Adult attention deficit hyperactivity disorder

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Adult Attention Deficit Hyperactivity Disorder is the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood. It is a neurodevelopmental disorder, meaning impairing symptoms must have been present in childhood except for when ADHD occurs after traumatic brain injury.^[1][2][3] Specifically, multiple symptoms must be present before the age of 12, according to DSM-5 diagnostic criteria.^[2][3][4][5] The cutoff age of 12 is a change from the previous requirement of symptom onset, which was before the age of 7 in the DSM-IV.^[3][6] This was done to add flexibility in the diagnosis of adults. ADHD was previously thought to be a childhood disorder that improved with age, but recent research has disproved this. Approximately two-thirds of childhood cases of ADHD continue into adulthood, with varying degrees of symptom severity that change over time and continue to affect individuals with symptoms ranging from minor inconveniences to impairments in daily functioning.^[7][8]

This new insight on ADHD is further reflected in the DSM-5, which lists ADHD as a “lifespan neurodevelopmental condition,” and has distinct requirements for children and adults. Per DSM-5 criteria, children must display “six or more symptoms in either the inattentive or hyperactive-impulsive domain, or both” for the diagnosis of ADHD.^[3] Older adolescents and adults (age 17 and older) need to demonstrate at least five symptoms before the age of 12 in either domain to meet diagnostic criteria.^[3][6] The International Classification of Diseases 11th Revision (ICD-11) also updated its diagnostic criteria to better align with the new DSM-5 criteria, but in a change from the DSM-5 and the ICD-10, while it lists the key characteristics of ADHD, the ICD-11 does not specify an age of onset, the required number of symptoms that should be exhibited, or duration of symptoms.^[6]

A final update to the DSM-5 from the DSM-IV is a revision in the way it classifies ADHD by symptoms, exchanging "subtypes" for "presentations" to better represent the fluidity of ADHD features displayed by individuals as they age.^[3][6]