View Full Version : late onset ADHD


daveddd
07-23-17, 06:38 PM
Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood.

Agnew-Blais JC1, Polanczyk GV2, Danese A3, Wertz J1, Moffitt TE4, Arseneault L1.
Author information
Abstract
IMPORTANCE:
Attention-deficit/hyperactivity disorder (ADHD) is now recognized to occur in adulthood and is associated with a range of negative outcomes. However, less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence, and the possibility of its emergence in young adulthood in nonclinical populations.
OBJECTIVE:
To investigate childhood risk factors and young adult functioning of individuals with persistent, remitted, and late-onset young adult ADHD.
DESIGN, SETTING, AND PARTICIPANTS:
The study sample was the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins born in England and Wales from January 1, 1994, to December 4, 1995. Evaluation of childhood ADHD (ages 5, 7, 10, and 12 years) included prenatal and perinatal factors, clinical characteristics, and aspects of the family environment. Among participants aged 18 years, ADHD symptoms and associated impairment, overall functioning, and other mental health disorders were examined. Data analysis was conducted from February 19 to September 10, 2015.
MAIN OUTCOMES AND MEASURES:
Attention-deficit/hyperactivity disorder according to DSM-IV diagnostic criteria in childhood and DSM-5 diagnostic criteria in young adulthood.
RESULTS:
Of 2232 participants in the E-Risk Study, 2040 were included in the present analysis. In total, 247 individuals met diagnostic criteria for childhood ADHD; of these, 54 (21.9%) also met diagnostic criteria for the disorder at age 18 years. Persistence was associated with more symptoms (odds ratio [OR], 1.11 [95% CI, 1.04-1.19]) and lower IQ (OR, 0.98 [95% CI, 0.95-1.00]). At age 18 years, individuals with persistent ADHD had more functional impairment (school/work: OR, 3.30 [95% CI, 2.18-5.00], home/with friends: OR, 6.26 [95% CI, 3.07-12.76]), generalized anxiety disorder (OR, 5.19 [95% CI, 2.01-13.38]), conduct disorder (OR, 2.03 [95% CI, 1.03-3.99]), and marijuana dependence (OR, 2.88 [95% CI, 1.07-7.71]) compared with those whose ADHD remitted. Among 166 individuals with adult ADHD, 112 (67.5%) did not meet criteria for ADHD at any assessment in childhood. Results from logistic regressions indicated that individuals with late-onset ADHD showed fewer externalizing problems (OR, 0.93 [95% CI, 0.91-0.96]) and higher IQ (OR, 1.04 [95% CI, 1.02-1.07]) in childhood compared with the persistent group. However, at age 18 years, those with late-onset ADHD demonstrated comparable ADHD symptoms and impairment as well as similarly elevated rates of mental health disorders.
CONCLUSIONS AND RELEVANCE:
We identified heterogeneity in the DSM-5 young adult ADHD population such that this group consisted of a large, late-onset ADHD group with no childhood diagnosis, and a smaller group with persistent ADHD. The extent to which childhood-onset and late-onset adult ADHD may reflect different causes has implications for genetic studies and treatment of ADHD.

https://www.ncbi.nlm.nih.gov/pubmed/27192174

Identifying Early Markers of "Late Onset" Attention Deficit and Hyperactivity/Impulsivity Symptoms.

Murray AL1,2, Eisner M1, Obsuth I1, Ribeaud D3.
Author information
Abstract
OBJECTIVE:
In recent years, there has been an increased focus on "late onset" ADHD, referring to the onset of symptoms beyond childhood, into adolescence and adulthood. We aimed to identify childhood predictors of ADHD symptom increases over development.
METHOD:
We used growth mixture modeling to evaluate predictors of a "late onset" symptom trajectories in a longitudinal cohort study of youth measured at eight points from ages 7 to 15.
RESULTS:
Individuals with high levels of sensation seeking at age 7 were more likely to show a trajectory of ADHD symptoms characterized by increasing levels from age 7 than persistently low symptom levels.
CONCLUSION:
The late versus early onset distinction may align with the distinction between deficits in "bottom-up" versus "top-down" processes previously discussed in relation to ADHD. Results also raise the possibility that later onset symptoms could be predicted based on characteristics in childhood.
KEYWORDS:
ADHD; age of onset; growth mixture modeling; sensation seeki

https://www.ncbi.nlm.nih.gov/pubmed/28440106


looks like later onset ADHD is becoming accepted

i view this as a positive , people with this late onset will no longer have to be judged , invalidated or confused by the subjective ever changing DSM

Fuzzy12
07-24-17, 05:17 AM
Fascinating! ! :eek:

If there are childhood predictors then doesn't that mean it's still a developmental disorder just that the systems only become obvious in adulthood?

Does anyone know what they mean by high levels of sensation seeking?

