OBJECTIVE Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD. METHOD Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. RESULTS Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history. CONCLUSIONS Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.

中文翻译：

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通过对 10 岁至 25 岁之间的全面重复评估重新考虑迟发性多动症。


目的 没有儿童注意力缺陷多动障碍 (ADHD) 的青少年和年轻人经常到诊所寻求针对迟发性 ADHD 症状的兴奋剂药物。最近的出生队列研究支持迟发性多动症的概念，但这些研究受到限制，因为依赖筛查工具来评估多动症，没有考虑症状的其他原因，或者未能获得完整的精神病史。作者通过检查对多动症多模式治疗研究的当地规范对照组纵向进行的精神评估来解决这些局限性。方法 对没有儿童 ADHD 的个体 (N=239) 从比较基线（平均年龄=9.89 岁）到成年早期（平均年龄=24.40 岁）进行八次评估。诊断程序利用家长、老师和多动症症状、障碍、物质使用和其他精神障碍的自我报告，并考虑症状背景和时间。结果 大约 95% 最初在症状检查表上筛查呈阳性的个体被排除在迟发性 ADHD 诊断之外。在晚发性多动症症状受损的个体中，诊断排除的最常见原因是仅在大量物质使用的情况下出现的症状或损害。大多数晚发病例表现为青春期发病且仅限于青春期。没有证据表明成人发病的多动症与复杂的精神病史无关。结论 寻求治疗迟发性多动症的个体可能是有效的病例；然而，更常见的是，症状代表非损害性认知波动、共病障碍或物质使用的认知影响。 如果没有仔细评估，假阳性迟发性多动症病例很常见。在治疗潜在的迟发病例之前，临床医生应仔细评估损伤、精神病史和物质使用情况。