Attention deficit hyperactivity disorder in adulthood: a controversial topic

摘要

Objective: Traditionally, attention-deficit/hyperactivity disorder (ADHD) has been considered a neurodevelopmental disorder affecting children and adolescents. However, some studies, although controversies do exist, would suggest the existence of adult-onset ADHD. In this article we reviewed the literature on adult ADHD and discussed whether or not it may be a condition with a childhood onset and persisting later on, or an independent clinical entity.Method: The systematic review was carried out according to the PRISMA guidelines through searching electronic databases of PubMed, Google Scholar, Cochrane Library, Embase, MEDLINE, PsycINFO and Scopus for English language papers published from January 1960 to May 31st, 2018. The keywords used and combined with “ADHD”or “ADHD symptoms” were “Epidemiology” or “Prevalence” or “Persistence” or “Adulthood” or “Adult-onset” or “Pathophysiology”. Only studies carried out in clinical samples of adults diagnosed with standardized ADHD criteria and structured interviews were included.Results: Literature data are extremely heterogeneous, as both rates of persistence of ADHD in adults and lateonset ADHD seem to be influenced by different factors, including methods of collecting data, recall bias, screening instruments, diagnostic thresholds, misdiagnosing, and even malingering.Conclusions: The weakness of well-defined diagnostic assessments in adults, as well as data heterogeneity do not permit to disentangle the question of the possible persistence of ADHD into adulthood; similarly, it is not unclear whether an adult-onset ADHD might exist.