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Cited by 618Attention Deficit Hyperactivity DisorderAutism Spectrum Disorder ResearchChild and Adolescent Psychosocial and Emotional Development

Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study

Open access
Moffitt, Terrie E., Houts, Renate, Asherson, Philip, Belsky, Daniel W., Corcoran, David L., Hammerle, Maggie, Harrington, HonaLee, Hogan, Sean +8 more·2015·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2015.14101266PMC PMC4591104
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Abstract

OBJECTIVE: Despite a prevailing assumption that adult ADHD is a childhood-onset neurodevelopmental disorder, no prospective longitudinal study has described the childhoods of the adult ADHD population. The authors report follow-back analyses of ADHD cases diagnosed in adulthood, alongside follow-forward analyses of ADHD cases diagnosed in childhood, in one cohort. METHOD: Participants belonged to a representative birth cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38, with 95% retention. Symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, genome-wide association study-derived polygenic risk, and life impairment indicators were assessed. Data sources were participants, parents, teachers, informants, neuropsychological test results, and administrative records. Adult ADHD diagnoses used DSM-5 criteria, apart from onset age and cross-setting corroboration, which were study outcome measures. RESULTS: As expected, childhood ADHD had a prevalence of 6% (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3% (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the childhood ADHD and adult ADHD groups comprised virtually nonoverlapping sets; 90% of adult ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD. CONCLUSIONS: The findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, then the disorder's place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.

AI snapshot

Written from the paper’s full text.

TL;DR

In the Dunedin 1972–73 birth cohort followed to age 38, adult ADHD diagnosed by DSM-5 was largely not a continuation of childhood ADHD: only 3 of 61 childhood cases still met criteria at 38, and those 3 were just 10% of the 31 adult cases. Adult ADHD cases also lacked childhood neuropsychological deficits and childhood-ADHD polygenic risk, suggesting adult ADHD may not be the same childhood-onset neurodevelopmental disorder.

Key findings

  • Childhood ADHD prevalence was 6% and adult ADHD prevalence was 3%; the two diagnostic groups were virtually non-overlapping, with 90% of adult-ADHD cases lacking a history of childhood ADHD. Follow-forward showed only 3 (5%) of 61 childhood cases still met diagnostic criteria at age 38, and follow-back showed these 3 constituted only 10% of the cohort’s 31 adult-ADHD cases.
  • The childhood-ADHD group showed expected male excess, childhood comorbid conduct/depression/anxiety, cognitive deficits (age-3 composite .55 SD below norm; childhood IQ 10 points below norm; adult IQ still 10 points below norm), elevated childhood-ADHD polygenic risk, and residual adult life impairment despite having outgrown the diagnosis.
  • The adult-ADHD group showed no significant sex difference, elevated adult substance dependence (48.4% alcohol/cannabis/other drug dependence; 38.7% persistent tobacco dependence), marked self-reported ADHD-associated impairment (ES=2.26 SD), and 70% mental-health treatment contact, but no significant childhood cognitive deficits apart from mild reading delay and no elevated childhood-ADHD polygenic risk.
  • Prospective parent/teacher reports before age 12 showed extremely elevated symptoms for childhood ADHD (ES=1.60 SD) but only mildly elevated symptoms for adult ADHD (ES=.33 SD); retrospective parental recall missed 78% of documented childhood-ADHD cases and falsely recalled ADHD in 35 controls.

Methods

  • Participants were the Dunedin Study representative birth cohort: N=1,037 born in Dunedin, New Zealand in 1972–73, followed to age 38 with 95% retention; 52% male, primarily white, assessed repeatedly from birth through adulthood.
  • Childhood ADHD was diagnosed using DSM-III at ages 11, 13, and 15 via child psychiatrist/trained interviewers plus parent and teacher checklists, identifying 61 children. Adult ADHD was diagnosed at age 38 via structured diagnostic interviews using DSM-5 criteria, apart from onset-age and cross-setting corroboration, which were study outcomes; 31 adults were identified, with 920 never-diagnosed controls.
  • The study used follow-forward analyses of childhood-ADHD cases and follow-back analyses of adult-ADHD cases, comparing more than fifty DSM-5-identified correlates from participants, parents, teachers, informants, neuropsychological testing, administrative records, and GWAS-derived polygenic risk; sex was included as a covariate in significance tests.