Also I keep forgetting what top down amd bottom up processes are...

sarahsweets
07-24-17, 07:16 AM
I tried to read your post and admittedly it was hard for me. Do you mean that adhd can occur in someone in adulthood but not until then? I always thought it had to be during childhood and the level of impairments got worse and worse into adulthood depending on the coping skills learned and as adulthood became more and more unmanageable. Dont you think the natural progression makes sense rather than the sudden onset of symptoms as an adult? On the surface it would seem that sudden onset would be more from other mental health issues then adhd, or that the responsibilities on adulthood can make adulthood in general tough. I am not saying its impossible yet because I agree more research should be done. Maybe I need to get over my preconceived notions of childhood being the requirement? or maybe I need to move beyond the DSM criteria?

mildadhd
07-24-17, 10:01 AM
How could someone develop age appropriate neocortical self regulation, then become underdeveloped?

This does not make sense.



M

Little Missy
07-24-17, 10:33 AM
I'm thinking, you never know, I could be incorrect, but a lot of people kind of skate on through life and then without any plan B back ups in place later on in life when things do not go well, it could be labeled late onset ADHD and most certainly by then it would be definitely time for treatment.

mildadhd
07-24-17, 10:33 AM
I think this is really sad.

We should be learning and educating how neocortical self-regulation develops in the first few years of life.


M

Little Missy
07-24-17, 10:35 AM
How could someone develop age appropriate neocortical self regulation, then become underdeveloped?

This does not make sense.



M

They don't. It was never there to begin with.

finallyfound10
07-24-17, 10:36 AM
I want to read this more closely as it looks very, very interesting. Thanks!

mildadhd
07-24-17, 10:42 AM
They don't. It was never there to begin with.

If they have impaired neocortical self regulation from early childhood.

Then there is no such thing as late on set ADHD.

Only late diagnosis.



M

Little Missy
07-24-17, 10:47 AM
If they have impaired neocortical self regulation from early childhood.

Then there is no such thing as late on set ADHD.

Only late diagnosis.



M

This is kind of what I believe.

mildadhd
07-24-17, 11:01 AM
There are top down commorbities due living with ADHD throughout life.

But neocortical self-regulation develops from the bottom up, first.


M

Unmanagable
07-24-17, 11:05 AM
Those darn E-Risks keep tripping stuff up, ay?

Just when you think something you discover is an exact science, we learn just how exact science isn't.

aeon
07-24-17, 11:11 AM
Does anyone know what they mean by high levels of sensation seeking?

Behaviors that are colloquially described as being a “stimulation junkie.”


Cheers,
Ian

aeon
07-24-17, 11:13 AM
I tried to read your post and admittedly it was hard for me. Do you mean that adhd can occur in someone in adulthood but not until then? I always thought it had to be during childhood and the level of impairments got worse and worse into adulthood depending on the coping skills learned and as adulthood became more and more unmanageable. Dont you think the natural progression makes sense rather than the sudden onset of symptoms as an adult? On the surface it would seem that sudden onset would be more from other mental health issues then adhd, or that the responsibilities on adulthood can make adulthood in general tough. I am not saying its impossible yet because I agree more research should be done. Maybe I need to get over my preconceived notions of childhood being the requirement? or maybe I need to move beyond the DSM criteria?

Currently the DSM specifies childhood onset.

That said, the DSM does not define the real world...it only attempts to describe and categorize it.


Cheers,
Ian

aeon
07-24-17, 11:14 AM
How could someone develop age appropriate neocortical self regulation, then become underdeveloped?

This does not make sense.

Only if you want to force the world to fit a model, which is a fool’s errand.

There are a multitude of ways, perhaps too many to list.


Cheers,
Ian

stef
07-24-17, 11:16 AM
I'm thinking, you never know, I could be incorrect, but a lot of people kind of skate on through life and then without any plan B back ups in place later on in life when things do not go well, it could be labeled late onset ADHD and most certainly by then it would be definitely time for treatment.

I don't have time to read the article, but this seems totally plausible.

aeon
07-24-17, 11:18 AM
I think this is really sad.

We should be learning and educating how neocortical self-regulation develops in the first few years of life.

Why is new information, and the associated widening of perspective such that we have a better perceptual understanding of the world we live in, sad?

I agree with your second statement, but I’m not one to say what others should or should not do.


Cheers,
Ian

daveddd
07-24-17, 12:12 PM
This was just a couple of articles of many

I think this is more than just skating by and missing it

I'd hope the pros would control for that

daveddd
07-24-17, 12:13 PM
Currently the DSM specifies childhood onset.

That said, the DSM does not define the real world...it only attempts to describe and categorize it.


Cheers,
Ian

Yes this

It tries its best at times You would hope

I've also read accounts of lazy dsm criteria that isn't agreed upon by many

daveddd
07-24-17, 12:16 PM
I tried to read your post and admittedly it was hard for me. Do you mean that adhd can occur in someone in adulthood but not until then? I always thought it had to be during childhood and the level of impairments got worse and worse into adulthood depending on the coping skills learned and as adulthood became more and more unmanageable. Dont you think the natural progression makes sense rather than the sudden onset of symptoms as an adult? On the surface it would seem that sudden onset would be more from other mental health issues then adhd, or that the responsibilities on adulthood can make adulthood in general tough. I am not saying its impossible yet because I agree more research should be done. Maybe I need to get over my preconceived notions of childhood being the requirement? or maybe I need to move beyond the DSM criteria?

