Updates in Adult-Onset ADHD With Dr. Vladimir Maletic

(Part 1 of 4)

In this video, Psych Congress cochair Vladimir Maletic, MD, MS, gives the latest updates on adult-onset attention deficit/hyperactivity disorder (ADHD).

Dr. Maletic is Clinical Professor of Psychiatry, University of South Carolina School of Medicine, Greenville. He spoke at the Psych Congress 2020 psychopharmacology preconference on "ADHD Across the Lifespan: How Neurobiology Informs Our Treatment Choice." 

Read the transcript:

There's a lot of work being done currently on differentiating child and adolescent-onset from adult-onset ADHD. Most of this work was stimulated by several longitudinal studies that have been completed within the last 5 years.

These studies have noted that anywhere between 2 to 10 percent of individuals afflicted by ADHD has adolescent or adult-onset of ADHD, so this is after age 12 or older.

What kind of questions does it raise? First of all, amongst individuals who have so-called adult-onset of ADHD, anywhere between 65 and 90 percent did not meet criteria during their child and adolescent years. Are we dealing with a different subtype of ADHD? Is its neurobiology different? Are there different treatments appropriate for this class of subgroup of individuals?

Here's what the answer seems to be. It is most likely that even those individuals have had some degree of inattentiveness, impulsivity, or hyperactivity that was present there before age 18. However, in order to meet the criteria for ADHD, in addition to symptomatology, one had to have significant functional impairment related to these symptoms.

More recent work has been focused on, what kind of factors will contribute to this later adolescent and adult-onset of ADHD? Some of them have been identified. If parents have very high aspirations from these children, when asked, "What kind of grades you expect to see from your children?" they'll say, "Oh, straight As," so a high parental aspiration expectation can be a factor.

Unfortunately, it is very often associated with low reward signaling. These are child and adolescent individuals who are not particularly motivated.

In addition to that, these are also individuals who have more severe ADHD symptomatology across the board, who tend to have more anxiety, more irritability, more emotional dysregulation, and more stress during their life, including potentially a history of abuse.

If all these factors are present, that is a scenario where ADHD may not be meeting criteria and not fully expressed in childhood, but does become expressed in adolescence and in adulthood.