Karam Rafael G, Bau Claiton H D, Salgado Carlos A I, Kalil Katiane L S, Victor Marcelo M, Sousa Nyvia O, Vitola Eduardo S, Picon Felipe A, Zeni Gregory D, Rohde Luis A, Belmonte-de-Abreu Paulo, Grevet Eugenio H
ADHD Outpatient Program - Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
J Psychiatr Res. 2009 Apr;43(7):697-701. doi: 10.1016/j.jpsychires.2008.10.001. Epub 2008 Nov 12.
The requirement in classificatory systems that some impairment from attention-deficit/hyperactivity disorder (ADHD) symptoms starts before 7 years of age (age of onset of impairment criteria - AOC) has been harshly criticized. Although there is evidence that late-onset ADHD is a valid diagnosis, little is known about the role of age of onset of impairment on the clinical profile of adult patients.
The diagnoses of 349 adults with ADHD followed DSM-IV criteria. ADHD and oppositional defiant disorder (ODD) were evaluated with the K-SADS-E, and other comorbidities with the SCID-IV and the MINI. Subjects were divided in early and late-onset groups (age of onset of impairment between 7 and 12 years old). The effect of age of onset over clinical and demographic characteristics was tested by regression models.
Late-onset subjects were diagnosed later (P=0.04), had a lower frequency of problems with authority and discipline (P=0.004), and lower scores in SNAP-IV (P<0.001) and in Barkley's scale for problems in areas of life activities (P=0.03). On the other hand, late-onset patients presented a higher prevalence of comorbid general anxiety disorder (GAD) (P=0.01). Both groups had a similar profile in the remaining comorbidities and sociodemographic characteristics.
This study provides initial evidence that adults with late-onset ADHD have less severity, lower frequency of externalizing symptoms and increased comorbidity with GAD, but similar profile in other comorbidities. In addition, the data suggest that late-onset patients have a higher probability of delayed diagnosis despite the significant impairment of their condition.
注意力缺陷多动障碍（ADHD）症状导致的某些损害需在7岁之前出现（损害标准发病年龄 - AOC）这一分类系统要求受到了严厉批评。尽管有证据表明起病较晚的ADHD是一种有效的诊断，但对于损害发病年龄在成年患者临床特征中的作用知之甚少。
349名成年ADHD患者的诊断遵循DSM - IV标准。使用儿童情感障碍和精神分裂症问卷（K - SADS - E）评估ADHD和对立违抗性障碍（ODD），使用DSM - IV轴I障碍临床定式检查问卷（SCID - IV）和简明国际神经精神访谈（MINI）评估其他共病情况。受试者被分为早发组和晚发组（损害发病年龄在7至12岁之间）。通过回归模型测试发病年龄对临床和人口统计学特征的影响。
晚发组受试者的诊断时间较晚（P = 0.04），权威和纪律问题的发生率较低（P = 0.004），在SNAP - IV量表上得分较低（P < 0.001），在巴克利生活活动领域问题量表上得分也较低（P = 0.03）。另一方面，晚发组患者共病广泛性焦虑障碍（GAD）的患病率较高（P = 0.01）。两组在其余共病情况和社会人口统计学特征方面具有相似的概况。
本研究提供了初步证据，表明起病较晚的成年ADHD患者症状严重程度较低，外化症状发生率较低，但共病GAD的情况增加，且在其他共病方面概况相似。此外，数据表明，尽管病情有明显损害，但晚发组患者延迟诊断的可能性较高。
