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Letter to the Editor   |    
Increasing the Age at Onset for ADHD?
Allen Frances, M.D.
Am J Psychiatry 2010;167:718-718. doi:10.1176/appi.ajp.2010.10010097
View Author and Article Information
Coronado, Calif.

The author receives royalties from American Psychiatric Publishing for a DSM—IV guidelines book.

Accepted March , 2010.

Copyright © American Psychiatric Association

To the Editor: In their commentary, published in the January 2010 issue of the Journal, Christian Kieling, M.D., et al. (1) presented the rationale for a DSM—5 proposal to increase the required age at onset for attention deficit hyperactivity disorder (ADHD) from age 7 years to 12 years. Unfortunately, the commentary did not include a risk/benefit analysis. The authors focus only on the benefit of reducing false negatives and ignore the considerable risk that eliminating this age of onset gatekeeper will result in a flood of new false positives for a diagnosis that may already be quite overinclusive.

Especially in adolescents and adults, real or perceived attention problems are so common and so nonspecific that ADHD can be easily overdiagnosed in those suffering from any number of other mental disorders and in those who are merely seeking performance enhancement (26).

Kieling  C;  Kieling  RR;  Rohde  LA;  Frick  PJ;  Moffitt  T;  Nigg  JT;  Tannock  R;  Castellanos  FX:  The age at onset of attention deficit hyperactivity disorder.  Am J Psychiatry 2010; 167:14—15
[CrossRef] | [PubMed]
 
Visser  S;  Lesesne  C:  Mental health in the United States: prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder: United States, 2003.  JAMA 2005; 294:2293—2296
 
Faraone  S;  Sergeant  J;  Gillberg  C;  Biederman  J:  The worldwide prevalence of ADHD: Is it an American condition? World Psychiatry 2003; 2:104—113
[PubMed]
 
Olfson  M;  Gameroff  M;  Marcus  S;  Jensen  P:  National trends in the treatment of attention deficit hyperactivity disorder.  Am J Psychiatry 2003; 160:1071—1077
[CrossRef] | [PubMed]
 
Bogle  K;  Smith  B:  Illicit methylphenidate use: a review of prevalence, availability, pharmacology, and consequences.  Curr Drug Abuse Rev 2009; 2:157—176
[CrossRef] | [PubMed]
 
Wilens  T;  Adler  L;  Adams  J;  Sgambati  S;  Rotrosen  J;  Sawtelle  R;  Utzinger  L;  Fusillo  S:  Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature.  J Am Acad Child Adolesc Psychiatry 2008; 47:21—31
[CrossRef] | [PubMed]
 
References Container
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References

Kieling  C;  Kieling  RR;  Rohde  LA;  Frick  PJ;  Moffitt  T;  Nigg  JT;  Tannock  R;  Castellanos  FX:  The age at onset of attention deficit hyperactivity disorder.  Am J Psychiatry 2010; 167:14—15
[CrossRef] | [PubMed]
 
Visser  S;  Lesesne  C:  Mental health in the United States: prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder: United States, 2003.  JAMA 2005; 294:2293—2296
 
Faraone  S;  Sergeant  J;  Gillberg  C;  Biederman  J:  The worldwide prevalence of ADHD: Is it an American condition? World Psychiatry 2003; 2:104—113
[PubMed]
 
Olfson  M;  Gameroff  M;  Marcus  S;  Jensen  P:  National trends in the treatment of attention deficit hyperactivity disorder.  Am J Psychiatry 2003; 160:1071—1077
[CrossRef] | [PubMed]
 
Bogle  K;  Smith  B:  Illicit methylphenidate use: a review of prevalence, availability, pharmacology, and consequences.  Curr Drug Abuse Rev 2009; 2:157—176
[CrossRef] | [PubMed]
 
Wilens  T;  Adler  L;  Adams  J;  Sgambati  S;  Rotrosen  J;  Sawtelle  R;  Utzinger  L;  Fusillo  S:  Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature.  J Am Acad Child Adolesc Psychiatry 2008; 47:21—31
[CrossRef] | [PubMed]
 
References Container
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