It may not hurt to drop all preconceived notions about dsm illness

They seem to change at a rapid clip.

daveddd
07-24-17, 12:27 PM
It may not hurt to drop all preconceived notions about dsm illness

They seem to change at a rapid clip.

I don't mean you Sarah. Just in general

I feel preconceived notions stop a lot of meaningful discourse in mental health leaving us in the poor state of understanding we're in

Little Missy
07-24-17, 12:37 PM
This was just a couple of articles of many

I think this is more than just skating by and missing it

I'd hope the pros would control for that

I skimmed it and just blew out an answer. oops.

namazu
07-24-17, 02:09 PM
Moderator note:

The topic of this thread is late-onset ADHD, as discussed in the two abstracts posted by daveddd.

If your post does not directly address this topic, or if you wish to discuss early-onset ADHD without reference to the possibility of adult-onset ADHD described in the abstracts, please start a new thread elsewhere.

Please remember that the scientific discussion section is intended for more formal scientific discussion, based on scientific literature. Off-topic posts may be removed.

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*Treat your fellow members with courtesy (especially if you disagree with them).

namazu
07-24-17, 04:45 PM
For those wondering how a developmental disorder could possibly have a late onset, I've sketched out a diagram to help people visualize one way this could occur:
http://oi63.tinypic.com/2ylo0wi.jpg
Explanation: On the x-axis is age (person gets older as you go from left to right). On the y-axis is self-regulation or executive function (as you go from the bottom to the top, the person has better ability to self-regulate, or better executive functions).

Here I've sketched out 3 example trajectories (pathways):

In blue is what we might think of as average.

In red is what we most commonly have thought of as early-onset ADHD -- self-regulation or executive function are delayed from birth onward, and the person never really catches up. [One study that will be looking at developmental brain trajectories in ADHD (early-onset, according to current DSM criteria) is described here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4787204/); will be interesting to see what they find.]

In purple is a possible trajectory for someone with late-onset ADHD. They start out developing in line with the average, but as they hit puberty (or perhaps early adulthood), their executive function development slows down/levels off, such that by mid-adulthood, they're as far behind average as someone with early-onset ADHD, and likely have impairments to match.

(For an easy-to-relate-to example, imagine a kid who's average height (or even a bit tall) for their age, hits puberty early, and stops growing. Even though they started out average height as a kid, they may eventually be passed by kids who hit puberty later or keep growing. As an adult, they may end up considerably shorter than average due to their particular growth trajectory.)

Now, in sketching this out, I've made a number of assumptions about how development occurs, and I'm sure some of them are inaccurate. For example, there may be some "growth spurts" in self-regulation ability or executive function at puberty or in early adulthood, but I've assumed here that most of the development occurs in early childhood and things start to level off. These lines shouldn't be considered "to scale"; this is just a conceptual sketch. And I haven't defined executive function or self-regulation, which is another area of active research.

I'm also assuming that whatever processes contribute to ADHD occur by the time maximum adult executive function ability is reached, which for most people is around mid-20s, I think. If there are people whose ADHD onset is later than that, then either this is a faulty assumption, or we might be looking at a degenerative process or brain injury of some kind.

Looking at this chart, one could also imagine a person with early-onset ADHD who actually grows out of it...instead of continuing to lag behind, they may have a "growth spurt" or acceleration in self-regulation ability around puberty or early adulthood such that they actually catch up to the average. This isn't the most common thing that happens, but it's also been reported in the literature [for example, here (https://www.ncbi.nlm.nih.gov/pubmed/28414486)].

It's also important to recognize that while I've drawn these 3 paths as individual lines, ADHD isn't strictly a "yes/no" condition, even if our current diagnostic procedures make it seem binary. ADHD is often described as the extreme end of certain traits that shade into normal, so you could imagine a lot of people whose trajectories fit in between the lines I've drawn, with plenty of variations.

daveddd
07-24-17, 04:59 PM
I skimmed it and just blew out an answer. oops.

no, that's a perfectly reasonable response

it almost hints that that can play a role in a way

It's key to remembering (which for me is difficult) this wouldnt be like acquiring a blood born pathogen early adulthood

Its crossing a threshold of human traits

Fuzzy12
07-24-17, 06:13 PM
Namazu you are a genius. Thanks for that brilliant graph and explanation. :eek::)

Fuzzy12
07-24-17, 06:20 PM
Dave have you read the full article? It says in the conclusion of the second abstract that childhood characteristics could be used to predict adhd could be used as predictors for adhd. Apart from sensation seeking what are these characteristics?

mildadhd
07-24-17, 06:24 PM
Conclusion

The late versus early onset distinction may align with the distinction between deficits in "bottom-up" versus "top-down" processes previously discussed in relation to ADHD. Results also raise the possibility that later onset symptoms could be predicted based on characteristics in childhood.

Early onset and late onset are different stages of development in the same person with ADHD.

Early onset is being equated with bottom up development.
(Critical period of bottom up implicit self regulation is before the age of 4*)

Late onset is being equated with top down development.
(Critical period of top down explicit development is after the age of 4*)


M

namazu
07-24-17, 06:37 PM
Early onset and late onset are different stages of development in the same person with ADHD.

