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

Published online by Cambridge University Press:  08 October 2018

Brandy L. Callahan*
Department of Psychology, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, Calgary, Alberta, Canada
André Plamondon
Department of Foundations and Practices in Education, Laval University, Québec, Québec, Canada
*Address for correspondence: Brandy L. Callahan, PhD, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary (AB) T2N 1N4, Canada. Email:



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.


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 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.


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.

Original Research
© Cambridge University Press 2018 

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Both authors have contributed equally to this work.


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.Google Scholar
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.Google ScholarPubMed
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.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th rev. 2016. Accessed December 5, 2017.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 2nd ed. Washington, DC: American Psychiatric Association; 1968.Google Scholar
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.CrossRefGoogle ScholarPubMed
Callahan, BL, Bierstone, D, Stuss, DT, Black, SE. Adult ADHD: risk factor for dementia or phenotypic mimic? Front Aging Neurosci. 2017;9:115.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Skodzik, T, Holling, H, Pedersen, A. Long-term memory performance in adult ADHD. J Atten Disord. 2017;21(4):267283. doi:10.1177/1087054713510561.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Conners, C, Erhardt, D, Sparrow, E. CAARS Adult ADHD Rating Scales. Technical Manual. Toronto, Ontario, Canada: Multi-Health Systems; 1999.Google Scholar
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.CrossRefGoogle ScholarPubMed
Wechsler, D. Wechsler Memory Scale–Revised Manual. New York: Psychological Corporation; 1987.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO. Mplus User’s Guide. 7th ed. Los Angeles, CA: Muthén & Muthén; 2012.Google Scholar
Little, TD. Longitudinal Structural Equation Modeling. New York: Guilford Press; 2013.Google Scholar
Chen, FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling. 2007;14(3):464504. doi:10.1080/10705510701301834.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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