Cited by 33Attention Deficit Hyperactivity DisorderAutism Spectrum Disorder ResearchChild and Adolescent Psychosocial and Emotional Development

The decreasing prevalence of ADHD across the adult lifespan confirmed

Open access
Vos, Melissa, Hartman, Catharina A·2022·Journal of Global Health

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder common in both children and adults. Diagnostic criteria are based on two core symptom domains: inattention and hyperactivity-impulsivity. Additionally, symptoms should first occur before age twelve and be accompanied by impairments in daily life [1]. In childhood, ADHD has an estimated prevalence of 5%-7% [2,3]. It is well […]

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Written from the paper’s full text.

TL;DR

Using a large Dutch general-population sample (n = 35,216), this study replicates Song et al.’s meta-analytic finding that adult ADHD prevalence declines across the adult lifespan. It confirms decreasing prevalence for symptomatic, persistent, and persistent-with-impairment ADHD, while emphasizing that ADHD remains underrecognized and undertreated in old age.

Key findings

  • In the Lifelines add-on sample, overall prevalence was 8.1% for symptomatic ADHD (2861 cases), 6.5% for persistent ADHD (2269 cases), and 3.4% for persistent ADHD with impairment (1192 cases).
  • Prevalence fell with age: symptomatic ADHD decreased from 15.5% at ages 18–24 to 4.3% at 60+; persistent ADHD from 15.4% to 2.8%; persistent ADHD with impairment from 8.1% to 1.1%.
  • Binomial regression with a log link showed a decreasing prevalence across adulthood (PRage = 0.96–0.97, 95% CI = 0.95–0.97, P < 0.001), with a stronger decrease for persistent than symptomatic ADHD.
  • The authors’ estimate for individuals aged 60+ was 1.1%, similar to the 0.8% reported by Song et al. for that age range; Song et al. estimated overall prevalence of 6.8% for symptomatic adult ADHD and 2.6% for persistent adult ADHD.

Methods

  • Add-on study within the Lifelines cohort, largely representative of the general population in the Northern Netherlands; n = 35,216, data collected 2017–2019, mean age 43.0 years, 42.6% males, mean highest education 2.21 on a 1–3 scale.
  • ADHD symptoms assessed with the Dutch adult ADHD DSM-IV questionnaire: 11 inattention and 12 hyperactivity-impulsivity items scored 0–3; a symptom was considered present when an item was rated 2 or higher. Symptomatic ADHD required at least five inattention or at least five hyperactivity-impulsivity symptoms; persistent ADHD additionally required retrospectively reported age of onset before 18; persistent ADHD with impairment additionally required impairment ≥6 on a 1–10 scale.
  • Prevalence was estimated by age band and modelled across the adult lifespan using binomial regression with a log link, then compared with Song et al.’s systematic review and meta-analysis.

Limitations

  • The paper states that as a single study, its findings do not provide “a global estimate of the prevalence of adult ADHD”; rather, they complement the meta-analytic findings.
  • Age at onset was retrospectively assessed, and the authors note that recall problems on symptoms before age 18 may have played a role; they used a more lenient onset criterion (before age 18 rather than DSM-V’s before age 12) partly because of retrospective reporting difficulties and evidence that ADHD may have full clinical onset in adolescence.
  • The paper discusses Song et al.’s limitations—heterogeneity across studies in diagnostic criteria, case definitions, study designs, sampling methods, populations, diagnostic tools, DSM version, sex, setting, and investigation period—and notes that such heterogeneity makes it difficult to distinguish a real declining prevalence from methodological differences. Evident from the text: the present study is cross-sectional, so age-related prevalence differences cannot be distinguished from cohort effects.

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

Integrity signals

Registry

Crossref · 10.7189/jogh.12.03024

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

28 of 33 cited sources checked · 19 supported · 2 flagged · accuracy not yet measured

  • Premisecitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    Song et al. estimated an overall prevalence of 6.8% for symptomatic adult ADHD.

    “Song et al. [8] estimated an overall prevalence of 6.8% for symptomatic adult ADHD and 2.6% for persistent adult ADHD.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Song, 2021, The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis., J Glob Health source
  • Premisecitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    In Song et al., symptomatic adult ADHD prevalence decreased from 9.0% in young adulthood to 4.5% above age 60.

    “For symptomatic adult ADHD, the estimated prevalence decreased from 9.0% in young adulthood to 4.5% above age 60.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Song, 2021, The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis., J Glob Health source
  • Premisecitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    In individuals aged fifty years and older, the prevalence of treated ADHD is 0.09%.