Early onset is being equated with bottom up development.
(Critical period of bottom up implicit self regulation is before the age of 4*)

Late onset is being equated with top down development.
(Critical period of top down explicit development is after the age of 4*)
These stages of development are relevant to all people, but maybe there are differences between people in where developmental processes can get bogged down.

It seems possible that people with early-onset ADHD are delayed in their early (or bottom-up, implicit?) self-regulation from early childhood (before the age of 4?), while people with late-onset ADHD do not fall behind until later (perhaps related to specific delays in top-down explicit development?).

That could help explain why in some people, (relative) problems with self-regulation or executive function do not show up until later.

However, as Fuzzy12 pointed out, at least one of the studies found some earlier predictors of late-onset ADHD. That suggests that there could be subtle differences early on that simply don't become clinically notable or significantly impairing until puberty, adolescence, or adulthood. Incidentally, the second study in the OP was looking at kids from ages 7-15, which is "late-onset" according to DSM-IV and earlier criteria, but with DSM-5, the criteria only require symptoms by age 12, so some of the cases the researchers in the second study were classifying as "late-onset" may not be all that "late".

daveddd
07-24-17, 07:05 PM
These stages of development are relevant to all people, but maybe there are differences between people in where developmental processes can get bogged down.

It seems possible that people with early-onset ADHD are delayed in their early (or bottom-up, implicit?) self-regulation from early childhood (before the age of 4?), while people with late-onset ADHD do not fall behind until later (perhaps related to specific delays in top-down explicit development?).

That could help explain why in some people, (relative) problems with self-regulation or executive function do not show up until later.

However, as Fuzzy12 pointed out, at least one of the studies found some earlier predictors of late-onset ADHD. That suggests that there could be subtle differences early on that simply don't become clinically notable or significantly impairing until puberty, adolescence, or adulthood. Incidentally, the second study in the OP was looking at kids from ages 7-15, which is "late-onset" according to DSM-IV and earlier criteria, but with DSM-5, the criteria only require symptoms by age 12, so some of the cases the researchers in the second study were classifying as "late-onset" may not be all that "late".

yea i just picked a couple studies for something to look at after studying the topic awhile

none are too great yet
Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome.

Caye A1, Rocha TB1, Anselmi L2, Murray J3, Menezes AM2, Barros FC2, Gonçalves H2, Wehrmeister F2, Jensen CM4, Steinhausen HC5, Swanson JM6, Kieling C1, Rohde LA7.
Author information
Abstract
IMPORTANCE:
The requirement of a childhood onset has always been a key criterion for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults, but recently this requirement has become surrounded by controversy.
OBJECTIVE:
To investigate whether impaired young adults with ADHD symptoms always have a childhood-onset disorder in a population-based longitudinal study.
DESIGN, SETTING, AND PARTICIPANTS:
Participants belonged to the 1993 Pelotas Birth Cohort Study, including 5249 individuals born in Pelotas, Brazil, in 1993. They were followed up to 18 to 19 years of age, with 81.3% retention. The data analysis was performed between August 8, 2015, and February 5, 2016.
MAIN OUTCOMES AND MEASURES:
The ADHD status was first ascertained at 11 years of age using a screening instrument (hyperactivity subscale of the Strength and Difficulties Questionnaire) calibrated for a DSM-IV ADHD diagnosis based on clinical interviews with parents using the Development and Well-Being Assessment. At 18 to 19 years of age, ADHD diagnosis was derived using DSM-5 criteria, except age at onset. We estimated the overlap between these groups assessed at 11 and 18 to 19 years of age and the rates of markers of impairment in these 2 groups compared with those without ADHD.
RESULTS:
At 11 years of age, childhood ADHD (C-ADHD) was present in 393 individuals (8.9%). At 18 to 19 years of age, 492 individuals (12.2%) fulfilled all DSM-5 criteria for young adult ADHD (YA-ADHD), except age at onset. After comorbidities were excluded, the prevalence of YA-ADHD without comorbidities decreased to 256 individuals (6.3%). Children with C-ADHD had a male preponderance not observed among children without ADHD (251 [63.9%] vs 1930 [47.9%] male, P < .001), whereas the YA-ADHD group had a female preponderance (192 [39.0%] vs 1786 [50.4%] male, P < .001). Both groups had increased levels of impairment in adulthood, as measured by traffic incidents, criminal behavior, incarceration, suicide attempts, and comorbidities. However, only 60 children (17.2%) with ADHD continued to have ADHD as young adults, and only 60 young adults (12.6%) with ADHD had the disorder in childhood.
CONCLUSIONS AND RELEVANCE:
The findings of this study do not support the assumption that adulthood ADHD is necessarily a continuation of childhood ADHD. Rather, they suggest the existence of 2 syndromes that have distinct developmental trajectories.

mildadhd
07-25-17, 12:12 PM
Namazu

There could be some individual reasons why some people's ADHD is not as noticeable til later later in life, like a great support system at home during the early years, no support, less severe ADHD, etc.

But I do not think there are two different conditions.

Both having roots in bottom up development. (And both may have top down commoribities)

Let's consider some developmental facts that your chart does not represent.

