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Personality traits among ADHD adults: implications of late-onset and subthreshold diagnoses

Published online by Cambridge University Press:  30 June 2008

S. V. Faraone ,
A. Kunwar ,
J. Adamson  and
J. Biederman
S. V. Faraone*
Affiliation:
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
A. Kunwar
Affiliation:
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
J. Adamson
Affiliation:
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Yawkey Center for Outpatient Care, Boston, MA, USA
J. Biederman
Affiliation:
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Yawkey Center for Outpatient Care, Boston, MA, USA
*
*Address for correspondence: Dr S. V. Faraone, Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY13210, USA. (Email: [email protected])
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Abstract

Background

Diagnosing attention deficit hyperactivity disorder (ADHD) in adults is difficult when diagnosticians cannot establish onset prior to the DSM-IV criterion of age 7 or if the number of symptoms does not achieve the DSM threshold for diagnosis. Previous work has assessed the validity of such diagnoses based on psychiatric co-morbidity, family history and neuropsychological functions but none of these studies have used personality as a validation criterion.

Method

We compared four groups of adults: (1) full ADHD subjects who met all DSM-IV criteria for childhood-onset ADHD; (2) late-onset subjects who met all criteria except the age at onset criterion, (3) subthreshold subjects who did not meet full symptom criteria and (4) non-ADHD subjects who did not meet any of the above criteria. Diagnoses were made by using the Structured Clinical Interview for DSM-IV (SCID) and the Temperament and Character Inventory (TCI) was used to assess personality traits.

Results

We found that full ADHD and late-onset ADHD showed similar personality profiles with significant deviations on all TCI scales except reward dependence and self-transcendence. By contrast, subthreshold cases only showed deviations on novelty seeking and self-directiveness.

Conclusions

These data call into question the stringent age of onset of ADHD symptom criteria for adults when making retrospective diagnoses of ADHD. Subthreshold ADHD seems to be a milder form of the disorder that is consistent with dimensional views of the disorder.

Keywords

Attention deficit hyperactivity disorder (ADHD)diagnosispersonality
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 4 , April 2009 , pp. 685 - 693
Copyright
Copyright © 2008 Cambridge University Press

