ADHD Symptoms Are Not Always Obvious during Childhood

The criteria set out in DSM-IV stipulate that at least some of the impairing ADHD symptoms must have been present before age seven. But this requirement has no basis in empirical research; it was arbitrarily stipulated by the committee that wrote the diagnostic criteria for DSM-IV. Presumably the rationale was to establish that ADHD does not appear de novo later in life. Such a view makes no sense when ADHD is seen as a developmental impairment of executive functions, an impairment that in some persons may not become apparent until such functions are challenged by the demands of elementary or secondary school, or perhaps even later, when the individual experiences the trials of adulthood.

Russell Barkley and Joseph Biederman published an article in 1997 cautioning clinicians to avoid use of the age seven cutoff as a requirement for diagnosis of ADHD. They emphasized the lack of research to support it and argued that this age of onset requirement "deserves to be abandoned or very generously interpreted as occurring sometime in childhood, broadly construed." They noted that "to do otherwise would be simply arbitrary, surely discriminatory, and empirically indefensible" (p. 1209).

Increasing numbers of older adolescents and adults are now recognizing that they suffer from ADHD. Media coverage or prompting by friends or family leads them to realize that they have suffered for many years from ADHD impairments not recognized by their parents, their teachers, or themselves. Many have struggled throughout their schooling, frustrated by their inability to perform with any consistency to the level of their ability. Others were successful, perhaps very successful, in the early years of their education, then floundered in high school, college, or beyond. Chapters 5 and 6 provide examples of individuals whose impairments of ADD syndrome were not apparent until the tasks of adolescence or adulthood challenged their capacity to exercise executive functions. In my view, childhood ADHD should not be considered essential for diagnosis of ADHD in adults any more than childhood diabetes is required for the diagnosis of adult-onset diabetes.

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