Limitations

  • Authors state: findings were not hypothesized in advance and require replication; childhood ADHD was diagnosed using then-available DSM-III; ADHD was not assessed during participants’ twenties because DSM-IIIR deemed it childhood-only; the adult-ADHD group was small, limiting power and heterogeneity analyses; personality disorder was not ascertained; neuroimaging data were lacking; and the cohort’s largely untreated, referral-unbiased ADHD cases may limit generalization to clinical treatment populations.
  • Evident from the text: adult ADHD diagnoses did not require childhood onset or informant corroboration because these were study outcomes, so the adult group is defined by current symptoms and impairment; retrospective recall was shown to be invalid in this cohort, limiting reliance on recalled childhood onset.
  • Evident from the text: substance dependence was highly comorbid in adult ADHD (48.4%), and the study cannot resolve whether substance abuse led to ADHD symptoms or adult-ADHD symptoms antedated substance abuse; 55% of adult-ADHD cases had no other concurrent diagnosis at age 38.

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

Integrity signals

Registry

Crossref · 10.1176/appi.ajp.2015.14101266

Cites

61 of 61 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Childhood-ADHD cases had significantly elevated depression as children.

    “As expected, childhood-ADHD cases had significantly elevated conduct disorder, depression, and anxiety as children.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the Dunedin cohort, the prevalence of childhood ADHD was 6%.

    “the childhood-ADHD group showed 6% prevalence”
    • Also stated in: § Prevalence and continuity · plain
      “The cohort prevalence of ADHD was 6% in childhood and 3% at age 38 (Table 1)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Childhood-ADHD cases had significantly elevated conduct disorder as children.

    “As expected, childhood-ADHD cases had significantly elevated conduct disorder, depression, and anxiety as children.”
    Quote in the paperNot a substantial claim
  • Findingown data

    At age 38, according to informants, the childhood-ADHD group had significantly elevated symptoms of inattention (ES=.87SD).

    “According to informants, as adults the childhood-ADHD group had significantly elevated symptoms of inattention (ES=.87SD) and hyperactivity/impulsivity (ES=.81SD).”
    Quote in the paperSubstantial claim
  • Findingown data

    Adult-ADHD cases felt less satisfied with their lives.

    “They reported markedly elevated impairment as a result of ADHD-associated problems (ES=2.26SD), felt less satisfied with their lives, and reported problems stemming from being disorganised, under-achieving, exhausting or draining others, having accidents from over-doing it, and risky driving (tailgating, speeding).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 17

  • May combine two claims.

    Findingown data

    Adult-ADHD cases reported problems stemming from being disorganised, under-achieving, exhausting or draining others, having accidents from over-doing it, and risky driving.

    “They reported markedly elevated impairment as a result of ADHD-associated problems (ES=2.26SD), felt less satisfied with their lives, and reported problems stemming from being disorganised, under-achieving, exhausting or draining others, having accidents from over-doing it, and risky driving (tailgating, speeding).”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Among adult-ADHD cases there was no significant sex difference.

    “Among adult-ADHD cases there was no significant sex difference.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Few adult-ADHD cases scored at least one symptom rated '2=certainly' by their elementary-school teachers, whereas most childhood-ADHD cases had more than one symptom rated '2=certainly'.

    “For example, few adult-ADHD cases scored at least one symptom rated “2=certainly” by their elementary-school teachers (Figure 3), whereas most childhood-ADHD cases had more than one symptom rated “2=certainly”.”
    Quote in the paperSubstantial claim

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

    Findingown data

    Childhood-ADHD cases were predominantly male.

    “Childhood-ADHD cases were predominantly male.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    ADHD medication was ever used during adulthood by only 5 persons: 1 control participant with illicit methylphenidate use, and 4 adult-ADHD participants, of whom 1 had also had childhood ADHD.

