Late onset/manifestation of ADHD
Let me remind you, that you stated, quite confidently:
“ADHD is a lifelong condition that has to have shown signs from childhood and persistent through life.” And “ADHD is a neurological condition, present since birth”
This is all because I have contested these to points as inaccurate and out of date.
The first case report.
You said: “The 58 yr old case study actually says that she reported a tendency of forgetfulness and forgetfulness since childhood.”
May I observe [without insulting you], that you stated earlier “Self reporting is not reliable due to false negatives and positives and a desire to seek affirmation.” So why are you relying on it here? I haven’t, I dismissed it, because self-reporting based on recall of childhood isn’t reliable. You seem to be going against your own scientific principles here.
I’m relying on the assessment they did of this 58yr old, diagnosing her with late onset ADHD.
You said: “She also reported difficulties after starting her own business, so an environmental influence that you cannot rule out.”
No, that’s inaccurate because the start of her business did not coincide with the appearance of her symptoms as you imply:
“The patient was president of her own company, and she ran her business well. However, she gradually became inattentive and forgetful that it interfered with her work and daily life; thus, she visited our hospital with the encouragement of her family and employees, who worried that she was suffering from dementia. After various inspections, dementia was ruled out and she finally diagnosed with very late-onset ADHD.”
You said: “They also diagnosed her based on her condition in work and at home. No childhood consideration.”
Correct, and as mentioned before the self-reported childhood recall of forgetfulness is not reliable and cannot be used as evidence of childhood ADHD. She had no ADHD symptoms until she was 58 and there was no new environmental influence despite you implying there was.
You said:”In 2022 Sasaki et al, a follow on from the previous study, they base their conclusions on 7 dementia patients out of 446 (1.6%)”
No, they were not technically dementia patients- they were patients referred for a dementia assessment: “These patients comprised 246 women and 200 men. All patients have been referred to our hospital by their family physicians for assessment of dementia.”
You said “They do not consider comorbidity.”
Not the case, they did a very thorough job of ruling out all other organic or psychological comorbidities:
“After ruling out 39 patients with psychiatric diseases or organic diseases, 81 fulfilled our criteria and 326 did not. Developmental disorder specialists examined and reviewed the medical records for these 81 patients. As a result, 9 patients were suspected of having ADHD, and 7 of these 9 patients were given a diagnosis of ADHD. In terms of EOAD, neuropsychiatric specialists suspected 37 patients of having EOAD at the first examination. Of those 37 patients, 22 patients (3 who fulfilled our criteria and 19 who did not) were diagnosed with EOAD and 6 patients were diagnosed with ADHD. The remaining 9 patients were diagnosed with the other diseases. From the point of view of ADHD, ADHD accounted for 1.6% of patients who initially visited our specialty outpatient clinic for dementia and accounted for 16% of patients initially suspected of having EOAD”
You said: “I'm not willing to completely reverse decades of research based on a single individual with ADHD symptoms in childhood as evidence of late onset ADHD in adults” and then the same on “…7 people with ADHD symptoms.”
But you’re not being asked to “reverse decades of research” because prior to this NO research has been done on ADHD diagnosis of middle age & older adults that were known not to have ADHD in childhood:
“In recent years, many studies on ADHD in adults have been published [2,3,4,5,6,7,8,9,10,11,12,13], including some on the late-onset type of ADHD [8,9,10,11,12,13]. Some of the reports on late-onset ADHD have been attracting particular attention because they presented data challenging an accepted finding that the symptoms of ADHD should appear at < 12 years of age as established by studies conducted over the past 2 decades [14,15,16,17]. However, all reports on late-onset ADHD published to date were confined only to the period until early adulthood, thus making the occurrence of ADHD during the senile period questionable.”
Finally I included this study because of your extreme insistence that “ADHD is a lifelong condition that has to have shown signs from childhood and persistent through life.” and “ADHD is a neurological condition, present since birth”
You said “For the Breda et al 2020 study, they look at young people up to 22 years of age. This is under 25 years of age (neurologically immature), which is not late onset in adults. For 22% of the young people diagnosed with ADHD they identified an 'ascending symptom trajectory' and identified that this was most common in females with high IQ. No surprise; smart girls mask. This doesn't mean they didn't have ADHD in childhood, it means they covered it up well. They then conclude that it's a neurodevelopmental disorder.”
You’ve not really summarised this very well or accurately. First off, it’s a bit off to argue that late onset of ADHD in people aged 18-25 is “not late onset in adults”….they’re plainly young adults and referred to as adults in all the scientific literature.
The study specifically says in three prior studies many did not have ADHD in childhood ranging from 25% to 80%:
“Three birth cohorts that assessed ADHD in >8000 individuals from New Zealand, Brazil and the UK showed that around 80% of adults with current ADHD syndrome did not have the disorder in childhood. Furthermore, those adults with late-onset ADHD did not differ from their full-criteria counterparts in terms of clinical profile, severity, comorbidities and impairment. Two additional population studies that considered subtle ADHD symptoms in childhood as evidence of a neurodevelopmental trajectory found that 25% of adults with ADHD were late-onset cases.”
“Until now, no single study has followed children up to adulthood with a sufficiently long follow-up to permit identifying possible ascending trajectories.”
“We tested both polythetic definitions and latent growth modelling analyses to differentiate between neurodevelopmental and late-onset ADHD cases.”
“This study was carried out with data from 5249 individuals born in 1993, representing 99.1% of all live-born children in the southern Brazilian city of Pelotas (340 000 inhabitants), and followed up to 22 years of age. The participants underwent five evaluation waves at the perinatal period and at 11, 15, 18 and 22 years of age. In 2015, 4003 individuals were traced (including 193 deaths), with a final retention rate of 76.3%”
This study essentially found that 33% of adults with ADHD had no symptoms of ADHD in childhood, not even subclinical symptoms:
“According to the multi-step polythetic approach, most adult ADHD cases (67%) had chronic symptoms since childhood or early adolescence and had a homotypic neurodevelopmental trajectory, as previously reported.
These results also confirm one of the possible causes of dubious late-onset ADHD related to the presence of subthreshold symptoms instead of a full disorder in childhood. Thus, our results are in line with previous findings showing that subthreshold ADHD symptoms in childhood predict ADHD in late adolescence, and that children with subthreshold symptoms are at higher risk for adverse outcomes later in life.”
It also found that girls weren’t being “missed” but that
“In our analysis, the ascending (late-onset) trajectory was associated with female gender and higher IQ. “
“In summary, both polythetic and latent trajectory analyses support the view that the majority of adults with ADHD had a chronic, stable neurodevelopmental trajectory of the disorder. On the other hand, our results also confirm the existence of late-onset ADHD in around a fifth of cases, owing to an age-dependent ascension of symptoms.”
May I remind you again, your statements were:
“ADHD is a lifelong condition that has to have shown signs from childhood and persistent through life.” And “ADHD is a neurological condition, present since birth”
The studies clearly show this is not the case.