Attention deficit/hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition. It frequently persists into adulthood and can have serious health and other adverse consequences. The majority of previous adult ADHD studies have focused on young adults so that relatively little is known about ADHD symptoms and their effects in mid and late life. In addition, effects of subclinical levels of attention deficit and hyperactivity have not been studied in detail. In this study we investigated ADHD symptoms and related impairment in a large population-based sample of middle-aged Australian adults (n = 2091; 47% male). Applying the WHO adult ADHD Self Report Screener (ASRS) we observed that 6.2% of participants had scores that were previously associated with ADHD diagnosis. No significant gender difference in the distribution of ASRS scores was observed. Multiple regression analyses indicated strong positive correlations between symptoms of ADHD and depression/anxiety and significant negative associations (p<0.01) with employment, financial stress, relationship quality, health and well-being measures in this age group. Importantly, associations were highly significant even when few ADHD symptoms were reported. Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms. Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied. Our results suggest that ADHD symptoms continue to be associated with ill-health and functional impairment in mid-life and are, therefore, likely to be a major, previously unrecognized source of late-life morbidity with associated social and economic costs. Thus, there is a compelling need for better understanding and development of age-appropriate approaches to the diagnosis and treatment of ADHD in mid- to late-life.
R？sler M, Casas M, Konofal E, Buitelaar J (2010) Attention deficit hyperactivity disorder in adults. World J Biol Psychiatry 11: 684–698.
[3]
Barkley R (2010) Attention Deficit Hyperactivity Disorder in Adults. Sudbury, Massachusetts: Jones and Bartlett Publishers.
[4]
Karam RG, Bau CHD, Salgado CAI, Kalil KLS, Victor MM, et al. (2009) Late-onset ADHD in adults: milder, but still dysfunctional. J Psychiatr Res 43: 697–701.
[5]
Bernfort L, Nordfeldt S, Persson J (2008) ADHD from a socio-economic perspective. Acta Paediatr 97: 239–245.
[6]
Matza LS, Paramore C, Prasad M (2005) A review of the economic burden of ADHD. Cost Eff Resour Alloc 3: 5.
[7]
Secnik K, Swensen A, Lage MJ (2005) Comorbidities and costs of adult patients diagnosed with attention-deficit hyperactivity disorder. Pharmacoeconomics 23: 93–102.
[8]
Birnbaum HG, Kessler RC, Lowe SW, Secnik K, Greenberg PE, et al. (2005) Costs of attention deficit-hyperactivity disorder (ADHD) in the US: excess costs of persons with ADHD and their family members in 2000. Curr Med Res Opin 21: 195–206.
[9]
Swensen AR, Birnbaum HG, Secnik K, Marynchenko M, Greenberg P, et al. (2003) Attention-deficit/hyperactivity disorder: increased costs for patients and their families. J Am Acad Child Adolesc Psychiatry 42: 1415–1423.
[10]
Simon V, Czobor P, Bálint S, Mészáros A, Bitter I (2009) Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry 194: 204–211.
[11]
Medina-Mora ME, Borges G, Lara C, Benjet C, Blanco J, et al. (2005) Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican National Comorbidity Survey. Psychol Med 35: 1773–1783.
[12]
Almeida Montes LG, Hernández García AO, Ricardo-Garcell J (2007) ADHD prevalence in adult outpatients with nonpsychotic psychiatric illnesses. J Atten Disord 11: 150–156.
[13]
Barbaresi W, Katusic S, Colligan R, Weaver A, Pankratz V, et al. (2004) How common is attention-deficit/hyperactivity disorder? Towards resolution of the controversy: results from a population-based study. Acta Paediatr Suppl 93: 55–59.
[14]
Bitter I, Simon V, Bálint S, Mészáros A, Czobor P (2010) How do different diagnostic criteria, age and gender affect the prevalence of attention deficit hyperactivity disorder in adults? An epidemiological study in a Hungarian community sample. Eur Arch Psychiatry Clin Neurosci 260: 287–296.
[15]
DuPaul GJ, Schaughency EA, Weyandt LL, Tripp G, Kiesner J, et al. (2001) Self-report of ADHD symptoms in university students: cross-gender and cross-national prevalence. J Learn Disabil 34: 370–379.
[16]
Faraone SV, Biederman J (2005) What is the prevalence of adult ADHD? Results of a population screen of 966 adults. J Atten Disord 9: 384–391.
[17]
Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, et al. (2007) Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 190: 402–409.
[18]
Gadow KD, Sprafkin J, Schneider J, Nolan EE, Schwartz J, et al. (2007) ODD, ADHD, versus ODD+ADHD in clinic and community adults. J Atten Disord 11: 374–383.
[19]
Heiligenstein E, Conyers LM, Berns AR, Miller MA, Smith MA (1998) Preliminary normative data on DSM-IV attention deficit hyperactivity disorder in college students. J Am Coll Health 46: 185–188.