    “ADHD medication (methylphenidate, d-amphetamine, atomoxetine) was ever used during adulthood by only 5 persons; 1 control participant with illicit methylphenidate use, and 4 adult-ADHD participants, of whom 1 had also had childhood ADHD.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Only 1 childhood-ADHD and 2 adult-ADHD cases took ADHD medication at the time of the age-38 assessment.

    “(Only 1 childhood-ADHD and 2 adult-ADHD cases took ADHD medication at the time of the age-38 assessment.)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The adult-ADHD group shared a childhood history of conduct disorder, but this link was more prominent among childhood-ADHD cases (59%) than among adult-ADHD cases (31%).

    “Although the adult ADHD group shared a childhood history of conduct disorder, this link was more prominent among childhood-ADHD cases (59%) than among adult-ADHD cases (31%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Adult-ADHD cases had relatively few tested cognitive deficits as adults, apart from scoring significantly beneath controls on perceptual reasoning, and making more false alarms on the Rapid Visual Processing test.

    “In comparison, adult-ADHD cases had relatively few tested cognitive deficits as adults, apart from scoring significantly beneath controls on perceptual reasoning, and making more false alarms on the Rapid Visual Processing test.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Childhood-ADHD cases exhibited deficits on reading achievement, the Trail-making-B test, and verbal-learning delayed recall.

    “They exhibited deficits on reading achievement, the Trail-making-B test, a commonly used test of executive control, and on verbal-learning delayed recall.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Neither the childhood-ADHD nor the adult-ADHD group had significantly elevated rates of mania, depression, or anxiety disorders as adults.

    “Neither the childhood-ADHD nor the adult-ADHD group had significantly elevated rates of mania, depression, or anxiety disorders as adults.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Administrative records revealed that childhood-ADHD cases had significantly lower credit ratings, longer duration of social welfare benefit receipt, more injury-related insurance claims, and more criminal convictions than controls.

    “Administrative records revealed that childhood-ADHD cases had significantly lower credit ratings, longer duration of social welfare benefit receipt, more injury-related insurance claims, and more criminal convictions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Convictions were elevated among adult-ADHD cases, but did not reach significance.

    “Convictions were elevated, but did not reach significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Administrative records revealed that adult-ADHD cases had significantly lower credit ratings, longer duration of social welfare benefit receipt, and more injury-related insurance claims than controls.

    “Administrative records revealed that adult-ADHD cases also had significantly lower credit ratings, longer duration of social welfare benefit receipt, and more injury-related insurance claims than controls.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Childhood-ADHD cases showed a deficit on the CANTAB-Rapid Visual Processing continuous performance test, earning under-par scores for attentional vigilance and making more false-alarm errors.

    “Childhood-ADHD cases also showed a deficit on the CANTAB-Rapid Visual Processing “continuous performance test”; they earned under-par scores for attentional vigilance and made more false-alarm errors from jumping to respond too soon.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Despite lack of tested deficits in childhood and relatively mild tested deficits in adulthood, adult-ADHD cases reported many subjective cognitive complaints, scoring 1.62SD above the norm (and 1.48SD worse than childhood-ADHD cases).

    “Despite their lack of tested deficits in childhood and relatively mild tested deficits in adulthood, our adult-ADHD cases reported many subjective cognitive complaints, scoring 1.62SD above the norm (and 1.48SD worse than childhood-ADHD cases).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Adult-ADHD cases reported significantly fewer saving behaviors and more troubles with debt/cashflow than controls.

    “Although adult-ADHD cases did not differ from controls on university education or income, they reported significantly fewer saving behaviors and more troubles with debt/cashflow.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many former-ADHD children had experienced PTSD, a suicide attempt, injury-related insurance claims or adult criminal convictions.

    “Many had experienced PTSD, a suicide attempt, injury-related insurance claims or adult criminal convictions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Teacher symptom ratings were mildly elevated but far below the threshold for diagnosis.

