (TACTICS), 602450 (IMAGEMEND))
- European Community's Horizon 2020 Programme (n° 643051 (MiND) and 667302 (CoCA))
- Netherlands Organization for Scientific Research (NWO), i.e. the Vici Innovation Program (016-130-669)
- Hungarian Brain Research Program (NAP-B KTIA_NAP_13-2014-0011)
- 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, ADHD persistence, remission, comorbidities, substance use disorders, depression, anxiety, accidents, age of onset, cognitive trajectories, treatment effects, lifespan development, neurodevelopmental disorders, biological factors
- MeSH terms
- Aging, Attention Deficit Disorder with Hyperactivity, Humans, Comorbidity
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