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References

Adler, LA, Chua, HC (2002). Management of ADHD in adults. Journal of Clinical Psychiatry 63, 29–35.Google ScholarPubMed
Anckarsater, H, Stahlberg, O, Larson, T, Hakansson, C, Jutblad, SB, Niklasson, L, Nyden, A, Wentz, E, Westergren, S, Cloninger, CR, Gillberg, C, Rastam, M (2006). The impact of ADHD and autism spectrum disorders on temperament, character, and personality development. American Journal of Psychiatry 163, 1239–1244.CrossRefGoogle ScholarPubMed
Applegate, B, Lahey, B, Hart, E, Biederman, J, Hynd, G, Barkley, R, Ollendick, T, Frick, P, Greenhill, L, McBurnett, K, Newcorn, J, Kerdyk, L, Garfinkel, B, Waldman, I, Shaffer, D (1997). Validity of the age of onset criterion for attention-deficit/hyperactivity disorder: a report from the DSM-IV field trials. Journal of the American Academy of Child and Adolescent Psychiatry 36, 1211–1221.CrossRefGoogle ScholarPubMed
Barkley, RA, Biederman, J (1997). Toward a broader definition of the age-of-onset criterion for attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 36, 1204–1210.CrossRefGoogle Scholar
Barkley, RA, Fischer, M, Smallish, L, Fletcher, K (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology 111, 279–289.CrossRefGoogle ScholarPubMed
Barkley, RA, Murphy, K, Fischer, M (2007). The Science of ADHD in Adults: Clinic Referred Adults vs. Children Grown Up. Guilford Press: New York, NY.Google Scholar
Biederman, J, Faraone, SV, Doyle, AE, Lehman, BK, Kraus, I, Perrin, J, Tsuang, MT (1993). Convergence of the Child Behavior Checklist with structured interview- based psychiatric diagnoses of ADHD children with and without comorbidity. Journal of Child Psychology and Psychiatry 34, 1241–1251.CrossRefGoogle ScholarPubMed
Biederman, J, Faraone, SV, Mick, E, Moore, P, Lelon, E (1996). Child Behavior Checklist (CBCL) findings further support comorbidity between ADHD and major depression in a referred sample. Journal of the American Academy of Child and Adolescent Psychiatry 35, 734–742.CrossRefGoogle Scholar
Biederman, J, Mick, E, Faraone, SV (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry 157, 816–818.CrossRefGoogle ScholarPubMed
Biederman, J, Monuteaux, M, Mick, E, Spencer, T, Wilens, T, Silva, J, Snyder, L, Faraone, SV (2006). Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year prospective follow-up study. Psychological Medicine 36, 167–179.CrossRefGoogle Scholar
Biederman, J, Petty, C, Fried, R, Fontanella, J, Doyle, AE, Seidman, LJ, Faraone, SV (2007 a). Can self-reported behavioral scales assess executive function deficits? A controlled study of adults with ADHD. Journal of Nervous and Mental Disease 195, 240–246.CrossRefGoogle ScholarPubMed
Biederman, J, Petty, CR, Fried, R, Doyle, AE, Spencer, T, Seidman, LJ, Gross, L, Poetzl, K, Faraone, SV (2007 b). Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD. Acta Psychiatrica Scandinavica 116, 129–136.CrossRefGoogle Scholar
Bird, H, Canino, G, Gould, M, Ribera, J, Rubio-Stipec, M, Woodbury, M, Huertas-Goldman, H, Sesman, M (1987). Use of the child behavior checklist as a screening instrument for epidemiological research in child psychiatry: results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry 26, 207–213.CrossRefGoogle ScholarPubMed
Boyle, M, Offord, D, Racine, Y, Szatmari, P, Sanford, M, Fleming, J (1997). Adequacy of interviews vs checklists for classifying childhood psychiatric disorder based on parent reports. Archives of General Psychiatry 54, 793–799.CrossRefGoogle ScholarPubMed
Chen, W, Faraone, S, Biederman, J, Tsuang, M (1994). Diagnostic accuracy of the Child Behavior Checklist scales for attention deficit hyperactivity disorder: A receiver operating characteristic analysis. Journal of Consulting and Clinical Psychology 62, 1017–1025.CrossRefGoogle ScholarPubMed
Cloninger, C, Adolfsson, R, Svrakic, N (1996). Mapping genes for human personality. Nature Genetics 12, 3–4.CrossRefGoogle ScholarPubMed
Cloninger, CR (1987). Neurogenetic adaptive mechanisms in alcoholism. Science 236, 410–416.CrossRefGoogle ScholarPubMed
Cloninger, CR, Przybeck, TR, Svrakic, DM (1991). The tridimensional personality questionnaire: U.S. normative data. Psychological Reports 69, 1047–1057.CrossRefGoogle ScholarPubMed
