Assessing the Validity of the Age at Onset Criterion for Diagnosing ADHD in DSM-5.

Objective: Research about Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) age of onset criterion for ADHD led to increasing that criterion to 12 in Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Although an improvement from the previous age at onset of 7, whether this new criterion is adequate to capture all cases with ADHD remains uncertain. Method: We compared three groups of adults: (a) ADHD participants who met all DSM-5 criteria for ADHD (n = 182), (b) late-onset ADHD participants who met all criteria except for later age at onset (n = 17), and (c) non-ADHD participants who did not meet criteria for ADHD (n = 117). We assessed patterns of symptoms, psychiatric comorbidity, functional impairment, familial transmission, quality of life, social adjustment, and intelligence. Results: Compared with non-ADHD participants, all ADHD groups had poorer quality of life and had more impaired social adjustment. Compared with each other, the ADHD groups had similar patterns of psychiatric comorbidity, functional impairment, familial transmission, and intelligence. Conclusion: When assessing adult ADHD, self-reported onsets of ADHD after 12 years of age may be warranted.

Trajectories of psychiatric diagnoses and medication usage in youth with 22q11.2 deletion syndrome: a 9-year longitudinal study.

BACKGROUND: Chromosome 22q11.2 deletion syndrome (22q11DS) is associated with high rates of psychiatric disorders, including schizophrenia in up to 30% of individuals with the syndrome. Despite this, we know relatively little about trajectories and predictors of persistence of psychiatric disorders from middle childhood to early adulthood. Accordingly, we followed youth over four timepoints, every 3 years, to assess long-term trajectories of attention-deficit hyperactivity disorder (ADHD), anxiety, mood, and psychosis-spectrum disorders (PSDs), as well as medication usage. METHODS: Eighty-seven youth with 22q11DS and 65 controls between the ages of 9 and 15 years at the first timepoint (T1; mean age 11.88 ± 2.1) were followed for 9 years (mean age of 21.22 ± 2.01 years at T4). Baseline cognitive, clinical, and familial predictors of persistence were identified for each class of psychiatric disorders. RESULTS: Baseline age and parent-rated hyperactivity scores predicted ADHD persistence [area under curve (AUC) = 0.81]. The presence of family conflict predicted persistence of anxiety disorders (ADs) whereas parent ratings of child internalizing symptoms predicted persistence of both anxiety and mood disorders (MDs) (AUC = 0.84 and 0.83, respectively). Baseline prodromal symptoms predicted persistent and emergent PSDs (AUC = 0.83). Parent-reported use of anti-depressants/anxiolytics increased significantly from T1 to T4. CONCLUSIONS: Psychiatric, behavioral, and cognitive functioning during late childhood and early adolescence successfully predicted children with 22q11DS who were at highest risk for persistent psychiatric illness in young adulthood. These findings emphasize the critical importance of early assessments and interventions in youth with 22q11DS.