Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25
Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25
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DOI：
10.1176/appi.ajp.2017.17030298
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发表时间：
2018-02-01
影响因子：
17.7
通讯作者：
Stehli, Annamarie
中科院分区：
文献类型：
--
作者：
Sibley, Margaret H.;Rohde, Luis A.;Stehli, Annamarie
目的：没有儿童注意缺陷多动障碍（ADHD）的青少年和年轻人经常到诊所寻求兴奋剂治疗晚发性ADHD症状。最近的出生队列研究支持迟发性ADHD的概念，但这些调查依赖于筛查工具来评估ADHD，没有考虑症状的其他原因，或者未能获得完整的精神病史，因此受到限制。作者通过对ADHD多模式治疗研究的本地规范对照组进行纵向精神病学评估来解决这些局限性。方法：从比较基线（平均年龄= 9.89岁）到青年期（平均年龄= 24.40岁），对无儿童ADHD的个体（N= 239）进行8次评估。诊断程序利用父母、老师和ADHD症状、损伤、物质使用和其他精神障碍的自我报告，并考虑症状背景和时间。结果：大约95%最初在症状检查表上筛选呈阳性的个体被排除在迟发性ADHD诊断之外。在迟发性ADHD症状受损的个体中，诊断排除的最常见原因是症状或损害仅发生在大量药物使用的背景下。大多数迟发性病例表现为青春期发病，且表现为青春期受限。没有证据表明成人发病的ADHD独立于复杂的精神病史。结论：寻求治疗晚发性ADHD的个体可能是有效病例；然而，更常见的是，症状表现为非损害性认知波动、合并症或物质使用的认知影响。假阳性的迟发性ADHD病例在没有仔细评估的情况下很常见。临床医生在治疗潜在的迟发性病例之前，应仔细评估损害、精神病史和药物使用情况。
Objective: Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD.Method: Individuals without childhood ADHD (N= 239) were administered eight assessments from comparison baseline (mean age= 9.89 years) to young adulthood (mean age= 24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing.Results: Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history.Conclusions: Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatrichistory, and substance use before treating potential late-onset cases.