Downey, K, Pomerleau, CS, Pomerleau, OF (1996). Personality differences related to smoking and adult attention deficit hyperactivity disorder. Journal of Substance Abuse 8, 129–135.CrossRefGoogle ScholarPubMed
Downey, K, Stelson, F, Pomerleau, O, Giordiani, B (1997). Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical population. Journal of Nervous and Mental Disease 185, 32–38.CrossRefGoogle ScholarPubMed
Edelbrock, C (1986). Behavioral ratings of children diagnosed for attention deficit disorder. Psychiatric Annals 16, 36–40.CrossRefGoogle Scholar
Edelbrock, C, Rende, R, Plomin, R, Thompson, LA (1995). A twin study of competence and problem behavior in childhood and early adolescence. Journal of Child Psychology and Psychiatry 36, 775–785.CrossRefGoogle ScholarPubMed
Faraone, S, Biederman, J, Mick, E (2006 a). The age-dependent decline of attention-deficit/hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159–165.CrossRefGoogle ScholarPubMed
Faraone, SV (2000). Attention deficit hyperactivity disorder in adults: implications for theories of diagnosis. Current Directions in Psychological Science 9, 33–36.CrossRefGoogle Scholar
Faraone, SV (2004). Genetics of adult attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America 27, 303–321.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J (2005). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. Journal of Attention Disorders 9, 384–391.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Doyle, AE, Murray, K, Petty, C, Adamson, J, Seidman, L (2006 b). Neuropsychological studies of late-onset and subthreshold diagnoses of adult ADHD. Biological Psychiatry 60, 1081–1087.CrossRefGoogle Scholar
Faraone, SV, Biederman, J, Spencer, T, Wilens, T, Seidman, LJ, Mick, E, Doyle, AE (2000). Attention deficit hyperactivity disorder in adults: an overview. Biological Psychiatry 48, 9–20.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Spencer, TJ, Mick, E, Murray, K, Petty, C, Adamson, JJ, Monuteaux, MC (2006 c). Diagnosing adult attention deficit hyperactivity disorder: are late-onset and subthreshold diagnoses valid? American Journal of Psychiatry 163, 1720–1729.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Wilens, TE, Adamson, JJ (2007 a). A naturalistic study of the effects of pharmacotherapy on substance use disorders among ADHD adults. Psychological Medicine 37, 1–10.CrossRefGoogle ScholarPubMed
Faraone, SV, Spencer, T, Aleardi, M, Pagano, C, Biederman, J (2004 a). Meta-analysis of the efficacy of methylphenidate for treating adult attention deficit hyperactivity disorder. Journal of Clinical Psychopharmacology 54, 24–29.CrossRefGoogle Scholar
Faraone, SV, Spencer, T, Montano, CB, Biederman, J (2004 b). Attention deficit hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care. Archives of Internal Medicine 164, 1221–1226.CrossRefGoogle ScholarPubMed
Faraone, SV, Wilens, TE, Petty, C, Antshel, K, Spencer, T, Biederman, J (2007 b). Substance use among ADHD adults: implications of late-onset and subthreshold diagnoses. American Journal on Addictions 16, 24–34.CrossRefGoogle ScholarPubMed
First, M, Spitzer, R, Gibbon, M, Williams, J (1997). Structured Clinical Interview for DSM-IV Axis I Disorders. American Psychiatric Press: Washington, DC.Google Scholar
Gjone, H, Stevenson, J, Sundet, J (1996). Genetic influence on parent-reported attention-related problems in a Norwegian general population twin sample. Journal of the American Academy of Child and Adolescent Psychiatry 35, 588–598.CrossRefGoogle Scholar
Goodman, R, Stevenson, J (1989 a). A twin study of hyperactivity: I. An examination of hyperactivity scores and categories derived from Rutter teacher and parent questionnaires. Journal of Child Psychology and Psychiatry 30, 671–689.CrossRefGoogle ScholarPubMed
Goodman, R, Stevenson, J (1989 b). A twin study of hyperactivity: II. The aetiological role of genes, family relationships and perinatal adversity. Journal of Child Psychology and Psychiatry 30, 691–709.CrossRefGoogle ScholarPubMed
