Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T12:43:12.417Z Has data issue: false hasContentIssue false

Adults with attention deficit hyperactivity disorder: an investigation of age-related differences in behavioural symptoms, neuropsychological function and co-morbidity

Published online by Cambridge University Press:  28 February 2012

J. Bramham*
Affiliation:
School of Psychology, University College Dublin, Dublin, Republic of Ireland
D. G. M. Murphy
Affiliation:
King's College London, Institute of Psychiatry, London, UK
K. Xenitidis
Affiliation:
King's College London, Institute of Psychiatry, London, UK
P. Asherson
Affiliation:
King's College London, Institute of Psychiatry, London, UK
G. Hopkin
Affiliation:
King's College London, Institute of Psychiatry, London, UK
S. Young
Affiliation:
King's College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: J. Bramham, Ph.D., UCD School of Psychology, Newman Building, University College Dublin, Belfield, Dublin, Republic of Ireland. (Email: jessica.bramham@ucd.ie)

Abstract

Background

The outcomes of attention deficit hyperactivity disorder (ADHD) have been studied extensively in the first decades of life, but less is known about ADHD in adulthood. Hence we investigated cross-sectional age-related differences in behavioural symptoms, neuropsychological function and severity of co-morbid disorders within a clinically referred adult ADHD population.

Method

We subdivided 439 referrals of individuals with ADHD (aged 16–50 years) into four groups based on decade of life and matched for childhood ADHD severity. We compared the groups on measures of self- and informant-rated current behavioural ADHD symptoms, neuropsychological performance, and self-rated co-morbid mood and anxiety symptoms.

Results

There was a significant age-related reduction in the severity of all ADHD symptoms based on informant-ratings. In contrast, according to self-ratings, inattentive symptoms increased with age. Neuropsychological function improved across age groups on measures of selective attention and response inhibition. There was a mild correlation between the severity of depression symptoms and increasing age.

