迟发性注意缺陷多动障碍：理解证据并构建理论框架。
Late-Onset ADHD: Understanding the Evidence and Building Theoretical Frameworks.
机构信息
Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Department of Psychiatry and Behavioral Health at the Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA.
出版信息
Curr Psychiatry Rep. 2017 Nov 13;19(12):106. doi: 10.1007/s11920-017-0858-7.
PURPOSE OF REVIEW
The traditional definition of Attention-Deficit/Hyperactivity Disorder (ADHD), assuming onset in childhood, has been challenged by evidence from four recent birth-cohort studies that reported most adults with ADHD lacked a childhood categorical ADHD diagnosis.
RECENT FINDINGS
Late onset of symptoms was evaluated in the long-term follow-up of the Multimodal Treatment study of ADHD (MTA). In most cases, other factors were present that discounted the late onset of ADHD symptoms and excluded the diagnosis of ADHD. We offer two theoretical frameworks for understanding the ADHD trajectory throughout the life cycle: (1) the complex phenotype model, and (2) the restricted phenotype model. We conclude that (a) late onset (after age 12) is a valid trajectory for ADHD symptoms, (b) the percentage of these cases with onset after adolescence is yet uncertain, and
综述目的：传统的注意力缺陷多动障碍（ADHD）定义假设其发病于儿童期，但最近四项出生队列研究的证据对此提出了挑战，这些研究报告称，大多数患有 ADHD 的成年人在儿童时期并未被明确诊断为 ADHD。
最新发现：ADHD 的多项治疗研究（MTA）的长期随访中评估了症状的迟发性发病。在大多数情况下，存在其他因素使 ADHD 症状的迟发性发病失去意义，并排除了 ADHD 的诊断。我们提供了两种理解 ADHD 整个生命周期轨迹的理论框架：（1）复杂表型模型，和（2）限制表型模型。我们的结论是：（a）迟发性发病（12 岁以后）是 ADHD 症状的一个有效发病轨迹，（b）这些病例中在青春期后发病的比例尚不确定。
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