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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重新考虑了晚期多动症，并在10至25岁之间进行了全面的重复评估。

目的没有儿童注意缺陷多动障碍（ADHD）的青少年和青年人经常到诊所寻求针对迟发性ADHD症状的刺激药物。最近的出生队列研究支持迟发性多动症的概念，但是这些研究受到限制，因为它们依靠筛查工具评估多动症，不考虑症状的替代原因或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本地规范化比较组纵向进行的精神病学评估来解决这些局限性。方法从比较基线（平均年龄= 9.89岁）到成年（平均年龄= 24.40岁），对没有儿童ADHD（N = 239）的个人进行八项评估。诊断程序利用了父母，老师，并考虑症状的背景和时间，自我报告多动症的症状，功能障碍，药物滥用和其他精神障碍。结果最初在症状检查表上筛查为阳性的个体中约有95％被排除在迟发性ADHD诊断之外。在患有迟发性ADHD症状受损的个体中，诊断排除的最常见原因是仅在使用重物质的情况下出现的症状或损害。大多数晚期发病病例在青春期和有限的青春期表现出发病。没有证据表明成人多动症独立于复杂的精神病史。结论为迟发性多动症寻求治疗的个体可能是有效病例。但是，更常见的是，症状代表无损害的认知波动，合并症，或物质使用的认知作用。假阳性的迟发性多动症多见，没有仔细评估。在治疗潜在的迟发病例之前，临床医生应仔细评估损伤，精神病史和药物使用情况。