    “Although teacher symptom ratings were mildly elevated, the elevation represented a level far below the threshold for diagnosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    They did not differ from controls on the WAIS-IV Working Memory index or a continuous-performance test of attentional vigilance.

    “They did not differ from controls on the WAIS-IV Working Memory index or a continuous-performance test of attentional vigilance”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    These ADHD adults as a group had not had symptoms just below the threshold at the time of diagnosis; according to their parents' reports, their mean symptom score was normative then.

    “these ADHD adults as a group had not had symptoms just below the threshold at the time of diagnosis; according to their parents' reports, their mean symptom score was normative then.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The study supported both follow-forward and follow-back analyses of a representative birth cohort, in which ADHD cases were ascertained without bias by referral or treatment.

    “Our four-decade study supported both follow-forward and follow-back analyses of a representative birth cohort, in which ADHD cases were ascertained without bias by referral or treatment.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    Adult ADHD diagnostic interviewers were blind to prior data.

    “Interviewers were blind to prior data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The Dunedin cohort represents the full range of socioeconomic status on New Zealand's South Island and matches the New Zealand National Health and Nutrition Survey on adult health indicators (e.g., BMI, smoking, GP visits).

    “The cohort represents the full range of socioeconomic status on NZ's South Island and matches the NZ National Health and Nutrition Survey on adult health indicators (e.g., BMI, smoking, GP visits)(19).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Poulton R, 2006, N Z Med J

      Not checked in the free run.

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

    Interpretationown data

    This conformity allays concerns about the use of this cohort for researching ADHD.

    “This conformity allays concerns about the use of this cohort for researching ADHD.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Participants' self-reports could be supplemented by independent sources: parents, teachers, informants, formal cognitive testing, and administrative records.

    “Participants' self-reports could be supplemented by independent sources: parents, teachers, informants, formal cognitive testing, and administrative records.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study did not assess ADHD during the participants' twenties.

    “Third, as ADHD was deemed a childhood-only disorder by DSM-IIIR our study did not assess ADHD during the participants' twenties.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Childhood ADHD cases exhibited neuro-cognitive dysfunctions as young as age 3 years, and had poor cognitive test performance, consistent with the conceptualization of ADHD as a neurodevelopmental disorder.

    “They exhibited neuro-cognitive dysfunctions as young as age 3 years, and had poor cognitive test performance, consistent with the conceptualization of ADHD as a neurodevelopmental disorder(36,37).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36] source

      Not checked in the free run.

    • cites [37] source

      Not checked in the free run.

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

    Study design and conductown data

    At the age-38 assessment, 95% of the 1,007 study members still alive took part.

    “Assessments were carried out at birth and ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, 32, and, most recently, 38 years, when 95% of the 1,007 study members still alive took part.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The findings were not hypothesized in advance.

    “First, as the findings were not hypothesized in advance, replication in other cohorts is imperative.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Childhood-ADHD individuals tended to out-grow the full ADHD diagnosis but continued to experience difficulties in life adjustment into their thirties.

    “Like previous follow-ups of individuals with childhood ADHD, we found that childhood-ADHD individuals tended to out-grow the full ADHD diagnosis but continued to experience difficulties in life adjustment into their thirties.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Personality disorder was not ascertained.

    “Fifth, personality disorder was not ascertained.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The cohort's ADHD cases were unbiased by clinical referral and largely untreated with ADHD medications, which is an advantage for studying the natural history of ADHD but may be a disadvantage for generalizing to patients in treatment.

    “Finally, the fact that our cohort's ADHD cases were unbiased by clinical referral and largely untreated with ADHD medications is an advantage for studying the natural history of ADHD, but may be a disadvantage for clinicians needing an evidence base that generalizes to patients in treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Developmental research on adult ADHD has been limited to two designs, each with a shortcoming that limits inference about childhood origins of adult ADHD.

    “A test is lacking because developmental research on adult ADHD has been limited to two designs, each with a shortcoming that limits inference about childhood origins of adult ADHD(2).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

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

    Premisecitation

    DSM-5 places adults' ADHD alongside children's ADHD within the category of neurodevelopmental disorders and states that ADHD begins in childhood.

