Adult ADHD criteria may need revising

By David Douglas

NEW YORK (Reuters Health) - Attention deficit hyperactivity disorder (ADHD) is routinely diagnosed and treated in children, but doing so in adults may present problems, doctors warn in the American Journal of Psychiatry.

This, they say, is chiefly due to criteria outlined in the American Psychiatric Association's main reference work, the Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition (DSM-IV), which was published in 1994.

"When diagnosing ADHD in adults," lead investigator Dr. Stephen V. Faraone told Reuters Health, "the current requirement that the disorder begin prior to age 7 is too stringent. The next revision of the diagnostic manual should consider raising this age-at-onset requirement."

Faraone, of SUNY Upstate University, Syracuse, New York and colleagues came to this conclusion after studying 127 adult subjects with full ADHD who met all DSM-IV criteria for childhood onset. Also involved were 79 comparable subjects who did not meet age-at-onset criteria, 41 with borderline ADHD who did not meet full symptom criteria and 123 controls who did not meet any ADHD criteria.

The team found that subjects with late-onset and full ADHD had similar patterns of psychiatric comorbidity, functional impairment and family history of ADHD. Most (83 percent) of those with late-onset ADHD were originally diagnosed at younger than 12 years of age. Borderline ADHD was milder and had a different pattern of "familial transmission."

The results of this study, the researchers conclude, hint that doctors "should not dismiss the diagnosis of ADHD in adults when the onset occurs later than allowed by DSM-IV."

Dr. James J. McGough, co-author of an accompanying editorial pointed out in remarks to Reuters Health, "these findings cast additional doubt on the validity of the age-of-onset criterion."

However, McGough, of UCLA, added that they also "suggest that current symptom thresholds have value in identifying more adults with more severe disorders."

SOURCE: American Journal of Psychiatry, October 2006.