The Age of Onset of Attention-Deficit Hyperactivity Disorder
Whilst the contemporary concept of attention deficit/hyperactivity disorder (ADHD) is relatively recent, the typical pattern of ADHD symptoms has been described in the literature since the nineteenth century, and these early descriptions all emphasised an onset early in life. ADHD symptoms and impairments are often present during the preschool period. However making a diagnosis during this period is challenging due to the greater variability in normal behaviours during this developmental period. The ADHD construct has been refined over time, and with the introduction of the DSM and ICD classification systems, an age of onset (AOO) criterion was introduced making it a requirement that symptoms, and later on impairment, were present before the age of 7 years. This criterion was challenged as arbitrary and lacking empirical support. In DSM-5 the AOO criterion for ADHD was adjusted such that only some symptoms appearing before the age of 12 years are required to make a diagnosis. ADHD was traditionally thought of as a disorder of childhood, and perhaps adolescence. It is now clear that ADHD often persists into adulthood, either as the full disorder or partially remitted but with continuing impairment. Several recent studies have challenged the notion that ADHD always begins in childhood. Four large community studies have identified a group of adults who did not have ADHD as children but who do meet diagnostic criteria for ADHD as adults. These findings have resulted in considerable debate, and several lines of argument have been put forward to explain the findings.
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