How Related Are Adult and Childhood ADHD?

Summary and Comment |
June 5, 2015

How Related Are Adult and Childhood ADHD?

  1. Joel Yager, MD

In this four-decade-long study, almost no individuals had attention-deficit/hyperactivity disorder diagnosed in both childhood and adulthood.

  1. Joel Yager, MD

Diagnosing attention-deficit/hyperactivity disorder (ADHD) in adults is tricky, especially if clinicians demand prior diagnoses of childhood ADHD. Investigators in New Zealand studied 1037 individuals born in 1972 and 1973 (men, 53%; white, 93%). They were assessed every 2 to 3 years until age 21 and then at ages 26, 32, and 38. For both children and adults, close informants confirmed symptoms.

DSM-III childhood ADHD diagnoses were made through age 15 and required symptom onset before age 7; 61 children (6%) met ADHD criteria. Diagnoses at age 38 were based on a 27-item inventory operationalizing the 18 DSM-5 adult ADHD symptoms; 31 respondents met criteria (3%). Although 70% of diagnosed adults had contact with professionals for mental health problems and 48% received psychiatric medications for non-ADHD problems between ages 21 and 28, only four ever received stimulants or atomoxetine.

Only three participants with childhood ADHD (5%) later met ADHD criteria at age 38; they constituted only 10% of adult cases. Whereas 79% of childhood cases were male, significant sex differences were not seen in the adult group. Adults with ADHD reported social, vocational, and financial impairments resulting from disorganization, underachievement, accidents, and being exhausting to others. Conduct-disorder histories were nearly twice more common in childhood cases than adult cases (59% vs. 31%). Adult cases had neither the elevated genome-wide polygenic risk scores nor the signature neurocognitive dysfunctions of childhood ADHD, but 48% were dependent on alcohol, cannabis or other drugs, and 39% were tobacco-dependent.


These findings suggest that frequently, childhood and adult ADHD are not the same disorder. Attentional problems associated with adult ADHD might instead be nonspecifically related to substance dependence and other comorbidities. Regardless, high impairment rates in adults with ADHD underscore the need for better understanding and treatment studies.

Editor Disclosures at Time of Publication

  • Disclosures for Joel Yager, MD at time of publication Grant /Research support Agency for Healthcare Research and Quality Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Prevention; Eating Disorders Review (Editor-in-Chief Emeritus); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry Leadership positions in professional societies American Psychiatric Association (Chair, Council of Quality Care)


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