Validation of DSM-5 age-of-onset criterion of attention deficit/hyperactivity disorder (ADHD) in adults: Comparison of life quality, functional impairment, and family function.
Adults whose ADHD began by age 12 suffer the same life problems as those with earlier onset, so the DSM-5 cutoff is valid.
01Research in Context
What this study did
Researchers asked the adults with ADHD when their symptoms first showed up.
Half said before age 7. The other half said between 7 and 12.
Both groups filled out surveys on life quality, work problems, and family support.
A control group of the adults without ADHD did the same surveys.
What they found
Both ADHD groups scored worse than controls on every real-life measure.
The early-onset group and the later-onset group looked the same.
Family support and anxiety or depression explained part of the damage, but not all.
How this fits with other research
Lee et al. (2016) extends these results downward. Their meta-analysis shows kids with ADHD also suffer large drops in quality of life.
DeRoma et al. (2004) is a predecessor. That study checked if an older interview tool caught ADHD well. It only partly worked, so the field moved on to DSM-5 rules like the one tested here.
Gau et al. (2013) adds family detail. They found teens with ADHD feel less warmth from moms. Lin et al. (2015) now show the same family strain lasts into adulthood.
Why it matters
You can now accept adult clients whose ADHD started up to age 12 without doubting the diagnosis. Use quality-of-life scales like PedsQL or adult versions to show insurance why treatment is needed. Track family support and mood issues too—they partly drive the pain you see.
Get CEUs on This Topic — Free
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Add a quick life-quality checklist to your intake packet for any adult who reports ADHD symptoms starting before age 12.
02At a glance
03Original abstract
The newly published Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) elevates the threshold of the ADHD age-of-onset criterion from 7 to 12 years. This study evaluated the quality of life and functional impairment of adults with ADHD who had symptoms onset by or after 7 years and examined the mediation effect of family function and anxiety/depression symptoms between ADHD diagnosis and quality of life and functional impairment. We assessed 189 adults with ADHD and 153 non-ADHD controls by psychiatric interview and self-administered reports on the Adult ADHD Quality of Life Scale, Weiss Functional Impairment Rating Scale, Family APGAR, and Adult Self Report Inventory-4. The ADHD group was divided into early-onset ADHD (onset <7 years, n=147) and late-onset ADHD (onset between 7 and 12 years, n=42). The mediation analysis was conducted to verify the mediating factors from ADHD to functional impairment and quality of life. The late-onset ADHD had more severe functional impairment at work and poorer family support than early-onset ADHD while they had comparable impairment at other domains. Less perceived family support and current anxiety/depressive symptoms partially mediated the link between ADHD diagnosis and quality of life/functional impairment both in early- and late-onset ADHD. Our data support decreased quality of life and increased functional impairment in adult ADHD, regardless of age of onset, and these adverse outcomes may be mediated by family support and anxiety/depression at adulthood. Our findings also imply that the new DSM-5 ADHD criteria do not over-include individuals without impairment.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2015.07.026