Category: ADHD - Adult

Symposium

What Can We Learn About Late-Onset ADHD Not Captured in Traditional Assessments? Qualitative Approach

Friday, November 17
12:00 PM - 1:30 PM
Location: Aqua Salon C & D, Level 3, Aqua Level

Keywords: ADHD - Adult | Assessment | Parenting
Presentation Type: Symposium

While ADHD is historically considered to have childhood onset, recent studies suggest a late-onset form developing in adolescence or adulthood. These cases, identified by traditional assessment techniques, putatively disconfirm childhood onset of ADHD. However, traditional assessment techniques do not typically capture contextual factors that may decrease recognition of ADHD in childhood or delay diagnosis, such as environments that accommodate distractibility or overactivity and thereby attenuate symptom severity, expression, or impairment. Methods that can identify these contextual factors are needed to assess their possible influence on, or masking of, childhood ADHD symptoms among individuals proposed to have late-onset. The primary objective of this study was an exploratory qualitative analysis of young adult and caregiver narratives about ADHD to identify contextual factors that may influence when late-onset ADHD cases were identified. Individuals from the local normative comparison group (LNCG) of the Multimodal Treatment Study of ADHD (MTA) with late-onset or suspected late-onset ADHD who completed a qualitative MTA substudy participated (n = 8). Separate narratives of young adults and their caregivers were analyzed to identify contextual factors that may have delayed or obscured early identification of childhood ADHD. Preliminary analysis indicated two general types of contextual factors: environmental and within-person. Environmental factors included non-traditional schooling placement and parental attitudes towards ADHD/ADHD treatment. For example, parental attitudes that attributed ADHD to “laziness” and pharmacological treatment as “speed” appeared to minimize parental report of ADHD in childhood. Within-person factors included symptom presentation. For example, non-disruptive inattentive behaviors elicited less concern from parents and consequently minimized concern about symptom severity at the time. The current study identifies contextual factors that may have delayed diagnosis in late-onset ADHD cases, which is important to inform if, how, and to what extent ADHD manifests in childhood among “late-onset” cases. 

John Mitchell

Assistant Professor in Psychiatry and Behavioral Sciences
Duke University Medical Center

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