-everyone (AD(H)D or not) has both bottom up and top down trajectories.

-rapid rate and greater amount of development of early implicit development over a shorter period of time before the age of 4, verses, slower rate and lesser amount of development of explicit development over a longer period of time, between the ages of 4 and 21 (Comparing critical periods of implicit and explicit development)

-early environmental influences are most influential during the early years of life (environmental influences decline dramatically after the age of 7)

-nobody is born with neocortical self regulation (self-regulation develops after birth) (ADHD emerges after birth in the first few years of life)






M

namazu
08-08-17, 06:57 PM
Here's a recently-published paper (https://www.ncbi.nlm.nih.gov/pubmed/28780281?dopt=Abstract) whose abstract suggests a low prevalence of adult-onset ADHD:
Recent population-based longitudinal studies concluded that most adults with attention deficit/hyperactivity disorder (ADHD) symptoms would not have a childhood history of ADHD, leading to the concept of adult-onset ADHD. In a large, well-characterized clinical population of 446 adults with a primary complaint of ADHD, we reported a low frequency of adult-onset ADHD (6.9%), being a primary isolated condition in 2.8%. They had less severe symptoms and tendencies for higher hypersomnolence disorder comorbidity than patients with typical childhood-onset ADHD. Our findings reinforce the requirement to exclude other disorders that might overlap with ADHD or mimic ADHD symptoms in adulthood onset patients.

I haven't dug up the full text yet, so can't comment in full, but my thoughts based on the abstract and other stuff that's been rolling around in my head:

1. They studied a "Well-characterized population with primary complaint of ADHD". That may exclude some who were not diagnosed precisely because they lacked a history of childhood symptoms, which would bias their sample. Need to read paper to understand how they selected this population.

2. In trying to understand whether there is a distinct (or not-so-distinct?) late-onset form of ADHD, it's necessary to distinguish between people who may have had notable symptoms in childhood that went unrecognized or undocumented or didn't yet lead to marked impairment, vs. people who genuinely didn't have notable symptoms until later in life.

3. Case definitions evolve. Deciding what constitutes a distinct disorder is tricky (and sometimes arbitrary); we're trying to label and categorize human traits, which vary widely, come in different combinations, and usually don't confine themselves into neat, discrete bins. Making a diagnosis very broad can make it harder to figure out causes if we're lumping people together who may not have a lot in common. It also makes it harder to defend against those who would use its "squishiness" to argue that the diagnosis/label doesn't represent something real in nature (and there's some truth to that). On the other hand, defining a disorder very narrowly may mean that people with real concerns get cast by the wayside. And it can actually hurt efforts to understand the condition(s) in question if we exclude relevant information simply because it doesn't conform to our previous understanding.

ginniebean
08-08-17, 07:49 PM
If they have impaired neocortical self regulation from early childhood.

Then there is no such thing as late on set ADHD.

Only late diagnosis.



M

That is the curious thing about this article. My guess is until a legit biomarker for ADHD is found we can't know.

It has been postulated that life and especially work life has become so demanding it may be overwhelming the executive functions of those well within the standard deviation for disorder. Darned if I know. :scratch:

mildadhd
08-10-17, 02:59 PM
People with deficits of self-regulation have always had slightly underdeveloped self-regulation.

(We do not develop the skills, then loose those skills)

How could a child develop self-regulation, then loose that self-regulation in adulthood?

It is possible that something interferes with self-regulation in adulthood, but it is not ADHD.




M

daveddd
08-14-17, 07:44 PM
Here's a recently-published paper (https://www.ncbi.nlm.nih.gov/pubmed/28780281?dopt=Abstract) whose abstract suggests a low prevalence of adult-onset ADHD:


I haven't dug up the full text yet, so can't comment in full, but my thoughts based on the abstract and other stuff that's been rolling around in my head:

1. They studied a "Well-characterized population with primary complaint of ADHD". That may exclude some who were not diagnosed precisely because they lacked a history of childhood symptoms, which would bias their sample. Need to read paper to understand how they selected this population.

2. In trying to understand whether there is a distinct (or not-so-distinct?) late-onset form of ADHD, it's necessary to distinguish between people who may have had notable symptoms in childhood that went unrecognized or undocumented or didn't yet lead to marked impairment, vs. people who genuinely didn't have notable symptoms until later in life.

3. Case definitions evolve. Deciding what constitutes a distinct disorder is tricky (and sometimes arbitrary); we're trying to label and categorize human traits, which vary widely, come in different combinations, and usually don't confine themselves into neat, discrete bins. Making a diagnosis very broad can make it harder to figure out causes if we're lumping people together who may not have a lot in common. It also makes it harder to defend against those who would use its "squishiness" to argue that the diagnosis/label doesn't represent something real in nature (and there's some truth to that). On the other hand, defining a disorder very narrowly may mean that people with real concerns get cast by the wayside. And it can actually hurt efforts to understand the condition(s) in question if we exclude relevant information simply because it doesn't conform to our previous understanding.

posting the thread, i thought maybe it would just be enough to not immediately invalidate new posters who come here and experience symptoms later on

labels represent very thoroughly studied groups of symptoms , sometimes we can make them far more concrete than they actually are

daveddd
08-14-17, 07:45 PM
People with deficits of self-regulation have always had slightly underdeveloped self-regulation.

