The Age at Onset of Attention Deficit Hyperactivity Disorder
Open accessAbstract
Classification systems inevitably reflect the state of science at the time they are formalized (1). In psychiatry, DSM-III revolutionized the field of mental health diagnosis in 1980 by eschewing theoretical explanations in favor of diagnostic reliability. Among the major consequences of this initiative was the flourishing of evidence-based research, leading to an exponential growth of psychiatric literature. Since then, some diagnostic criteria have been put to the test and retained, removed, or reconceptualized. A maximum age at onset as a diagnostic criterion for attention deficit hyperactivity disorder (ADHD) was introduced in DSM-III on the basis of clinical experience. In DSM-IV-TR, this B criterion specifies that "some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years." Over the intervening years, a number of studies have addressed the utility of criterion B, generally questioning its contribution to the validity of the diagnosis of ADHD (2).
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Research has failed to validate the age-7 onset criterion because the clinical syndrome that defines ADHD has similar clinical predictions for course, treatment response, and associated impairments regardless of whether symptoms with impairment started before age 7 or later.
“In fact, research has failed to validate to this criterion since it has been found that the clinical syndrome that defines ADHD has similar clinical predictions in terms of course, treatment response and associated impairments regardless of whether symptoms with impairment started before the age of 7 years or later [181-187].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [187]
Language development occurs earlier than ADHD and reading development.
“Due to the fact that language comes on-line earlier than ADHD and reading (Kieling et al., 2010; Kuhl & Rivera-Gaxiola, 2008)”
From Semantic Language as a Mechanism Explaining the Association between ADHD Symptoms and Reading and Mathematics Underachievement (2012) · cites this paper as Kieling et al., 2010
There is strong scientific consensus that it is extremely difficult to document childhood onset in adults with ADHD.
“there is strong scientific consensus that it is extremely difficult to document childhood onset in adults with ADHD(3,50,51).”
From Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study (2015) · cites this paper as [50]
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- Authors
- Kieling, C., Kieling, R. R., Rohde, L. A., Frick, P. J., Moffitt, T., Nigg, J. T., Tannock, R., & Castellanos, F. X.
- Affiliations
- Hospital de Clínicas de Porto Alegre (BR)
- Medical Research Council (GB)
- Universidade Federal do Rio Grande do Sul (BR)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2010-01
- Volume
- 167
- Issue
- 1
- Pages
- 14-16
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC4478075
- OpenAlex
- W2102726749
- Cited by
- 185
- References
- 48
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 9 · 2023: 9 · 2022: 7 · 2021: 8 · 2020: 8 · 2019: 10 · 2018: 11 · 2017: 13 · 2016: 13 · 2015: 11 · 2014: 16 · 2013: 16 · 2012: 20
- FWCI
- 12.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Civil War Book Review (submittedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Funders
- National Institute of Mental Health (R37MH059105, R01MH059105)
- 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, age of onset, diagnostic criteria, DSM-III, DSM-IV-TR, hyperactive-impulsive symptoms, inattentive symptoms, diagnostic validity, childhood onset
- MeSH terms
- Adolescent, Adult, Age Factors, Attention Deficit Disorder with Hyperactivity, Child, Humans, Psychiatric Status Rating Scales, Psychometrics, Research Design, Age of Onset, Databases as Topic, Diagnostic and Statistical Manual of Mental Disorders
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