Examining the validity of the ADHD concept in adults and older adults

Abstract

ObjectiveIt is crucial to clarify the structure of attention-deficit/hyperactivity disorder (ADHD) symptomatology in all age groups to determine how to best conceptualize this disorder across the lifespan. We tested the ADHD factor structure across adulthood and investigated independent associations with executive functions.MethodData from 645 adults aged 18–59 and 233 adults aged 60–85 were drawn from the Nathan Kline Institute Rockland Sample. Participants completed the Conners Adult ADHD Rating Scale and tests of executive functioning. Invariance of the ADHD factor structure was investigated using confirmatory factor analyses. Associations with cognition were explored using multiple linear regression.ResultsResults confirmed a bifactor model with 3 specific factors (inattention, hyperactivity, and impulsivity). Factor loadings and item intercepts were invariant across ages. Levels of hyperactivity and impulsivity were lower in older adults. Inattentive symptoms in young adults were positively related to cognitive flexibility. In older adults, ADHD symptoms predicted poorer working memory.ConclusionADHD symptoms manifest similarly across adulthood. The lack of robust associations between ADHD symptomatology and executive functions raises concerns about the usefulness of neuropsychological measures in diagnosing adult ADHD. These results support the validity of the ADHD concept in older adults but suggest a need for age-appropriate normative criteria.

ADHD and Neurodegenerative Disease Risk: A Critical Examination of the Evidence

“…Even young adults are poor historians of their childhood ADHD symptoms: nearly 40% of 22-year-old adults who do not recall their childhood symptoms actually did have ADHD as children, and roughly 60% remember symptoms that, in fact, were not present (Breda et al, 2020 ). A possible recall bias is supported by one study’s data (Walitza et al, 2007 ): healthy control participants (mean age 57.2 years) reported significantly fewer ADHD symptoms relative to the younger healthy normative sample (mean age 29.8 years: Retz-Junginger et al, 2002 ), whereas it has been established that population samples of younger and older adults should endorse similar rates of ADHD symptoms (Callahan and Plamondon, 2019 ). Self-report is also less sensitive than informant-report for detecting current and past ADHD symptoms (Zucker et al, 2002 ; Sibley et al, 2012 ).…”

A Systematic Review and Comparison of Neurocognitive Features of Late-Life Attention-Deficit/Hyperactivity Disorder and Dementia With Lewy Bodies

“…The DLB inclusion criteria followed a similar template with specific changes relevant to the DLB topic: (1) Participants must be human and 40 years of age or older; (2) A formal diagnosis of DLB must be a part of the study, using any version of the McKeith criteria 17 or adjusted criteria if studying a prodromal/mild cognitive impairment phase; (3) Studies were excluded if the sample included participants with comorbid neurodegenerative disorders (eg, DLB with comorbid Alzheimer disease); some studies reported depressive symptomatology in their DLB samples and those studies were retained; (4) Studies that included participants with Parkinson disease were excluded; (5) The study must include a clinical cognitive measure (ie, experimental measures were excluded); (6) DLB data must be reported in comparison to a control group, or report standardized scores calculated using normative data; (7) The neurocognitive measures are not used exclusively for correlational purposes or as predictors of a noncognitive outcome (eg, cognition as a predictor of survival); (8) Participants are generally considered representative of broader real-world samples (eg, samples consisting exclusively of veterans were excluded). These criteria were chosen to limit the included literature to clinically relevant findings, since the goal of the systematic review was to inform clinical decision-making.…”

“…Attention-deficit/hyperactivity disorder (ADHD) is generally considered a disorder of childhood, but there is growing recognition that symptoms can persist well into adulthood and late life. [1][2][3] Evidence suggests that behavioral (hyperactive) symptoms wane with age and give way to predominantly cognitive (inattentive) symptoms, 1,2,4,5 which may manifest as absentmindedness and forgetfulness. 6 In older adults, these symptoms can be misrecognized as signs of early dementia and contribute to misdiagnosis.…”

“…There is also reason to doubt the utility of ADHD rating scales as a supportive feature for differential diagnosis in adults. Specifically, performance on ADHD ratings scales may not perfectly align with current formal diagnostic criteria, 5 and most screening instruments have yet to be validated in cohorts of older adults. Many items on ADHD rating scales could plausibly be endorsed by individuals with earlystage DLB, including difficulty organizing tasks or difficulty focusing attention.…”

Contribution of vascular risk factors to the relationship between ADHD symptoms and cognition in adults and seniors

“…Its cognitive features (inattention, distractibility, impulsivity) tend to be associated with disruptions in executive functions (i.e., complex regulatory processes controlled in part by the frontal lobes) 3 , 4 . For example, increased ADHD symptoms in older adults, assessed as a continuous variable using the Conners Adult ADHD Rating Scale, have been linked to lower performance on tasks of working memory 5 and retrieval 6 , as well as slowed reaction time 6 . This aligns with findings of compromised frontal lobe integrity in ADHD 7 which, in older adults, may be compounded by the known deleterious effects of aging on frontal brain regions and processes 8 , 9 .…”