    “DSM-5 places adults' ADHD alongside children's ADHD within the category of neurodevelopmental disorders, and states, “ADHD begins in childhood” (pg.61).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites DSM-5 pg.61

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Consensus statements recommend treating adult ADHD on the grounds that it is a continuation from childhood ADHD.

    “Consensus statements recommend treating adult ADHD on the grounds that it is a continuation from childhood ADHD(1) (http://www.nice.org.uk/guidance/cg72).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The non-significant effect sizes were very small, suggesting that lack of power was not the reason for lack of significant differences.

    “However, the non-significant effect sizes were very small, suggesting that lack of power was not the reason for lack of significant differences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The adult-ADHD group was small, which limited statistical power and the ability to examine heterogeneity within this group.

    “Fourth, our adult-ADHD group was small, which limited statistical power and our ability to examine heterogeneity within this group.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Meta-analyses have reported wider cognitive differences between ADHD-adults and controls.

    “Meta-analyses have reported wider cognitive differences between ADHD-adults and controls(43,44)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [43] source

      Not checked in the free run.

    • cites [44] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Retrospective recall of psychiatric symptoms across decades has poor validity and yields false-negative reports of childhood-onset hyperactivity.

    “retrospective recall of psychiatric symptoms across decades has poor validity, and yields false-negative reports of childhood-onset hyperactivity(39-41).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [39] source

      Not checked in the free run.

    • cites [40] source

      Not checked in the free run.

    • cites [41] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The WAIS-IV Working Memory index and continuous-performance test of attentional vigilance are generally considered cardinal deficits in individuals with ADHD.

    “which are generally considered cardinal deficits in individuals with ADHD(42).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    By requiring childhood onset and a neuro-developmental root, DSM-5 leaves these impaired adults out of the classification system.

    “Ironically, by requiring childhood onset and a neuro-developmental root, DSM-5 leaves these impaired adults out of the classification system.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    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).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] source

      Not checked in the free run.

    • cites [50] source

      Not checked in the free run.

    • cites [51] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The adult-ADHD cases were getting professional attention but not the treatment-of-choice for ADHD.

    “As such, they were getting professional attention, but not the treatment-of-choice for ADHD”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Methylphenidate or atomoxetine is the treatment-of-choice for ADHD.

  • May combine two claims.

    Interpretationown data

    The authors found ample evidence of treatment need and treatment contact.

    “we found ample evidence of treatment need, and treatment contact.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Other research has uncovered different etiological factors for childhood versus adult ADHD, including heritability differences.

    “Other research has uncovered different etiological factors for childhood versus adult ADHD, including heritability differences(52,53).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] source

      Not checked in the free run.

    • cites [53] source

      Not checked in the free run.

45 of 45

  • The paper relies on this without support.

    No prospective-longitudinal study has tested whether adult ADHD is a neurodevelopmental disorder that begins in childhood.

    “However, to our knowledge the dual assumptions that adult ADHD is a neurodevelopmental disorder and begins in childhood remain untested by a prospective-longitudinal study of the childhoods of adults with ADHD.”

  • The paper relies on this without support.

    This is the first follow-back prospective study of the childhood origins of individuals diagnosed with DSM-5 adult ADHD.

    “To our knowledge this is the first follow-back prospective study of the childhood origins of individuals diagnosed with DSM-5 adult ADHD; thus, our novel finding must be evaluated in other studies.”

  • The paper relies on this without support.

    At age 38, the Dunedin cohort is too young for prodromal dementia.

    “At 38, this cohort is too young for prodromal dementia.”

  • The paper relies on this without support.

    Dunedin Study members lack any motive to fabricate their reports to the authors.

    “Dunedin Study members lack any motive to fabricate their reports to us.”

  • The paper relies on this without support.

    Methylphenidate or atomoxetine is the treatment-of-choice for ADHD.

