Late-Onset ADHD: Understanding the Evidence and Building Theoretical Frameworks

Curr Psychiatry Rep. 2017 Nov 13;19(12):106. doi: 10.1007/s11920-017-0858-7.


Purpose of review: The traditional definition of Attention-Deficit/Hyperactivity Disorder (ADHD), assuming onset in childhood, has been challenged by evidence from four recent birth-cohort studies that reported most adults with ADHD lacked a childhood categorical ADHD diagnosis.

Recent findings: Late onset of symptoms was evaluated in the long-term follow-up of the Multimodal Treatment study of ADHD (MTA). In most cases, other factors were present that discounted the late onset of ADHD symptoms and excluded the diagnosis of ADHD. We offer two theoretical frameworks for understanding the ADHD trajectory throughout the life cycle: (1) the complex phenotype model, and (2) the restricted phenotype model. We conclude that (a) late onset (after age 12) is a valid trajectory for ADHD symptoms, (b) the percentage of these cases with onset after adolescence is yet uncertain, and

Keywords: ADHD; Course; Development; Late-onset; Persistence.

Publication types

  • Review

MeSH terms

  • Age of Onset
  • Attention Deficit Disorder with Hyperactivity / complications
  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Attention Deficit Disorder with Hyperactivity / therapy
  • Cohort Studies
  • Evidence-Based Medicine*
  • Humans
  • Mental Health
  • Phenotype
  • Substance-Related Disorders / complications