[20]
Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, et al. (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163: 716–723.
[21]
Kooij JJS, Buitelaar JK, Van Den Oord EJ, Furer JW, Rijnders CAT, et al. (2005) Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med 35: 817–827.
[22]
Murphy K, Barkley RA (1996) Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: Implications for clinical diagnosis. J Atten Disord 1: 147–161.
[23]
Manor I, Meidad S, Zalsman G, Zemishlany Z, Tyano S, et al. (2008) Objective versus subjective assessment of methylphenidate response. Child Psychiatry Hum Dev 39: 273–282.
[24]
Manor I, Rozen S, Zemishlani Z, Weizman A, Zalsman G (2011) When does it end? Attention-deficit/hyperactivity disorder in the middle aged and older populations. Clin Neuropharmacol 34: 148–154.
[25]
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Publishing Inc.
[26]
Barkley RA (2006) Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis. New York: The Gulliford Press.
[27]
Hyman SE (2010) The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol 6: 155–179.
[28]
Arcos-Burgos M, Acosta MT (2007) Tuning major gene variants conditioning human behavior: the anachronism of ADHD. Curr Opin Genet Dev 17: 234–238.
[29]
Faraone SV, Biederman J, Doyle A, Murray K, Petty C, et al. (2006) Neuropsychological studies of late onset and subthreshold diagnoses of adult attention-deficit/hyperactivity disorder. Biol Psychiatry 60: 1081–1087.
[30]
Faraone SV, Biederman J, Spencer T, Mick E, Murray K, et al. (2006) Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid? Am J Psychiatry 163: 1720–1729.
[31]
de Zwaan M, Gru？ B, Müller A, Graap H, Martin A, et al. (2011) The estimated prevalence and correlates of adult ADHD in a German community sample. Eur Arch Psychiatry Clin Neurosci.
[32]
Guldberg-Kjar T, Johansson B (2009) Old people reporting childhood AD/HD symptoms: Retrospectively self-rated AD/HD symptoms in a population-based Swedish sample aged 65–80. Nord J Psychiatry 1–8.
[33]
Brod M, Schmitt E, Goodwin M, Hodgkins P, Niebler G (2011) ADHD burden of illness in older adults: a life course perspective. Qual Life Res. DOI 10.1007/s11136-11011-19981-11139.
[34]
Kessler RC, Adler L, Ames M, Demler O, Faraone S, et al. (2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 35: 245–256.
[35]
Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, et al. (2007) Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatr Res 16: 52–65.
[36]
Anstey KJ, Christensen H, Butterworth P, Easteal S, Mackinnon A, et al. (2011) Cohort Profile: The PATH through life project. Int J Epidemiol. DOI:10.1093/ije/dyr1025.
[37]
Spanier GB (1976) Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. J Marr Fam 38: 15–28.
[38]
Lubben J, Blozik E, Gillmann G, Iliffe S, von Renteln Kruse W, et al. (2006) Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. Gerontologist 46: 503–513.
[39]
Maddigan SL, Feeny DH, Johnson JA, Investigators D (2004) Construct validity of the RAND-12 and Health Utilities Index Mark 2 and 3 in type 2 diabetes. Qual Life Res 13: 435–448.
[40]
Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 282: 1737–1744.
[41]
Andrews FM, Withey SB (1976) Social indicators of well-being : Americans' perceptions of life quality. New York: Plenum Press. pp. 435–439.
[42]
Watson D, Clark LA, Tellegen A (1988) Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 54: 1063–1070.
[43]
Diener E, Emmons RA, Larsen RJ, Griffin S (1985) The Satisfaction With Life Scale. J Pers Assess 49: 71–75.
[44]
Berry CA, Shaywitz SE, Shaywitz BA (1985) Girls with attention deficit disorder: a silent minority? A report on behavioral and cognitive characteristics. Pediatrics 76: 801–809.
[45]
Gershon J (2002) A meta-analytic review of gender differences in ADHD. J Atten Disord 5: 143–154.
[46]
Barkley RA, Brown TE (2008) Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS Spectr 13: 977–984.
[47]
Biederman J, Faraone SV (2006) The effects of attention-deficit/hyperactivity disorder on employment and household income. MedGenMed 8: 12.
[48]
Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, et al. (1993) Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry 150: 1792–1798.
[49]
Kessler RC, Adler L, Ames M, Barkley RA, Birnbaum H, et al. (2005) The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. J Occup Environ Med 47: 565–572.
[50]
Neugebauer R, Ng S (1990) Differential recall as a source of bias in epidemiologic research. J Clin Epidemiol 43: 1337–1341.
[51]
Brewin CR, Andrews B, Gotlib IH (1993) Psychopathology and early experience: a reappraisal of retrospective reports. Psychol Bull 113: 82–98.
[52]
Antshel KM, Hargrave TM, Simonescu M, Kaul P, Hendricks K, et al. (2011) Advances in understanding and treating ADHD. BMC Med 9: 72.