(We do not develop the skills, then loose those skills)

How could a child develop self-regulation, then loose that self-regulation in adulthood?

It is possible that something interferes with self-regulation in adulthood, but it is not ADHD.




M

if it meets the symptoms of ADHD it's ADHD. (russell barkley )

daveddd
08-14-17, 08:06 PM
https://books.google.com/books?id=AeIdAAAAQBAJ&pg=PA78&dq=thomas+brown+late+onset+adhd&hl=en&sa=X&ved=0ahUKEwjqoc3_99fVAhVHTCYKHQW0A4UQ6AEIKDAA#v=on epage&q=thomas%20brown%20late%20onset%20adhd&f=false

not a study, but a page from thomas brown

i think i personally had signs since a baby

mildadhd
08-14-17, 09:12 PM
if it meets the symptoms of ADHD it's ADHD. (russell barkley )

Are you sure?

AD(H)D is a delay in early neurodevelopment.

People who have prefrontal traumatic brain injury, have symptoms of AD(H)D.

But not all people who have AD(H)D, had traumatic brain injury.

Two different causes.





M

daveddd
08-14-17, 09:21 PM
Are you sure?

AD(H)D is a delay in early neurodevelopment.

People who have prefrontal traumatic brain injury, have symptoms of AD(H)D.

But not all people who have AD(H)D, had traumatic brain injury.

Two different causes.





M

adhd is a group of symptoms without any known cause

mildadhd
08-14-17, 09:35 PM
adhd is a group of symptoms without any known cause

There are obviously to different causes in this case.

I do not think prefrontal traumatic brain injury is AD(H)D.

AD(H)D is a delay in early neurodevelopment.

The only possible exception I can think of is if the traumatic brain injury occurred during early development.







M

Lunacie
08-14-17, 09:45 PM
People with deficits of self-regulation have always had slightly underdeveloped self-regulation.

(We do not develop the skills, then loose those skills)

How could a child develop self-regulation, then loose that self-regulation in adulthood?

It is possible that something interferes with self-regulation in adulthood, but it is not ADHD.




M

I think it's possible to develop enough skills to get by with parental support
in a situation that isn't really difficult for the person.

Then after graduating from high school either going to a bigger more difficult
school or a demanding job without that parental support to fall back on ...
and realize the symptoms of adhd had been lurking in the shadows all along.

mildadhd
08-14-17, 10:03 PM
I think it's possible to develop enough skills to get by with parental support
in a situation that isn't really difficult for the person.

Then after graduating from high school either going to a bigger more difficult
school or a demanding job without that parental support to fall back on ...
and realize the symptoms of adhd had been lurking in the shadows all along.

I agree.

My early onset of AD(H)D, was not diagnosed until later in my life at age 35, when injured my back.

Early onset-late diagnosis of AD(H)D.


M

namazu
08-14-17, 10:18 PM
Early onset-late diagnosis of AD(H)D.
I think this is pretty common. There are plenty of people on ADDF who had a similar experience.

It is also plausible that some people's development took a somewhat different path, and that they hit "traffic jams" later on in their development (ages 7-12 or even later) that resulted in ADHD-like symptoms and impairments.

In refrence to your earlier comment:
Let's consider some developmental facts that your chart does not represent.
-everyone (AD(H)D or not) has both bottom up and top down trajectories.
-rapid rate and greater amount of development of early implicit development over a shorter period of time before the age of 4, verses, slower rate and lesser amount of development of explicit development over a longer period of time, between the ages of 4 and 21 (Comparing critical periods of implicit and explicit development)
-early environmental influences are most influential during the early years of life (environmental influences decline dramatically after the age of 7)
-nobody is born with neocortical self regulation (self-regulation develops after birth) (ADHD emerges after birth in the first few years of life)
The chart does explicitly show the rapid rate of development early on, slowing with age -- that's why the curve starts out steep and then levels off.
It also does explicitly acknowledge the fact that nobody is born with self-regulation -- that's why the curves all start at zero.
You're right that the chart does not show early environmental influences, because the chart was an attempt to illustrate "what", not "why".
Similarly, I did not separate out bottom-up and top-down development. It was the overall development of self-regulation that I was trying to show.
I'd be happy to explain further privately if you want to discuss it.
My point was simply that development of self-control is a lifelong, dynamic process. Different people develop at different rates, and may encounter problems at different stages, leading to different pathways to ADHD symptoms.

daveddd
08-14-17, 10:25 PM
I think this is pretty common. There are plenty of people on ADDF who had a similar experience.

It is also plausible that some people's development took a somewhat different path, and that they hit "traffic jams" later on in their development (ages 7-12 or even later) that resulted in ADHD-like symptoms and impairments.

the former happened to me, looking back it's befuddling

I literally have report cards from first grade with the teacher commenting "david works well below his potential " "is constantly distracted " "often staring out windows or into space"

real. actually comments, nothing done about it

aeon
08-15-17, 09:40 AM
I do not think prefrontal traumatic brain injury is AD(H)D.

