Diagnosing adult attention deficit hyperactivity disorder: Are late onset and subthreshold diagnoses valid?
Diagnosing adult attention deficit hyperactivity disorder: Are late onset and subthreshold diagnoses valid?
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DOI：
10.1176/appi.ajp.163.10.1720
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发表时间：
2006-10-01
影响因子：
17.7
通讯作者：
Monuteaux, Michael C.
中科院分区：
文献类型：
--
作者：
Faraone, Stephen V.;Biederman, Joseph;Monuteaux, Michael C.
目的：当诊断人员不能在7岁的DSM-IV标准之前建立起病，或者如果回忆的症状数量没有达到DSM的诊断阈值时，很难诊断成人的注意缺陷多动障碍(ADHD)。方法：通过比较四组成年人：127例完全ADHD患者符合儿童ADHD的所有DSM-IV标准，79例迟发性ADHD患者除起病年龄标准外，41例亚阈值ADHD患者不符合完整的ADHD症状标准，123名无ADHD且不符合任何标准的受试者。作者假设晚发型和阈值以下的ADHD患者将表现出与完全ADHD患者相似的精神共病、功能障碍和家族传播模式。结果：晚发型和完全ADHD患者的精神共病、功能障碍和家族传播模式相似。大多数ADHD起病较晚的儿童(83%)年龄在12岁以下。阈值以下的ADHD病情较轻，表现出不同于其他形式的ADHD的家族传播模式。结论：有关ADHD先证者的临床特征和ADHD在亲属中的传播模式的数据几乎没有证据表明这类患者的阈值下ADHD的有效性，他们报告的一些症状的终生病史从未达到DSM-IV的诊断阈值。相反，研究结果表明，迟发性成人ADHD是有效的，DSM-IV的发病年龄标准过于严格。
Objective: Diagnosing attention deficit hyperactivity disorder (ADHD) in adults is difficult when diagnosticians cannot establish an onset before the DSM-IV criterion of age 7 or if the number of symptoms recalled does not achieve DSM's diagnosis threshold.Method: The authors addressed the validity of DSM-IV's age-at-onset and symptom threshold criteria by comparing four groups of adults: 127 subjects with full ADHD who met all DSM-IV criteria for childhood-onset ADHD, 79 subjects with late-onset ADHD who met all criteria except the age-at-onset criterion, 41 subjects with subthreshold ADHD who did not meet full symptom criteria for ADHD, and 123 subjects without ADHD who did not meet any criteria. The authors hypothesized that subjects with late-onset and subthreshold ADHD would show patterns of psychiatric comorbidity, functional impairment, and familial transmission similar to those seen in subjects with full ADHD.Results: Subjects with late-onset and full ADHD had similar patterns of psychiatric comorbidity, functional impairment, and familial transmission. Most children with late onset of ADHD (83%) were younger than 12. Subthreshold ADHD was milder and showed a different pattern of familial transmission than the other forms of ADHD.Conclusions: The data about the clinical features of probands and the pattern of transmission of ADHD among relatives found little evidence for the validity of subthreshold ADHD among such subjects, who reported a lifetime history of some symptoms that never met DSM-IV's threshold for diagnosis. In contrast, the results suggested that late-onset adult ADHD is valid and that DSM-IV's age-at-onset criterion is too stringent.