Conclusions

This observational study suggests that, in adulthood, ADHD symptoms as measured using informant-ratings and neuropsychological measures continue to improve with increasing age. However the subjective experience of people with ADHD is that their symptoms worsen. This dichotomy may be partially explained by the presence of co-morbid affective symptoms. The main limitation of the study is that it is cross-sectional rather than longitudinal, and the latter design would provide more conclusive evidence regarding age-related changes in an adult ADHD population.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Able, SL, Johnston, JA, Adler, LA, Swindle, RW (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine 37, 97–107.CrossRefGoogle ScholarPubMed
Barkley, RA (1998). Attention-Deficit Hyperactivity Disorder: A Clinical Workbook. Guilford Press: New York.CrossRefGoogle Scholar
Biederman, J, Faraone, SV, Monuteaux, MC, Bober, M, Cadogen, E (2004). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry 55, 692700.CrossRefGoogle Scholar
Biederman, J, Mick, E, Faraone, S (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry 157, 816818.CrossRefGoogle ScholarPubMed
Biederman, J, Newcorn, J, Sprich, S (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry 148, 564577.Google ScholarPubMed
Cairnes, E, Cammock, T (1978). Development of a more reliable version of the Matching Familiar Figures Test. Developmental Psychology 14, 555560.CrossRefGoogle Scholar
Cohen, P, Cohen, J, Brook, J (1993). An epidemiological study of disorders in late childhood and adolescence – II. Persistence of disorders. Journal of Child Psychology and Psychiatry 34, 851867.CrossRefGoogle ScholarPubMed
Conners, CK, Parker, JDA, Sitarenios, G, Epstein, JN (1998). The Revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology 26, 257268.CrossRefGoogle ScholarPubMed
Cornblatt, BA, Erlenmeyer-Kimling, L (1985). Global attentional deviance as a marker of risk for schizophrenia: specificity and predictive validity. Journal of Abnormal Psychology 94, 470486.CrossRefGoogle ScholarPubMed
Craik, FIM, Bialystok, E (2006). Cognition through the lifespan: mechanisms of change. Trends in Cognitive Sciences 10, 131138.CrossRefGoogle ScholarPubMed
Diamond, A (2002). Normal development of prefrontal cortex from birth to young adulthood: cognitive functions, anatomy and biochemistry. In Principles of Frontal Lobe Function (ed. Stuss, D. T. and Knight, R. T.), pp. 466503. Oxford University Press: London.CrossRefGoogle Scholar
Epstein, JN, Johnson, D, Conner, CK (2000). Conners' Adult ADHD Diagnostic Interview for DSM-IV. Multi-Health Systems Inc.: North Tonawanda, NH.Google Scholar
Faraone, S (2000). Attention deficit hyperactivity disorder in adults: implications for theories of diagnosis. Current Directions in Psychological Science 9, 3336.CrossRefGoogle Scholar
Faraone, S, Biederman, J, Mick, E (2006). The age dependent decline of attention-deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159165.CrossRefGoogle ScholarPubMed
Fischer, M, Barkley, RA, Fletcher, K, Smallish, L (1993). The stability of dimensions of behavior in ADHD and normal children over an 8 year period. Journal of Abnormal Child Psychology 21, 315337.CrossRefGoogle Scholar
Halperin, JM, Trampush, JW, Miller, CJ, Marks, DJ, Newcorn, JH (2008). Neuropsychological outcome in adolescents/young adults with childhood ADHD: profiles of persisters, remitters and controls. Journal of Child Psychology and Psychiatry 49, 958966.CrossRefGoogle ScholarPubMed
Hart, EL, Lahey, BB, Loeber, R, Appelgate, B, Frick, PJ (1995). Developmental change in attention-deficit hyperactivity disorder in boys: a four-year longitudinal study. Journal of Abnormal Child Psychology 23, 729749.CrossRefGoogle Scholar
Hedden, T, Lautenschlager, G, Park, DC (2005). Contributions of processing ability and knowledge to verbal memory tasks across the adult life-span. Quarterly Journal of Experimental Psychology 58, 169190.CrossRefGoogle ScholarPubMed
Hill, JC, Schoener, EP (1996). Age-dependent decline of attention deficit hyperactivity disorder. Journal of Attentional Disorders 2, 131132.Google Scholar
Hopwood, CJ, Morey, LC (2008). Emotional problems suppress disorder/performance associations in adult ADHD assessment. Journal of Psychopathology and Behavior Assessment 30, 204210.CrossRefGoogle Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.CrossRefGoogle ScholarPubMed
Koetsier, GC, Volkers, AC, Tulen, JHM, Passchier, J, van den Broek, WW, Bruijn, JA (2002). CPT performance in major depressive disorder before and after treatment with ipramine or fluvoxamine. Journal of Psychiatric Research 36, 391397.CrossRefGoogle ScholarPubMed
Mannuzza, S, Klein, RG, Moulton, JL (2003). Persistence of attention-deficit/hyperactivity disorder into adulthood: what have we learned from the prospective follow-up studies? Journal of Attentional Disorders 7, 93–100.CrossRefGoogle ScholarPubMed
Marks, DJ, Newcorn, JH, Halperin, JM (2001). Comorbidity in adults with attention-deficit/hyperactivity disorder. Annals of the New York Academy of Sciences 931, 216238.CrossRefGoogle ScholarPubMed
May, B, Bos, J (2000). Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes. Journal of Personality Assessment 75, 237248.CrossRefGoogle ScholarPubMed
McCarthy, S, Asherson, P, Coghill, D, Hollis, C, Murray, M, Potts, L, Sayal, K, de Soysa, R, Taylor, E, William, T, Wong, CK (2009). Attention-deficit hyperactivity disorder: treatment discontinuation in adolescents and young adults. British Journal of Psychiatry 194, 273277.CrossRefGoogle ScholarPubMed
McGough, JJ, Barkley, RA (2004). Diagnostic controversies in adult attention deficit hyperactivity disorder. American Journal of Psychiatry 161, 19481956.CrossRefGoogle ScholarPubMed
Ramtekkar, UP, Reiersen, AM, Todorov, AA, Todd, RD (2010). Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. Journal of the American Academy of Child and Adolescent Psychiatry 49, 217228.Google ScholarPubMed
Robertson, IH, Ward, A, Ridgeway, V, Nimmo-Smith, I (1994). Test of Everyday Attention. Thames Valley Test Company: Bury St Edmunds.Google Scholar
Salthouse, TA (1996). The processing-speed theory of adult age differences in cognition. Psychological Review 103, 403428.CrossRefGoogle ScholarPubMed
Van der Linden, G, Young, S, Ryan, P, Toone, B (2000). Attention deficit hyperactivity disorder in adults – experience of the first National Health Service clinic in the United Kingdom. Journal of Mental Health 9, 527535.CrossRefGoogle Scholar
Ward, MF, Wender, PH, Reimherr, FW (1993). The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry 150, 885890.Google ScholarPubMed
Wechsler, D (1997). Wechsler Adult Intelligence Scale, 3rd edn UK. Harcourt Assessment Inc.: San Antonio, TX.Google Scholar
Wechsler, D (1999). Wechsler Abbreviated Scale of Intelligence. Harcourt Assessment Inc.: San Antonio, TX.Google Scholar
Weissman, MM, Klerman, GL (1977). Sex differences and the epidemiology of depression. Archives of General Psychiatry 34, 98.CrossRefGoogle ScholarPubMed
West, RL (1996). An application of prefrontal cortex function theory to cognitive aging. Psychological Bulletin 120, 272292.CrossRefGoogle ScholarPubMed
Wilens, TE, Biederman, J, Faraone, SV, Martelon, M, Westerberg, D, Spencer, TJ (2009). Presenting ADHD symptoms, subtypes and comorbid disorder in clinically referred adults with ADHD. Journal of Clinical Psychiatry 70, 15571562.CrossRefGoogle ScholarPubMed
Wong, ICK, Asherson, P, Bilbow, A, Clifford, S, Coghill, D, DeSoysa, R (2009). Cessation of attention deficit hyperactivity disorder drugs in the young (CADDY) – a pharmacoepidemiological and qualitative study. Health Technology Assessment 13, 50.Google Scholar
Young, S, Gudjonsson, GH (2005). Neuropsychological correlates of the YAQ-S and YAQ-I self- and informant-reported ADHD symptomatology, emotional and social problems and delinquent behaviour. British Journal of Clinical Psychology 44, 4757.CrossRefGoogle ScholarPubMed
Young, S, Gudjonsson, GH (2008). Growing out of ADHD: the relationship between functioning and symptoms. Journal of Attentional Disorders 12, 162169.CrossRefGoogle Scholar
Young, S, Toone, B (2000). Attention deficit hyperactivity disorder in adults: clinical issues. A report from the first NHS clinic in the UK. Counselling Psychology Quarterly 13, 313319.CrossRefGoogle Scholar
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361370.CrossRefGoogle ScholarPubMed
Zuroff, DC, Colussy, SA, Wielgus, MS (1983). Selective memory and depression: a cautionary note concerning response bias. Cognitive Therapy and Research 7, 223231.CrossRefGoogle Scholar