Skip to main content Accessibility help
×
Home

Examining the validity of the ADHD concept in adults and older adults

  • Brandy L. Callahan (a1) (a2) and André Plamondon (a3)

Abstract

Objective

It is crucial to clarify the structure of attention-deficit/hyperactivity disorder (ADHD) symptomatology in all age groups to determine how to best conceptualize this disorder across the lifespan. We tested the ADHD factor structure across adulthood and investigated independent associations with executive functions.

Method

Data from 645 adults aged 18–59 and 233 adults aged 60–85 were drawn from the Nathan Kline Institute Rockland Sample. Participants completed the Conners Adult ADHD Rating Scale and tests of executive functioning. Invariance of the ADHD factor structure was investigated using confirmatory factor analyses. Associations with cognition were explored using multiple linear regression.

Results

Results confirmed a bifactor model with 3 specific factors (inattention, hyperactivity, and impulsivity). Factor loadings and item intercepts were invariant across ages. Levels of hyperactivity and impulsivity were lower in older adults. Inattentive symptoms in young adults were positively related to cognitive flexibility. In older adults, ADHD symptoms predicted poorer working memory.

Conclusion

ADHD symptoms manifest similarly across adulthood. The lack of robust associations between ADHD symptomatology and executive functions raises concerns about the usefulness of neuropsychological measures in diagnosing adult ADHD. These results support the validity of the ADHD concept in older adults but suggest a need for age-appropriate normative criteria.

Copyright

Corresponding author

*Address for correspondence: Brandy L. Callahan, PhD, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary (AB) T2N 1N4, Canada. Email: brandy.callahan@ucalgary.ca

Footnotes

Hide All

Both authors have contributed equally to this work.

