Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study

Terrie E. Moffitt, Renate Houts, Philip Asherson, Daniel W. Belsky, David L. Corcoran, Maggie Hammerle, Honalee Harrington, Sean Hogan, Madeline Meier, Guilherme V. Polanczyk, Richie Poulton, Sandhya Ramrakha, Karen Sugden, Benjamin Williams, Luis Augusto Rohde, Avshalom Caspi

Research output: Contribution to journalArticlepeer-review

302 Scopus citations

Abstract

Objective: Despite a prevailing assumption that adult ADHD is a childhood-onset neurodevelopmental disorder,noprospective longitudinal study has described the childhoods of the adult ADHD population. The authors report follow-back analyses of ADHD cases diagnosed in adulthood, alongside follow-forward analyses of ADHD cases diagnosed in childhood, in one cohort. Method: Participants belonged to a representative birth cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38, with 95% retention. Symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, genome-wide association study-derived polygenic risk, and life impairment indicatorswere assessed.Data sources were participants, parents, teachers, informants, neuropsychological test results, andadministrative records.AdultADHD diagnoses used DSM-5 criteria, apart from onset age and crosssetting corroboration, which were study outcome measures. Results: As expected, childhood ADHD had a prevalence of 6% (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3% (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the childhood ADHD and adult ADHD groups comprised virtually nonoverlapping sets; 90% of adult ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult ADHDgroup did notshowtested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD. Conclusions: The findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, then the disorder?s place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.

Original languageEnglish (US)
Pages (from-to)967-977
Number of pages11
JournalAmerican Journal of Psychiatry
Volume172
Issue number10
DOIs
StatePublished - Oct 1 2015

ASJC Scopus subject areas

  • Psychiatry and Mental health

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