AD(H)D is a delay in early neurodevelopment.

There are guesses and ideas and hypotheses as to what causes ADHD.

That said, the definition of ADHD doesn’t concern itself with causes, so much as it does presentation of disability across life domains.

As a result, if a person meets the criteria for ADHD, as part of a differential diagnosis that rules out other conditions, they have ADHD, regardless of the suspected and imagined causes.


Cheers,
Ian

sarahsweets
08-15-17, 01:48 PM
I think alot of people confuse late diagnosis with late onset. Personally I dont believe in late onset adhd. I do believe in late diagnosis, underdiagnosis and wrong diagnosis.

mildadhd
08-15-17, 02:45 PM
I think this is pretty common. There are plenty of people on ADDF who had a similar experience.

It is also plausible that some people's development took a somewhat different path, and that they hit "traffic jams" later on in their development (ages 7-12 or even later) that resulted in ADHD-like symptoms and impairments.

In refrence to your earlier comment:

The chart does explicitly show the rapid rate of development early on, slowing with age -- that's why the curve starts out steep and then levels off.
It also does explicitly acknowledge the fact that nobody is born with self-regulation -- that's why the curves all start at zero.
You're right that the chart does not show early environmental influences, because the chart was an attempt to illustrate "what", not "why".
Similarly, I did not separate out bottom-up and top-down development. It was the overall development of self-regulation that I was trying to show.
I'd be happy to explain further privately if you want to discuss it.
My point was simply that development of self-control is a lifelong, dynamic process. Different people develop at different rates, and may encounter problems at different stages, leading to different pathways to ADHD symptoms.

Early onset of AD(H)D is before the age of 4-7, right?

The peak period of implicit self-regulation is age 1.

The brain develops from the bottom up.

90 % of the brain develops before the age of 3.

Your chart does not include the dramatic peak and decline in implicit development occurring during the period of early onset of AD(H)D before birth and the age of 4, that the explicit executive functions are built upon.

Explicit functions are built upon implicit functions.

We must include implicit development, because there would be no explicit executive development if there is no implicit executive functions.

We need to understand early onset AD(H)D before we can explore the idea of late onset AD(H)D.

If we do, we will understand what I am trying to express.

Because that is the natural order our self-regulation develops.











M

mildadhd
08-16-17, 01:32 PM
For those wondering how a developmental disorder could possibly have a late onset, I've sketched out a diagram to help people visualize one way this could occur:
http://oi63.tinypic.com/2ylo0wi.jpg
Explanation: On the x-axis is age (person gets older as you go from left to right). On the y-axis is self-regulation or executive function (as you go from the bottom to the top, the person has better ability to self-regulate, or better executive functions).

Here I've sketched out 3 example trajectories (pathways):

In blue is what we might think of as average.

In red is what we most commonly have thought of as early-onset ADHD -- self-regulation or executive function are delayed from birth onward, and the person never really catches up. [One study that will be looking at developmental brain trajectories in ADHD (early-onset, according to current DSM criteria) is described here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4787204/); will be interesting to see what they find.]

In purple is a possible trajectory for someone with late-onset ADHD. They start out developing in line with the average, but as they hit puberty (or perhaps early adulthood), their executive function development slows down/levels off, such that by mid-adulthood, they're as far behind average as someone with early-onset ADHD, and likely have impairments to match.

(For an easy-to-relate-to example, imagine a kid who's average height (or even a bit tall) for their age, hits puberty early, and stops growing. Even though they started out average height as a kid, they may eventually be passed by kids who hit puberty later or keep growing. As an adult, they may end up considerably shorter than average due to their particular growth trajectory.)

Now, in sketching this out, I've made a number of assumptions about how development occurs, and I'm sure some of them are inaccurate. For example, there may be some "growth spurts" in self-regulation ability or executive function at puberty or in early adulthood, but I've assumed here that most of the development occurs in early childhood and things start to level off. These lines shouldn't be considered "to scale"; this is just a conceptual sketch. And I haven't defined executive function or self-regulation, which is another area of active research.

I'm also assuming that whatever processes contribute to ADHD occur by the time maximum adult executive function ability is reached, which for most people is around mid-20s, I think. If there are people whose ADHD onset is later than that, then either this is a faulty assumption, or we might be looking at a degenerative process or brain injury of some kind.

Looking at this chart, one could also imagine a person with early-onset ADHD who actually grows out of it...instead of continuing to lag behind, they may have a "growth spurt" or acceleration in self-regulation ability around puberty or early adulthood such that they actually catch up to the average. This isn't the most common thing that happens, but it's also been reported in the literature [for example, here (https://www.ncbi.nlm.nih.gov/pubmed/28414486)].

It's also important to recognize that while I've drawn these 3 paths as individual lines, ADHD isn't strictly a "yes/no" condition, even if our current diagnostic procedures make it seem binary. ADHD is often described as the extreme end of certain traits that shade into normal, so you could imagine a lot of people whose trajectories fit in between the lines I've drawn, with plenty of variations.

The rate of development during the early implicit development is so much more than it is at age 15.

There is a dramatic decline in the rate of development of self regulation, by the age of 4.