    “A recent meta-analysis focusing on individuals with ADHD aged fifty years and older identified a prevalence of 0.23% diagnosed with ADHD and 0.09% treated for ADHD [6].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] Dobrosavljevic, 2020, Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis., Neurosci Biobehav Rev source

      Section 3.2 reports 0.09% as the pooled prevalence based on ADHD treatment rates. However, Table 2 reports 0.02% for the sensitivity analysis restricted to studies with an age cutoff of at least 50, so the 0.09% estimate does not specifically apply to that age group. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Premisecitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    In Song et al., persistent adult ADHD prevalence ranged from 5.1% at 18-24 years of age to 0.8% above 60 years of age.

    “the prevalence ranged from 5.1% at 18-24 years of age to 0.8% above 60 years of age.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Song, 2021, The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis., J Glob Health source
  • Interpretationcitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    The findings of Song et al. establish that the decrease in the population prevalence of ADHD that sets in during adolescence continues across adulthood.

    “the findings of Song et al. establish that the decrease in the population prevalence of ADHD that sets in during adolescence continues across adulthood [7,8].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [7] Simon, 2009, Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis., Br J Psychiatry source
    • cites [8] Song, 2021, The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis., J Glob Health source

      The Results section (Age-specific prevalence and the number of cases of adult ADHD in 2020; page not provided) reports that both measures of adult ADHD prevalence declined from ages 18–24 to ages 60 and above. The passage labelled Abstract > Conclusions describes a decline during adolescence as a longstanding conception, not a finding established by this study. Thus the source supports the decline across adulthood but not the claim that its findings establish when the decline begins. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 4
  • May combine two claims. 5
  • Classified as probably not a substantial claim.

    Premisereasoning
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    It is unclear whether the prevalence of adult ADHD changes with age.

    “it is unclear whether the prevalence of adult ADHD changes with age.”
    Quote in the paperSubstantial claim4 of 4 sources checked
    • cites [4] Fayyad, 2007, Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder., Br J Psychiatry source

      The Socio-demographic correlates section (p. 4) reports prevalence differences by gender and education, but does not address whether prevalence changes with age. I searched for age-related prevalence and age-group comparisons; the passages found do not establish whether that relationship is unclear. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
    • cites [5] Franke, 2018, Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan Article., Eur Neuropsychopharmacol source
    • cites [6] Dobrosavljevic, 2020, Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis., Neurosci Biobehav Rev source

      The Discussion says the lower prevalence estimates in older adults are consistent with a “well-established effect of age on the prevalence of ADHD,” contrary to the claim that it is unclear whether prevalence changes with age. The Limitations section calls for more research on how age affects prevalence specifically after age 50; that narrower uncertainty does not support the claim about adults generally. (LLM, conf=0.84)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [7] Simon, 2009, Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis., Br J Psychiatry source

      The Results report a significant age-related decline in adult ADHD prevalence when men and women were equally represented, and the Conclusions state that prevalence declines with age in the general population. The paper says the cause of the observed decline is unclear, not whether its analysis found a change with age. The supplied passages have no page numbers. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • May combine two claims.

    Interpretationown data
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    Based on an independent large sample from the general population, the present study showed strikingly similar results compared to Song et al. and thus confirmed that ADHD in adults declines across the adult lifespan.

    “based on an independent large sample from the general population, the present study showed strikingly similar results compared to the findings of Song et al. and thus confirmed that ADHD in adults declines across the adult lifespan [8].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Song, 2021, The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis., J Glob Health source
    • Rests on an assumption: Cross-sectional age differences in ADHD prevalence reflect a true decline across the adult lifespan rather than cohort or period effects.
    • Rests on an assumption: Retrospective self-report of age of onset before age 18 accurately classifies persistent ADHD in older adults.
    • Rests on an assumption: Age-related recall or reporting biases do not substantially explain the observed decline in ADHD prevalence across adulthood.
  • May combine two claims.

    Interpretationcitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    ADHD is severely underrecognized and undertreated in old age: the lower prevalence in old age identified in the general population is much higher than the prevalence of referred older-aged patients diagnosed with ADHD, which is in turn higher than the prevalence of those treated.

    “ADHD is severely underrecognized and undertreated in old age: the lower prevalence in old age identified in the general population is much higher than the prevalence of referred older-aged patients diagnosed with ADHD, which is in turn higher than the prevalence of those treated [6].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Dobrosavljevic, 2020, Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis., Neurosci Biobehav Rev source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim.

    Premisecitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    Adult ADHD definitions strongly vary between studies.

