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Cited by 166Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentDevelopmental and Educational Neuropsychology

Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25

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Sibley, Margaret H., Rohde, Luis A., Swanson, James M., Hechtman, Lily T., Molina, Brooke S.G., Mitchell, John T., Arnold, L. Eugene, Caye, Arthur +4 more·2018·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2017.17030298PMC PMC5814300
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Abstract

OBJECTIVE: Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD. METHOD: Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. RESULTS: Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history. CONCLUSIONS: Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.

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  • Results from the Multimodal Treatment Study of ADHD suggest that common sources of impairing late-onset ADHD symptoms in adolescence and young adulthood were heavy substance use and comorbid psychiatric or learning problems.

    “Results from a recent large sample Multimodal Treatment Study of ADHD (MTA) suggest that common sources of impairing late-onset ADHD symptoms in adolescence and young adulthood were heavy substance use and comorbid psychiatric or learning problems (Sibley et al., 2018).”

    From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Sibley et al., 2018

    The Discussion reports that heavy substance use or another mental disorder better explained many cases initially meeting late-onset ADHD criteria; the Conclusion identifies substance use as the most common source of impairing symptoms. The Results also document adolescent cases attributed to other mental disorders. Our copy does not identify learning problems as a common source. (LLM, conf=0.87)

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  • In ADHD, hyperactivity, impulsivity and inattentive patterns change over the course of development, and research published over the last two decades has proposed a potential late-onset form, although this remains controversial.

    “In ADHD, hyperactivity, impulsivity and inattentive patterns change over the course of development, and research published over the last two decades has proposed the existence of a potential ‘late-onset’ form, although this remains controversial25,27,307,308.”

    From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [25]

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Authors
Sibley, M. H., Rohde, L. A., Swanson, J. M., Hechtman, L. T., Molina, B. S. G., Mitchell, J. T., Arnold, L. E., Caye, A., Kennedy, T. M., Roy, A., Stehli, A., & for the Multimodal Treatment Study of Children with ADHD (MTA) Cooperative Group
Affiliations
  • Universidade Federal do Rio Grande do Sul (BR)
  • From the Department of Psychiatry and Behavioral Health, Florida International University, Miami; the Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; the Child Development Center, School of Medicine, University of California, Irvine; the Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada; the Departments of Psychiatry, Psychology, and Pediatrics, University of Pittsburgh...
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2018-02-01
Volume
175
Issue
2
Pages
140-149
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2017.17030298
PMC
PMC5814300
OpenAlex
W2765395469
Cited by
165
References
36
Citations by year
2026: 16 · 2025: 18 · 2024: 8 · 2023: 22 · 2022: 21 · 2021: 18 · 2020: 21 · 2019: 14 · 2018: 26 · 2017: 1
FWCI
13.93
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (n01mh12011-0-0-1, n01mh012009-007, n01mh12008-0-0-1, n01mh12010-0-0-1, n01mh12004-0-0-0, n01mh12007-0-0-0, n01mh012012-001)
  • National Institute of Mental Health (N01 MH012007, U01MH050467, N01 MH012009, N01 MH012011, U01MH050440, N01 MH012012, U01MH050453, N01 MH012010, U01MH050461, N01 MH012004, N01 MH012008)
  • National Institute on Drug Abuse (HHSN271200800003C, K23DA032577, HHSN271200800006C, N01 DA085550, N01 DA085552, HHSN271200800008C, N01 DA085549, HHSN271200800005C, N01 DA085548, HHSN271200800007C, HHSN271200800009C, R01DA039881, N01 DA085553, N01 DA085554, HHSN271200800004C)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Keywords
late-onset ADHD, adult-onset ADHD, adolescents and young adults, stimulant medication, diagnostic exclusion, substance use, comorbidities, psychiatric history, longitudinal assessment, ADHD screening, cognitive fluctuations
MeSH terms
Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Child, Cognition, Female, Humans, Male, Comorbidity, Case-Control Studies, Age of Onset, Substance-Related Disorders, Young Adult

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