Skip to main content
    • Aa
    • Aa

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

  • S. V. Faraone (a1), A. Kunwar (a1), J. Adamson (a2) and J. Biederman (a2)

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.


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.


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.


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.

Corresponding author
*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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

H Anckarsater , O Stahlberg , T Larson , C Hakansson , SB Jutblad , L Niklasson , A Nyden , E Wentz , S Westergren , CR Cloninger , C Gillberg , M Rastam (2006). The impact of ADHD and autism spectrum disorders on temperament, character, and personality development. American Journal of Psychiatry 163, 12391244.

B Applegate , B Lahey , E Hart , J Biederman , G Hynd , R Barkley , T Ollendick , P Frick , L Greenhill , K McBurnett , J Newcorn , L Kerdyk , B Garfinkel , I Waldman , D Shaffer (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, 12111221.

RA Barkley , J Biederman (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, 12041210.

RA Barkley , M Fischer , L Smallish , K Fletcher (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, 279289.

J Biederman , SV Faraone , AE Doyle , BK Lehman , I Kraus , J Perrin , MT Tsuang (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, 12411251.

J Biederman , SV Faraone , E Mick , P Moore , E Lelon (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, 734742.

J Biederman , E Mick , SV Faraone (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry 157, 816818.

J Biederman , C Petty , R Fried , J Fontanella , AE Doyle , LJ Seidman , SV Faraone (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, 240246.

J Biederman , CR Petty , R Fried , AE Doyle , T Spencer , LJ Seidman , L Gross , K Poetzl , SV Faraone (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, 129136.

H Bird , G Canino , M Gould , J Ribera , M Rubio-Stipec , M Woodbury , H Huertas-Goldman , M Sesman (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, 207213.

M Boyle , D Offord , Y Racine , P Szatmari , M Sanford , J Fleming (1997). Adequacy of interviews vs checklists for classifying childhood psychiatric disorder based on parent reports. Archives of General Psychiatry 54, 793799.

W Chen , S Faraone , J Biederman , M Tsuang (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, 10171025.

C Cloninger , R Adolfsson , N Svrakic (1996). Mapping genes for human personality. Nature Genetics 12, 34.

CR Cloninger (1987). Neurogenetic adaptive mechanisms in alcoholism. Science 236, 410416.

CR Cloninger , TR Przybeck , DM Svrakic (1991). The tridimensional personality questionnaire: U.S. normative data. Psychological Reports 69, 10471057.

K Downey , CS Pomerleau , OF Pomerleau (1996). Personality differences related to smoking and adult attention deficit hyperactivity disorder. Journal of Substance Abuse 8, 129135.

K Downey , F Stelson , O Pomerleau , B Giordiani (1997). Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical population. Journal of Nervous and Mental Disease 185, 3238.

C Edelbrock (1986). Behavioral ratings of children diagnosed for attention deficit disorder. Psychiatric Annals 16, 3640.

C Edelbrock , R Rende , R Plomin , LA Thompson (1995). A twin study of competence and problem behavior in childhood and early adolescence. Journal of Child Psychology and Psychiatry 36, 775785.

SV Faraone (2000). Attention deficit hyperactivity disorder in adults: implications for theories of diagnosis. Current Directions in Psychological Science 9, 3336.

SV Faraone (2004). Genetics of adult attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America 27, 303321.

SV Faraone , J Biederman (2005). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. Journal of Attention Disorders 9, 384391.

SV Faraone , J Biederman , AE Doyle , K Murray , C Petty , J Adamson , L Seidman (2006 b). Neuropsychological studies of late-onset and subthreshold diagnoses of adult ADHD. Biological Psychiatry 60, 10811087.

SV Faraone , J Biederman , T Spencer , T Wilens , LJ Seidman , E Mick , AE Doyle (2000). Attention deficit hyperactivity disorder in adults: an overview. Biological Psychiatry 48, 920.

SV Faraone , J Biederman , TJ Spencer , E Mick , K Murray , C Petty , JJ Adamson , MC Monuteaux (2006 c). Diagnosing adult attention deficit hyperactivity disorder: are late-onset and subthreshold diagnoses valid? American Journal of Psychiatry 163, 17201729.

SV Faraone , T Spencer , CB Montano , J Biederman (2004 b). Attention deficit hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care. Archives of Internal Medicine 164, 12211226.

SV Faraone , TE Wilens , C Petty , K Antshel , T Spencer , J Biederman (2007 b). Substance use among ADHD adults: implications of late-onset and subthreshold diagnoses. American Journal on Addictions 16, 2434.

H Gjone , J Stevenson , J Sundet (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, 588598.

R Goodman , J Stevenson (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, 671689.

R Goodman , J Stevenson (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, 691709.

CP Jacob , J Romanos , A Dempfle , M Heine , C Windemuth-Kieselbach , A Kruse , A Reif , S Walitza , M Romanos , A Strobel , B Brocke , H Schafer , A Schmidtke , J Boning , KP Lesch (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, 309317.

RC Kessler , L Adler , R Barkley , J Biederman , CK Conners , O Demler , SV Faraone , LL Greenhill , MJ Howes , K Secnik , T Spencer , TB Ustun , EE Walters , AM Zaslavsky (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716723.

JF Leckman , D Sholomskas , D Thompson , A Belanger , MM Weissman (1982). Best estimate of lifetime psychiatric diagnosis: a methodological study. Archives of General Psychiatry 39, 879883.

F Levy , D Hay , M McStephen , C Wood , I Waldman (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, 737744.

B May , J Bos (2000). Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes. Journal of Personality Assessment 75, 237248.

JD Ranseen , DA Campbell , RA Baer (1998). NEO PI-R profiles of adults with attention deficit disorder. Assessment 5, 1924.

E Robins , SB Guze (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983987.

LA Rohde , J Biederman , H Zimmermann , M Schmitz , S Martins , S Tramontina (2000). Exploring ADHD age-of-onset criterion in Brazilian adolescents. European Child and Adolescent Psychiatry 9, 212218.

E Schaughency , R McGee , SN Raja , M Feehan , PA Silva (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, 173184.

D Sherman , W Iacono , M McGue (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, 745753.

J Silberg , M Rutter , J Meyer , H Maes , J Hewitt , E Simonoff , A Pickles , R Loeber (1996). Genetic and environmental influences on the covariation between hyperactivity and conduct disturbance in juvenile twins. Journal of Child Psychology and Psychiatry 37, 803816.

J Stevenson (1992). Evidence for a genetic etiology in hyperactivity in children. Behavior Genetics 22, 337344.

DM Svrakic , C Whitehead , TR Przybeck , CR Cloninger (1993). Differential diagnosis of personality disorders by the seven-factor model of temperament and character. Archives of General Psychiatry 50, 991999.

A Thapar , A Hervas , P McGuffin (1995). Childhood hyperactivity scores are highly heritable and show sibling competition effects: twin study evidence. Behavior Genetics 25, 537544.

EG Willcutt , BF Pennington , JC DeFries (2000). Etiology of inattention and hyperactivity/impulsivity in a community sample of twins with learning difficulties. Journal of Abnormal Child Psychology 28, 149159.

MT Willoughby , PJ Curran , EJ Costello , A Angold (2000). Implications of early versus late-onset of attention-deficit/hyperactivity disorder symptoms. Journal of the American Academy of Child and Adolescent Psychiatry 39, 15121519.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 6
Total number of PDF views: 52 *
Loading metrics...

Abstract views

Total abstract views: 374 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th March 2017. This data will be updated every 24 hours.