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Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25
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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 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
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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 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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Anbarasan, D., Safyer, G., & Adler, L. A. (2022) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2022.03.008 · Cited by 9
Early Predictors of De Novo and Subthreshold Late-Onset ADHD in a Child and Adolescent Cohort
Liu, C.-Y., Asherson, P., Viding, E., Greven, C. U., & Pingault, J.-B. (2021) · Journal of Attention Disorders · doi:10.1177/1087054719892888 · Cited by 8
Digital Media Use and ADHD Symptoms
Sibley, M. H., & Coxe, S. J. (2018) · JAMA · doi:10.1001/jama.2018.18095 · Cited by 8
Self-citationSasaki, H., Jono, T., Fukuhara, R., Yuki, S., Ishikawa, T., Boku, S., & Takebayashi, M. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02949-7 · Cited by 9
Sasaki, H., Jono, T., Fukuhara, R., Honda, K., Ishikawa, T., Boku, S., & Takebayashi, M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03978-0 · Cited by 10
Xu, Y., Chung, H., Shu, M., Liu, Y., Zhang, Y., & Qiu, H. X. (2023) · BMC Pediatrics · doi:10.1186/s12887-023-03850-4 · Cited by 7
Bertschy, G., Martz, É., Weibel, S., & Weiner, L. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s401330 · Cited by 10
Why are stimulant medication prescriptions rising globally?
Sibley, M. H. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30317-1 · Cited by 7
Self-citationRaasch, E., Fuermaier, A. B. M., Kneidinger, J., Albrecht, B., & Christiansen, H. (2025) · Behavioral Sciences · doi:10.3390/bs15081108 · Cited by 6
TDA/H, trouble de l’enfance ou de l’âge adulte ?
Ilario, C., Alt, A., Bader, M., & Sentissi, O. (2019) · L Encéphale · doi:10.1016/j.encep.2019.05.004 · Cited by 7
Bhattacharyya, N. K., Singh, S., Banerjee, A., Ghosh, R., Sinha, O., Das, N., Gayen, R., Pal, S. S., Ganguly, S., Dasgupta, T., et al. (2022) · Review of Scientific Instruments · doi:10.1063/5.0088044 · Cited by 7
Kato, M., Tsuda, H., Chen, Y., Tsuji, T., & Nishigaki, N. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s399915 · Cited by 6
Ito, M., Kinjo, T., Seki, T., Horie, J., & Suzuki, T. (2021) · Neuropsychopharmacology Reports · doi:10.1002/npr2.12181 · Cited by 6
Kwarteng, F., Wang, R., Micov, V., Hausknecht, K. A., Turk, M. C., Ishiwari, K., Oubraim, S., Wang, A., Richards, J. B., Haj‐Dahmane, S., et al. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06242-1 · Cited by 9
Late-Onset ADHD: Case Closed or Open Question?
Agnew‐Blais, J. C., & Arseneault, L. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.17111240 · Cited by 7
Diagnosing ADHD in Older Adults: Critical Next Steps for Research
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“I wish it wasn’t all on me”: women’s experiences living with a partner with ADHD
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“…these symptoms intruded into multiple life domains, including domestic and parenting tasks, social relationships, health management, and professional life. these findings underscore existing evidence that portrays aDhD as a chronic health condition profoundly impacting family life [2,9,10,49,50].”
BackgroundXiao, L.-R., Zhao, G., Zhang, P., Tian, X., Wu, X.-X., Li, J.-R., Liu, S.-Y., & Wu, H. (2024) · Journal of Attention Disorders · doi:10.1177/10870547241285971 · Cited by 4
Hartung, C. M., Shelton, C. R., Abu-Ramadan, T. M., & Canu, W. H. (2022) · The ADHD Report · doi:10.1521/adhd.2022.30.6.1 · Cited by 4
Attention-Deficit Hyperactivity Disorder
Swanson, J. M., Rommelse, N. N. J., Cotton, J., Sonuga-Barke, E. J. S., Jensen, P. S., & Castellanos, F. X. (2022) · Springer eBooks · doi:10.1007/978-1-4614-6434-1_169-2 · Cited by 4
Self-citationWechsler, D. L., Rijsdijk, F. V., Adamo, N., Eilertsen, E. M., Ahmadzadeh, Y. I., Badini, I., Hannigan, L. J., Ystrøm, E., & McAdams, T. A. (2022) · BJPsych Open · doi:10.1192/bjo.2023.554 · Cited by 5
The Importance of Scrutinizing Emergent ADHD Symptoms in Adults: Response to Chamberlain and Müller
Sibley, M. H., Arnold, L. E., Swanson, J. M., Hechtman, L. T., Mitchell, J. T., Molina, B. S. G., Kennedy, T. M., & Roy, A. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.17121308r · Cited by 4
Self-citation
Metadata
- 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
- Published
- 2018-02-01
- Volume
- 175
- Issue
- 2
- Pages
- 140-149
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- 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
- FWCI
- 13.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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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