Footnotes

References

Hide All
1.Adler, L, Shaw, D, Sitt, D, Maya, E, Morrill, MI. Issues in the diagnosis and treatment of adult ADHD by primary care physicians. Prim Psychiatry. 2009;16(5):5763.
2.Culpepper, L, Mattingly, G. Challenges in identifying and managing attention-deficit/hyperactivity disorder in adults in the primary care setting: a review of the literature. Prim Care Companion J Clin Psychiatry. 2010;12(6):111. doi:10.4088/PCC.10r00951pur.
3.Kieling, R, Rohde, LA. ADHD in children and adults: diagnosis and prognosis. Curr Top Behav Neurosci. 2012;9:116. doi:10.1007/7854_2010_115.
4.Kessler, RC, Adler, L, Barkley, R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716723. doi:10.1176/ajp.2006.163.4.716.
5.Kooij, JJS, Michielsen, M, Kruithof, H, Bijlenga, D. ADHD in old age: a review of the literature and proposal for assessment and treatment. Expert Rev Neurother. 2016;16(12):13711381. doi:10.1080/14737175.2016.1204914.
6.Michielsen, M, Semeijn, E, Comijs, HC, et al. Prevalence of attention-deficit hyperactivity disorder in older adults in the Netherlands. Br J Psychiatry. 2012;201(4):298305. doi:10.1192/bjp.bp.111.101196.
7.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
8.World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th rev. 2016. http://apps.who.int/classifications/icd10/browse/2016/en. Accessed December 5, 2017.
9.DuPaul, GJ, Reid, R, Anastopoulos, AD, Lambert, MC, Watkins, MW, Power, TJ. Parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms: factor structure and normative data. Psychol Assess. 2016;28(2):214225. doi:10.1037/pas0000166.
10.Rodenacker, K, Hautmann, C, Görtz-Dorten, A, Döpfner, M. The factor structure of ADHD—different models, analyses and informants in a bifactor framework. J Psychopathol Behav Assess. 2017;39(1):92102. doi:10.1007/s10862-016-9565-7.
11.Arias, VB, Ponce, FP, Nunez, DE. Bifactor models of attention-deficit/hyperactivity disorder (ADHD): an evaluation of three necessary but underused psychometric indexes. Assessment. In press. doi:10.1177/1073191116679260.
12.Burns, GL, de Moura, MA, Beauchaine, TP, McBurnett, K. Bifactor latent structure of ADHD/ODD symptoms: predictions of dual-pathway/trait-impulsivity etiological models of ADHD. J Child Psychol Psychiatry. 2014;55(4):393401.
13.Lee, S, Burns, GL, Beauchaine, TP, Becker, SP. Bifactor latent structure of attention-deficit/hyperactivity disorder (ADHD)/oppositional defiant disorder (ODD) symptoms and first-order latent structure of sluggish cognitive tempo symptoms. Psychol Assess. 2016;28(8):917928. doi:10.1037/pas0000232.
14.Matte, B, Anselmi, L, Salum, GA, et al. ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults. Psychol Med. 2015;45(2):361373. doi:10.1017/S0033291714001470.
15.Martel, MM, von Eye, A, Nigg, J. Developmental differences in structure of attention-deficit/hyperactivity disorder (ADHD) between childhood and adulthood. Int J Behav Dev. 2012;36(4):279292. doi:10.1177/0165025412444077.
16.Gibbins, C, Toplak, ME, Flora, DB, Weiss, MD, Tannock, R. Evidence for a general factor model of ADHD in adults. J Atten Disord. 2012;16(8):635644. doi:10.1177/1087054711416310.
17.Morin, AJS, Tran, A, Caci, H. Factorial validity of the ADHD Adult Symptom Rating Scale in a French community sample. J Atten Disord. 2016;20(6):530541. doi:10.1177/1087054713488825.
18.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 2nd ed. Washington, DC: American Psychiatric Association; 1968.
19.Fischer, BL, Gunter-Hunt, G, Steinhafel, CH, Howell, T. The identification and assessment of late-life ADHD in memory clinics. J Atten Disord. 2012;16(4):333338. doi:10.1177/1087054711398886.
20.Callahan, BL, Bierstone, D, Stuss, DT, Black, SE. Adult ADHD: risk factor for dementia or phenotypic mimic? Front Aging Neurosci. 2017;9:115.
21.Alderson, RM, Kasper, LJ, Hudec, KL, Patros, CHG. Attention-deficit/hyperactivity disorder (ADHD) and working memory in adults: a meta-analytic review. Neuropsychology. 2013;27(3):287302. doi:10.1037/a0032371.
22.Skodzik, T, Holling, H, Pedersen, A. Long-term memory performance in adult ADHD. J Atten Disord. 2017;21(4):267283. doi:10.1177/1087054713510561.
23.Ivanchak, N, Abner, E, Carr, S, et al. Attention-deficit/hyperactivity disorder in childhood is associated with cognitive test profiles in the geriatric population but not with mild cognitive impairment or Alzheimer’s disease. J Aging Res. 2011;2011:729801. doi:10.4061/2011/729801.
24.Schwartz, K, Verhaeghen, P. ADHD and Stroop interference from age 9 to age 41 years: a meta-analysis of developmental effects. Psychol Med. 2008;38(11):16071616. doi:10.1017/S003329170700267X.