    “adult ADHD definitions strongly varying between studies”
    Quote in the paperSubstantial claim4 of 4 sources checked
    • cites [4] Fayyad, 2007, Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder., Br J Psychiatry source
    • cites [5] Franke, 2018, Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan Article., Eur Neuropsychopharmacol source
    • cites [6] Dobrosavljevic, 2020, Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis., Neurosci Biobehav Rev source
    • cites [7] Simon, 2009, Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis., Br J Psychiatry source
  • May combine two claims.

    Premisecitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    In Song et al., the prevalence of both symptomatic and persistent adult ADHD decreased across adulthood.

    “the authors additionally showed that the prevalence of both symptomatic and persistent adult ADHD decreased across adulthood.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Song, 2021, The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis., J Glob Health source
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    The Dutch version of the adult ADHD DSM-IV questionnaire has shown good psychometric properties.

    “The Dutch version of the ADHD DSM-IV questionnaire has shown good psychometric properties [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Kooij, 2005, Internal and external validity of Attention-Deficit Hyperactivity Disorder in a population-based sample of adults., Psychol Med source
  • May combine two claims.

    Interpretationreasoning
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    Adding age of onset decreased the prevalence of adult ADHD by removing older participants with cognitive aging problems, although recall problems on symptoms before age 18 may also have played a role.

    “The non-parallel line of the persistent ADHD group compared to symptomatic ADHD further suggests that adding age of onset decreased the prevalence of adult ADHD by removing older participants with cognitive aging problems, although recall problems on symptoms before age 18 may also have played a role.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Retrospective self-report of age of onset before age 18 accurately classifies persistent ADHD in older adults.
    • Rests on an assumption: Age-related recall or reporting biases do not substantially explain the observed decline in ADHD prevalence across adulthood.
  • May combine two claims.

    Study design and conductcitation
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    Both the original Lifelines Cohort Study and the add-on study are largely representative of the general population in the Northern part of the Netherlands.

    “Both the original Lifelines Cohort Study and our add-on study are largely representative of the general population in the Northern part of the Netherlands”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Stolk, 2008, Universal risk factors for multifactorial diseases: LifeLines: A three-generation population-based study., Eur J Epidemiol source
    • cites [12] Scholtens, 2015, Cohort Profile: LifeLines, a three-generation cohort study and biobank., Int J Epidemiol source
  • Classified as probably not a substantial claim.

    Interpretationreasoning
    § The decreasing prevalence of ADHD across the adult lifespan confirmed

    Given that studies in Song et al. substantially differed in the age ranges studied, it cannot be distinguished whether a declining prevalence rate across adulthood is real or is the consequence of methodological differences between studies.

    “given that studies substantially differed in the age ranges studied, it cannot be distinguished if a declining prevalence rate across adulthood is real or is it the consequence of methodological differences between studies.”
    Quote in the paperSubstantial claim
9 of 9
  • The paper relies on this without support.

    Cross-sectional age differences in ADHD prevalence reflect a true decline across the adult lifespan rather than cohort or period effects.

    “the present study showed strikingly similar results compared to the findings of Song et al. and thus confirmed that ADHD in adults declines across the adult lifespan [8].”
  • The paper relies on this without support.

    Retrospective self-report of age of onset before age 18 accurately classifies persistent ADHD in older adults.

    “The age at onset was retrospectively assessed.”
  • The paper relies on this without support.

    Age-related recall or reporting biases do not substantially explain the observed decline in ADHD prevalence across adulthood.

    “although recall problems on symptoms before age 18 may also have played a role.”
3 of 3

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Authors
Vos, M., & Hartman, C. A.
Affiliations
University Medical Center Groningen (NL)
Venue
Journal of Global Health
Published
2022-06-15
Volume
12
Pages
03024-03024
ISSN
  • 2047-2978 (ISSN-L)
  • 2047-2986
OpenAlex
W4282943988
Cited by
33
References
14
Citations by year
2026: 3 · 2025: 14 · 2024: 11 · 2023: 5
FWCI
4.37
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Journal of Global Health (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (acceptedVersion, other-oa)
  • PubMed Central (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Funders
  • Ministerie van Volksgezondheid, Welzijn en Sport
  • Universitair Medisch Centrum Groningen
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
attention deficit hyperactivity disorder, adult ADHD, prevalence trends, inattention, hyperactivity/impulsivity, neurodevelopmental disorders, diagnostic criteria
MeSH terms
Adult, Attention Deficit Disorder with Hyperactivity, Humans, Longevity, Prevalence

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