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Revisiting ADHD age-of-onset in adults: to what extent should we rely on the recall of childhood symptoms?

Published online by Cambridge University Press:  10 April 2019

V. Breda Open the ORCID record for V. Breda [Opens in a new window] ,
L. A. Rohde Open the ORCID record for L. A. Rohde [Opens in a new window] ,
A. M. B. Menezes ,
L. Anselmi ,
A. Caye ,
D. L. Rovaris ,
E. S. Vitola ,
C. H. D. Bau  and
E. H. Grevet Open the ORCID record for E. H. Grevet [Opens in a new window]
V. Breda
Affiliation:
ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
L. A. Rohde
Affiliation:
Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil National Institute of Developmental Psychiatry for Children and Adolescents, Brazil
A. M. B. Menezes
Affiliation:
Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
L. Anselmi
Affiliation:
Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
A. Caye
Affiliation:
Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
D. L. Rovaris
Affiliation:
ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
E. S. Vitola
Affiliation:
ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
C. H. D. Bau
Affiliation:
ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
E. H. Grevet*
Affiliation:
ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
*
Author for correspondence: E. H. Grevet, E-mail: [email protected]
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Abstract

Background

ADHD diagnosis requires the presence of symptoms before the age of twelve. In clinical assessment of adults, the most frequent strategy to check this criterion is investigating self-report recall of symptoms, despite little evidence on the validity of this approach. We aim to evaluate the recall accuracy and factors associated with its reliability in a large population-based sample of adults.

Methods

Individuals from the 1993 Pelotas Birth Cohort were followed-up from childhood to adulthood. At the age of 22, 3810 individuals were assessed through structured interviews by trained psychologists regarding mental health outcomes, including ADHD diagnosis and ADHD symptoms in childhood. The retrospective recall was compared with available information on ADHD childhood symptoms at the age of eleven. We also assessed factors related to recall accuracy through multiple regression analyses.

Results

Self-reported recall of childhood symptoms at 22 years of age had an accuracy of only 55.4%, with sensitivity of 32.8% and positive predictive value of 40.7%. Current inattention symptoms were associated with lower risk and social phobia with higher risk for false-positive endorsement, while higher levels of schooling correlated with lower risk and male gender with higher risk for false-negative endorsement.

Conclusions

Clinicians treating male patients with social phobia and ADHD symptoms should assess even more carefully retrospective recall of ADHD childhood symptoms. Moreover, characteristics associated with recall improvement do not impact accuracy robustly. In this context, the recall of childhood ADHD symptoms seems an unreliable method to characterize the neurodevelopmental trajectory in adults with currently-impairing ADHD symptomatology.

Keywords

Adultage-of-onset criterionattention deficit/hyperactivity disorderdiagnosisrecall
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 5 , April 2020 , pp. 857 - 866
Copyright
Copyright © Cambridge University Press 2019

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