23 May ADHD Does Not Always Begin in Childhood
MedicalResearch.com Interview with:
Luis Augusto Rohde MD, PhD
Department of Psychiatry
Federal University of Rio Grande do Sul
Hospital de Clínicas de Porto Alegre
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The idea that Attention-deficit/Hyperactivity Disorder always begins in childhood has been held for decades even without proper testing. The main manuals of psychiatric diagnoses require age at onset in childhood as a core feature of the disorder. In a large birth cohort followed until age 18, we identified many young adults presenting with a full impairing ADHD syndrome. They had consistently worse outcomes – criminality, substance abuse, traffic accidents, among others – than their counterparts without ADHD. However, most of these young adults (84.6%) presenting with a full impairing syndrome did not have a prior diagnosis in their childhood years. This surprising observation held after many secondary analyses exploring possible biases, like comorbidities in young adulthood, subthreshold ADHD in childhood and change of information source.
MedicalResearch.com: What should readers take away from your report?
Response: The main message is that our results do not supports the idea that ADHD always begins in childhood. Furthermore, the clinical message is that age at onset should be given less emphasis in a context of clear symptoms and impairment for ADHD diagnosis.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research should aim at understanding this late-onset ADHD cases and see how much they share with childhood onset cases in terms of pathophysiology, genetics, prognosis and response to treatment. Are we dealing with the same disorder with a bimodal age incidence, or are these two totally different conditions?
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Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood Evidence From a Birth Cohort Supporting a Late-onset Syndrome Arthur Caye; Thiago Botter-Maio Rocha, MD, MSc; Luciana Anselmi, PhD; Joseph Murray, PhD; Ana M. B. Menezes, PhD; Fernando C. Barros, PhD; Helen Gonçalves, PhD; Fernando Wehrmeister, PhD; Christina M. Jensen, MSc; Hans-Christoph Steinhausen, MD, PhD, DMSc; James M. Swanson, PhD; Christian Kieling, MD, PhD; Luis Augusto Rohde, MD, PhD
JAMA Psychiatry Published online May 18, 2016
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