This makes growing out of AD(H)D much less likely after the age of 4-7.


I am guessing it would take 30 times longer to experience the same amount of development at age 15.

There is lots of mimicking medical conditions that could occur in our late teens/early adulthood.

But not the early neurobiological deficits of self-regulation called AD(H)D we all have.


https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcTQLtwPTEtSj1m2IkirH80HrVkBtTXS-v1mK5XhSRbe-NT8lS0m

daveddd
08-16-17, 03:46 PM
lot of strong opinions of what adhd actually is and isnt here

strong opinions are fine, but the science of the issue is what matters

and that says heterogenous , no known cause as of yet

one possibility is a predisposed person may not have the level of stress it takes to activate adhd until later

stress can very much permanently affect the parasympathetic regulatory system at any age

not everything is psychodynamic
the fact thomas brown uses research , has an ADHD clinic that has seen thousands of patients, thinks it may be possibility makes me believe it as a possibility

Lunacie
08-16-17, 04:52 PM
Yes, there is an amazing amount of growth in the first few years, but there is
also an important growth event around puberty. Both are important.

Most of the structure of the brain is formed in the early years, but changes in
the structure happen later in childhood, including the prefrontal cortex.

The prefrontal cortex is like the CEO of our brain, it controls planning,
working memory, organization, and modulates mood.

As this area develops the teenager can reason better, develop more control
over impulses and make better judgments.

If there is a problem during this period of development, the abilities affected
are those that are most related to adhd.

For more info on this, check out
www .pbs .org / wgbh / pages / frontline / shows /teenbrain / work / adolescent.html

mildadhd
08-16-17, 11:22 PM
i think important growth is always occurring.

There are different stages of development.

Biologically anyone who has AD(H)D, has had AD(H)D, since before the age of 4-7.

A child does not develop age related self-regulation, then lose it, between 7-18.

We never had it.



M

mildadhd
08-16-17, 11:25 PM
Maybe late onset AD(H)D is really SCT? I do not know?

I think I read age 15 is the peak period of explicit cognitive development?

AD(H)D involves both implicit affective development and explicit cognitive development.














M

namazu
08-17-17, 02:31 AM
A child does not develop age related self-regulation, then lose it, between 7-18.
No, they generally don't.

I don't think anyone is suggesting that.

The idea is that some people may develop early self-regulation normally (or close to normally) through early childhood, during the early critical periods of development, but then fail to keep pace with other people in adolescence and adulthood.

People in that situation wouldn't be losing what they'd developed already. They'd just not continue to develop at the same pace as other people through late childhood, adolescence, and adulthood. As a result, they fall behind to the point where they may become clinically impaired.

It's true that a tremendous amount of incredibly important development occurs at a rapid rate in early childhood, and it lays the foundation for the rest of life. I agree with you 100% on that.

But it's also obvious that most 47-year-olds have greater ability to self-regulate than most 7 year-olds. As some of us probably know better than we'd care to admit, a 47-year-old who self-regulated only as well as an average 7-year-old would be at a great disadvantage in life.

Even if the rate of development slows down in late childhood, it doesn't stop entirely. It's still a moving target, and one that people could hypothetically fail to reach later on, even if they'd been keeping pace earlier in life.

It's not that they lost their self-regulation ability. They just didn't continue to gain as much additional capacity for self-control as most people would have during the same time period.

Lunacie pointed out the boatload of research suggesting that the prefrontal cortex, which is involved in impulse control and good judgment, matures throughout adolescence and into early adulthood. If for any reason, that maturation didn't happen as it should, people could end up being markedly poorer at self-regulation than "average" adults.

You can certainly choose to call such a pattern of development and associated symptoms something other than ADHD, if you believe that it's so fundamentally distinct from "regular ADHD" that it needs a totally different name. Maybe some day we'll understand enough to give it an even better name.

On the other hand, if it walks like a duck and talks like a duck...there seem to be some researchers who are willing to call it a late-onset duck. ;)

As daveddd and aeon have pointed out a couple of times, we're already lumping together who-knows-how-many different sets of circumstances and quirks under the broad umbrella of ADHD. What's one more?

sarahsweets
08-17-17, 05:29 AM
Can someone shed light on this bottom up, top down stuff? I dont think I understand what it means, and how it plays into adhd and development.

aeon
08-17-17, 09:54 AM
Biologically anyone who has AD(H)D, has had AD(H)D, since before the age of 4-7.

That isn’t necessarily true.


Thanks,
Ian

Lunacie
08-17-17, 11:18 AM
i think important growth is always occurring.

There are different stages of development.

Biologically anyone who has AD(H)D, has had AD(H)D, since before the age of 4-7.

A child does not develop age related self-regulation, then lose it, between 7-18.

We never had it.



M

No, I'm not saying that the teen loses whatever development has occurred.

But when those next developmental milestones come along at or just after
puberty, that set of milestones is delayed or missed out on.

As I pointed out, those are the milestones for planning, working memory,
organization, and mood modulation.

My granddaughter, like most of the girls in my family, reached puberty at the
age of 10, or about 5th grade. So 5th grade was when the struggle with adhd
symptoms became overwhelming and she was finally diagnosed and treated.