title: Is ADHD a valid diagnosis in older adults?
abstract: ADHD is a neurodevelopmental syndrome that often persists into adulthood. It is possible that different criteria are necessary for older adults than younger adults: the manifestations of ADHD could change with age; other conditions with onset in later life share presenting symptoms with ADHD; different contextual challenges and patterns of compensatory support may exist. For these reasons, we reviewed evidence for the validity of DSM ADHD criteria in adulthood for individuals over the age of 50. Specifically, we evaluated evidence that the DSM criteria for ADHD identify a valid syndrome in older adults based on clinical presentation, laboratory or testing findings, absence of alternate diagnosis to explain symptoms, course of the syndrome, or familial presence of the condition. We found evidence that various ADHD criteria identify subjects with clinical presentations similar to that seen in younger adults, but only 92 well-described cases have been reported in the literature. ADHD traits also may be less common in the general population of older adults than in younger adults, suggesting that the threshold for an atypical burden of ADHD traits may be lower in older populations. Future research can establish a richer basis for validity of diagnostic criteria for ADHD in older adults.
authors.affiliation: Harvard Medical School, Boston, MA, USA. csurman@partners.org.|Adult ADHD Research Program, Massachusetts General Hospital, 55 Fruit Street, Warren 624, Boston, MA, 02114, USA. csurman@partners.org.
authors.forename: Craig B H
authors.initials: CBH
authors.lastname: Surman
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Adult Attention Deficit Disorder Center of Maryland, 10751 Falls Rd., Suite 306, Baltimore, MD, 21093, USA.|Suburban Psychiatric Associates, LLC, Johns Hopkins at Green Spring Stations, Baltimore, MD, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Goodman
mesh_terms: D000375:Aging / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D000067562:Late Onset Disorders / Q000175:diagnosis*
keywords: Attention-deficit/hyperactivity disorder; Clinical validity; Diagnosis; Nosology; Older adults