    “not the treatment-of-choice for ADHD”
5 of 5

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 [7]

    The Results (Prevalence and continuity, Figure 1b) report that only 3 of 31 adults with ADHD—10%—had documented childhood ADHD. The Discussion (The adult-ADHD group) likewise says that almost none of the adults diagnosed with ADHD had ADHD as children, contrary to the claimed figure of more than two-thirds. (LLM, conf=0.94)

    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 [12]

    The Discussion (‘The childhood-ADHD group’) says virtually all former-ADHD children no longer met full diagnostic criteria at age 38. It distinguishes outgrowing the ADHD diagnosis from retaining neuropsychological deficits and life difficulties, so it does not support the claim that children with ADHD do not outgrow the disorder. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • An increasing number of adolescents and young adults have presented to clinics with ADHD symptoms started after 12 or even later in life.

    “Recently, an increasing number of adolescents and young adults have presented to clinics with ADHD symptoms started after 12 or even later in life (Moffitt et al., 2015).”

    From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Moffitt et al., 2015

    The Results section, “Prospective onset before age 12” (page unavailable), finds only mildly elevated childhood symptoms among participants diagnosed with ADHD at age 38, which lends support to the possibility of later-onset symptoms. The paper does not establish that their symptoms began after 12, or report an increasing number of adolescents and young adults presenting to clinics. (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 [7]

    The Discussion reports that almost none of the adults diagnosed with ADHD had ADHD as children, supporting the possibility of non-childhood onset. But the Abstract conclusion calls this a possibility requiring replication, and the Discussion says the study could not trace when adult symptoms emerged. Thus “demonstrated” is stronger than the paper’s conclusion. Page numbers are not available in the supplied passages. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • 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).”

    From ADHD and associated psychopathology in older adults in a German community sample (2023) · cites this paper as Moffitt et al. 2015

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.

  • Reported 0.03% prevalence is impossible for this cohort size

    Minor

    In a cohort of 1,037 people, one case would represent about 0.096%. No whole-number case count can yield the stated nonzero prevalence of 0.03%.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Matte B, Psychol Med
  2. Poulton R, 2006, N Z Med J, 119, U2002
  3. Manuzza S, 2008, Diagnosing ADHD in Adults: DSM-IV Controversies and DSM-V Recommendations: Review Prepared for the American Psychiatric Association (DSM-V Disruptive Behavior Disorders Workgroup)

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Authors
Moffitt, T. E., Houts, R., Asherson, P., Belsky, D. W., Corcoran, D. L., Hammerle, M., Harrington, H., Hogan, S., Meier, M. H., Polanczyk, G. V., Poulton, R., Ramrakha, S., Sugden, K., Williams, B., Rohde, L. A., & Caspi, A.
Affiliations
  • Duke University (US)
  • From the Department of Psychology and Neuroscience, the Department of Psychiatry and Behavioral Sciences, School of Medicine, the Center for Genomic and Computational Biology, and the Social Science Research Institute, Duke University, Durham, N.C.; the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London; the Department of Psychology, University of Otago, Dunedin, New Zealand; the Department of Psychology, Arizona State University, Tempe; the Department of...
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2015-10-01
Volume
172
Issue
10
Pages
967-977
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2015.14101266
PMC
PMC4591104
OpenAlex
W2131518354
Cited by
618
References
61
Citations by year
2026: 32 · 2025: 47 · 2024: 51 · 2023: 44 · 2022: 55 · 2021: 57 · 2020: 67 · 2019: 47 · 2018: 68 · 2017: 65 · 2016: 69 · 2015: 12 · 2014: 1 · 2012: 1
FWCI
57.57
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • Medical Research Council (MR/K00381X/1)
  • National Institute on Aging (AG-032282, P30AG034424, R01AG032282)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
adult ADHD, childhood-onset ADHD, neurodevelopmental disorders, ADHD comorbidity, neuropsychological deficits, polygenic risk, substance dependence, ADHD classification, Dunedin birth cohort
MeSH terms
Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Longitudinal Studies, Male, Neuropsychological Tests, New Zealand, Prospective Studies, Prevalence, Neurodevelopmental Disorders

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