25.Thorell, LB, Holst, Y, Chistiansen, H, Kooij, JJS, Bijlenga, D, Sjöwall, D. Neuropsychological deficits in adults age 60 and above with attention deficit hyperactivity disorder. Eur Psychiatry. 2017;45:9096. doi:10.1016/j.eurpsy.2017.06.005.
26.Moffitt, TE, Houts, R, Asherson, P, et al. Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. Am J Psychiatry. 2015;172(10):967977. doi:10.1176/appi.ajp.2015.14101266.
27.Conners, C, Erhardt, D, Sparrow, E. CAARS Adult ADHD Rating Scales. Technical Manual. Toronto, Ontario, Canada: Multi-Health Systems; 1999.
28.Houck, G, Kendall, J, Miller, A, Morrell, P, Wiebe, G. Self-concept in children and adolescents with attention deficit hyperactivity disorder. J Pediatr Nurs. 2011;26(3):239247. doi:10.1016/j.pedn.2010.02.004.
29.Wechsler, D. Wechsler Memory Scale–Revised Manual. New York: Psychological Corporation; 1987.
30.Gur, RC, Richard, J, Hughett, P, et al. A cognitive neuroscience-based computerized battery for efficient measurement of individual differences: standardization and initial construct validation. J Neurosci Methods. 2010;187(2):254262. doi:10.1016/j.jneumeth.2009.11.017.
31.Kurtz, M, Ragland, JD, Moberg, PJ, Gur, RC. The Penn Conditional Exclusion Test: a new measure of executive-function with alternate forms for repeat administration. Arch Clin Neuropsychol. 2004;19(2):191201. doi:10.1016/S0887-6177(03)00003-9.
32.Fan, J, McCandliss, BD, Sommer, T, Raz, A, Posner, MI. Testing the efficiency and independence of attentional networks. J Cogn Neurosci. 2002;14(3):340347. doi:10.1162/089892902317361886.
33.Muthén, LK, Muthén, BO. Mplus User’s Guide. 7th ed. Los Angeles, CA: Muthén & Muthén; 2012.
34.Little, TD. Longitudinal Structural Equation Modeling. New York: Guilford Press; 2013.
35.Chen, FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling. 2007;14(3):464504. doi:10.1080/10705510701301834.
36.Cheung, GW, Rensvold, RB. Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling. 2002;9(2):233255. doi:10.1207/S15328007SEM0902_5.
37.Wagner, F, Martel, MM, Cogo-Moreira, H, et al. Attention-deficit/hyperactivity disorder dimensionality: the reliable “g” and the elusive “s” dimensions. Eur Child Adolesc Psychiatry. 2016;25(1):8390. doi:10.1007/s00787-015-0709-1.
38.Barkley, RA, Fischer, M. The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry. 2010;49(5):503513.
39.Gardner, DM, Gerdes, AC. A review of peer relationships and friendships in youth with ADHD. J Atten Disord. 2015;19(10):844855. doi:10.1177/1087054713501552.
40.Bramham, J, Murphy, DGM, Xenitidis, K, Asherson, P, Hopkin, G, Young, S. Adults with attention deficit hyperactivity disorder: an investigation of age-related differences in behavioural symptoms, neuropsychological function and co-morbidity. Psychol Med. 2012;42(10):22252234. doi:10.1017/S0033291712000219.
41.Das, D, Cherbuin, N, Easteal, S, Anstey, KJ. Attention deficit/hyperactivity disorder symptoms and cognitive abilities in the late-life cohort of the PATH through life study. PLoS One. 2014;9(1):112. doi:10.1371/journal.pone.0086552.
42.Elisa, RN, Balaguer-Ballester, E, Parris, BA. Inattention, working memory, and goal neglect in a community sample. Front Psychol. 2016;7:1428. doi:10.3389/fpsyg.2016.01428.
43.Mostert, JC, Onnink, AMH, Klein, M, et al. Cognitive heterogeneity in adult attention deficit/hyperactivity disorder: a systematic analysis of neuropsychological measurements. Eur Neuropsychopharmacol. 2015;25(11):20622074. doi:10.1016/j.euroneuro.2015.08.010.
44.Rapport, MD, Bolden, J, Kofler, MJ, Sarver, DE, Raiker, JS, Alderson, RM. Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits? J Abnorm Child Psychol. 2009;37(4):521534. doi:10.1007/s10802-008-9287-8.
45.Barkley, RA. Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. J Clin Child Adolesc Psychol. 2013;42(2):161173. doi:10.1080/15374416.2012.734259.
46.Retz, W, Stieglitz, R-D, Corbisiero, S, Retz-Junginger, P, Rösler, M. Emotional dysregulation in adult ADHD: what is the empirical evidence? Expert Rev Neurother. 2012;12(10):12411251. doi:10.1586/ern.12.109.
47.Christiansen, H, Hirsch, O, Philipsen, A, et al. German validation of the Conners Adult ADHD Rating Scale–Self-Report. J Atten Disord. 2013;17(8):690698. doi:10.1177/1087054711435680.

Keywords

Related content

Powered by UNSILO
Type Description Title
WORD
Supplementary materials

Callahan and Plamondon supplementary material
Appendix

 Word (15 KB)
15 KB

Examining the validity of the ADHD concept in adults and older adults

  • Brandy L. Callahan (a1) (a2) and André Plamondon (a3)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.