Factors for delayed or omitted diagnostics

• Late or omitted diagnosis in children

Late or omitted diagnosis in children¶

In a larger cohort study, people with ADHD were examined to determine whether their ADHD had been diagnosed early (at 5 to 7 years), late (at 11 to 14 years) or not at all.¹
Factors that were more common with an earlier diagnosis or a diagnosis at all:

• more problems with peers
• Behavioral problems
• emotional problems
• emotional dysregulation
• lower cognitive abilities
• weaker prosocial skills

People diagnosed with ADHD were more likely to be diagnosed with autism, and people with ADHD reported less physical activity.
Diagnosed men had greater emotional dysregulation than undiagnosed men. This correlation was not found in women.

A diagnosis (to be made in itself) was often omitted in the case of

• higher cognitive abilities
  • the higher the talent, the more this can mask an existing ADHD (coping)
• more physical activity
  • Sports are the most effective non-drug treatment for ADHD
• better prosocial skills
• no autism diagnosis
  • although autism was (incorrectly) considered an exclusion criterion for an ADHD diagnosis until the publication of the DSM 5 in 2013
• fewer behavioral problems
• fewer emotional problems
• fewer peer problems
• fewer disciplinary problems

Children from families with ADHD or ASD developed inconspicuously in 50% of cases between the ages of 6 and 12.² If the age by which the first symptoms must have appeared for an ADHD diagnosis is set at 16 years, 99% of people with ADHD are covered, according to one study.³⁴ However, even this would mean that one in every hundred cases of ADHD would still only develop their first symptoms after the age of 16. Assuming a prevalence of 8% for ADHD, this would mean 64,000 people in Germany, and at 5%, 40,000 people would have de novo late-onset ADHD after the age of 16.
It is usually found that at least one symptom was highly pronounced in adolescence.⁵
Barkley rightly points out that brain development is not complete until the mid-20s.
ICD-11 has therefore not correctly defined a hard age limit for the presence of first symptoms for ADHD diagnosis, just as the clinical ADHD diagnostic criteria of ICD-10 did not require this. The contrary criteria of DSM 5 and the research criteria of ICD-10 are therefore outdated.

For more information on late-onset and de-novo-late-onset ADHD, see the section Late Onset ADHD In the article ADHD in adults.