Hudziak, JJ (1997). Identification of phenotypes for molecular genetic studies of common childhood psychopathology. In Handbook of Psychiatric Genetics (ed. Blum, K. and Noble, E. P.), pp. 201–217. CRC Press: Boca Raton, FL.Google Scholar
Jacob, CP, Romanos, J, Dempfle, A, Heine, M, Windemuth-Kieselbach, C, Kruse, A, Reif, A, Walitza, S, Romanos, M, Strobel, A, Brocke, B, Schafer, H, Schmidtke, A, Boning, J, Lesch, KP (2007). Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. European Archives of Psychiatry and Clinical Neuroscience 257, 309–317.CrossRefGoogle ScholarPubMed
Judy, L, Silberg, J, Meyer, J, Maes, H, Simonoff, E, Pickles, A, Rutter, M, Reynolds, C, Heath, A, Truett, K, Meale, M, Erikson, M, Loeber, R, Hewitt, J (1997). Genetics and developmental psychopathology: 2. The main effects of genes and environment of behavioral problems in the Virginia Twin Study of Adolescent Behavioral Development. Journal of Child Psychology and Psychiatry 38, 965–980.Google Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716–723.CrossRefGoogle ScholarPubMed
Leckman, JF, Sholomskas, D, Thompson, D, Belanger, A, Weissman, MM (1982). Best estimate of lifetime psychiatric diagnosis: a methodological study. Archives of General Psychiatry 39, 879–883.CrossRefGoogle ScholarPubMed
Levy, F, Hay, D, McStephen, M, Wood, C, Waldman, I (1997). Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study. Journal of the American Academy of Child and Adolescent Psychiatry 36, 737–744.CrossRefGoogle ScholarPubMed
May, B, Bos, J (2000). Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes. Journal of Personality Assessment 75, 237–248.CrossRefGoogle ScholarPubMed
Ranseen, JD, Campbell, DA, Baer, RA (1998). NEO PI-R profiles of adults with attention deficit disorder. Assessment 5, 19–24.CrossRefGoogle ScholarPubMed
Robin, AJ, Tzelepis, A, Bedway, M, Gilroy, M, Sparague, D (1998). The empirical study of personality in ADHD adults: a new beginning. ADHD Report 5, 11–15.Google Scholar
Robins, E, Guze, SB (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983–987.CrossRefGoogle ScholarPubMed
Rohde, LA, Biederman, J, Zimmermann, H, Schmitz, M, Martins, S, Tramontina, S (2000). Exploring ADHD age-of-onset criterion in Brazilian adolescents. European Child and Adolescent Psychiatry 9, 212–218.CrossRefGoogle ScholarPubMed
Schaughency, E, McGee, R, Raja, SN, Feehan, M, Silva, PA (1994). Self reported inattention, impulsivity and hyperactivity at ages 15 and 18 in the general population. Journal of the American Academy of Child and Adolescent Psychiatry 33, 173–184.CrossRefGoogle ScholarPubMed
Sherman, D, Iacono, W, McGue, M (1997). Attention deficit hyperactivity disorder dimensions: a twin study of inattention and impulsivity hyperactivity. Journal of the American Academy of Child and Adolescent Psychiatry 36, 745–753.CrossRefGoogle ScholarPubMed
Silberg, J, Rutter, M, Meyer, J, Maes, H, Hewitt, J, Simonoff, E, Pickles, A, Loeber, R (1996). Genetic and environmental influences on the covariation between hyperactivity and conduct disturbance in juvenile twins. Journal of Child Psychology and Psychiatry 37, 803–816.CrossRefGoogle ScholarPubMed
Stevenson, J (1992). Evidence for a genetic etiology in hyperactivity in children. Behavior Genetics 22, 337–344.CrossRefGoogle ScholarPubMed
Svrakic, DM, Whitehead, C, Przybeck, TR, Cloninger, CR (1993). Differential diagnosis of personality disorders by the seven-factor model of temperament and character. Archives of General Psychiatry 50, 991–999.CrossRefGoogle ScholarPubMed
Thapar, A, Hervas, A, McGuffin, P (1995). Childhood hyperactivity scores are highly heritable and show sibling competition effects: twin study evidence. Behavior Genetics 25, 537–544.CrossRefGoogle ScholarPubMed
Willcutt, EG, Pennington, BF, DeFries, JC (2000). Etiology of inattention and hyperactivity/impulsivity in a community sample of twins with learning difficulties. Journal of Abnormal Child Psychology 28, 149–159.CrossRefGoogle Scholar
Willoughby, MT, Curran, PJ, Costello, EJ, Angold, A (2000). Implications of early versus late-onset of attention-deficit/hyperactivity disorder symptoms. Journal of the American Academy of Child and Adolescent Psychiatry 39, 1512–1519.CrossRefGoogle ScholarPubMed