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July 2016

Can Attention-Deficit/Hyperactivity Disorder Onset Occur in Adulthood?

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, New York
  • 2K. G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
  • 3Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
  • 4Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts
JAMA Psychiatry. 2016;73(7):655-656. doi:10.1001/jamapsychiatry.2016.0400

In this issue of JAMA Psychiatry, 2 large, longitudinal, population studies from Brazil1 and the United Kingdom2 propose a paradigmatic shift in our understanding of attention-deficit/hyperactivity disorder (ADHD). They conclude, not only that the onset of ADHD can occur in adulthood, but that childhood-onset and adult-onset ADHD may be distinct syndromes.

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    1 Comment for this article
    ADHD with Adult Onset??
    Jeffrey A. Mattes, M.D. | Psychopharmacology Research Association of Princeton
    Letter to the Editor:

    The Caye et al (1) article suggests that ADHD can begin in adulthood. Their study excludes patients with certain diagnoses, but does not exclude other diagnoses which are associated with impulsivity and difficulty concentrating. These symptoms are associated with a large number of psychiatric diagnoses including Personality Disorders, and if one modified the criteria for some of these other diagnoses (analogous to how the authors modified the criteria for ADHD by excluding childhood onset), the patients may have met criteria for a number of other conditions.

    To imply that adults with impaired concentration and
    impulsivity, without a childhood history of ADHD, have a variant of ADHD is pure conjecture. Many of these patients, I think, could be thought (just as reasonably) to have variants of other diagnoses including Intermittent Explosive Disorder, Borderline Personality Disorder (and other Personality Disorders), Anxiety Disorders other than GAD or SAD, etc.

    It’s important to note that almost all studies evaluating stimulants in adults with ADHD used criteria including a childhood onset, so there’s little reason to think that adults without a childhood onset will be helped by stimulants. It’s important to note too, given the increased prevalence of drug abuse in these adults, that self-reports of improvement on stimulants may not be valid; I think it’s important, if adults with presumed ADHD are given stimulants, that there be reasonably clear objective evidence of functional improvement on stimulants.

    It’s slightly disconcerting that some of the authors of this study and the accompanying editorial have received income from Shire and other drug companies. Is it too cynical to think that drug companies may be encouraging researchers to link (without good evidence) childhood onset ADHD with adults with ADHD-like symptoms?


    Jeffrey A. Mattes, M.D., Director
    Psychopharmacology Research Association of Princeton
    601 Ewing St., Ste. A-12
    Princeton, NJ 08540
    Phone: 609-921-9299
    Fax: 609-921-1332
    e-mail: jmattesmd@verizon.net


    (1) CayeA, Botter-Maio Rocha T, Anselmi L, et al. Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood. Evidence From a Birth Cohort Supporting a Late-Onset Syndrome. JAMA Psychiatry. 2016;73(7):705-712.