Although what we clinically refer to as ADHD has morphed from “minimal brain dysfunction” in the 1960s-1970s and then “ADD” in the 1980s-1990s, one factor has remained constant: ADHD has, from the very beginning, been characterized as a neurodevelopmental disorder, which means its genesis is in early childhood – according to DSM-5. Earlier editions of the DSM mandated that ADHD symptomology begin before age seven, but DSM-5, under clinical pressure, eased the criteria, extending symptom emergence to age twelve. I disagree with many DSM-5 criteria, but when it comes to the age designations for ADHD, we’re kindred spirits.
Teen-onset ADHD
Extending the symptom onset to age 12, however, is not enough for some. Why not symptom emergence in the teen years, or for that matter, in adulthood? Because that would defeat the neurodevelopmental aspects of this disorder, meaning there must be an age threshold, give or take a few years. ADHD symptoms can be subject to recall-related problems, so conceivably, the later on in life symptoms appear; the more difficult it is to remember how far back symptoms emerged. Thus the best way to determine their true onset is to follow subjects over time. Three such studies did just that. All of them suggested that ADHD can start during the teen years, but with this caveat: dig deep enough and you’ll likely find some indicators of the disorder embedded in the client’s childhood.
Adult-onset ADHD
A 2015 New Zealand study garnered attention with the claim that the first evidence of adult-onset ADHD had been isolated. The study followed 1,000 children from infancy to middle age, assessing for ADHD at two time points – ages 5-7 and age 38. When the study panelists investigated those who received the diagnosis, the results were eye-opening – there was almost no overlap between the children who were diagnosed with ADHD and adults also assigned the diagnosis. Then where, or from what, did the later-onset cases emanate? In other words, why is this? This is the conundrum with “adult-onset ADHD” and why it can’t be confirmed and in my estimation, never will be.
So…if you have never-before-diagnosed adults coming to you believing they have ADHD, probably 95 percent of them have something else. People with focusing difficulty, short attention span and distractibility often consult the Web to either become better informed about what’s possibly causing these symptoms or to self-diagnose. But the problem with most Web information regarding these symptoms is that it is poorly fleshed out – failing to mention other differentials which are associated with these same symptoms, such as medical disorders, TBI, cognitive decline, substance abuse, sleep deprivation and depression. Also important: Adults who really have ADHD and went undiagnosed in childhood or adolescence, or were diagnosed and decided not to pursue treatment, will generally report significant impairment in personal, occupational and social functioning. As such, there’s likely to be an historical account of difficulties, right? Look for a paper trail, so to speak, by taking a detective-like approach to assessment.
In spite of challenges that inevitably emerge, ADHD is and will remain a diagnosis with symptoms emerging between the ages of 6-12.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.