Unraveling the phenotypic expression of ADHD symptoms in middle- and older-aged adults: insights from confirmatory factor analysis of the US Health and Retirement Study

Stephen Z Levine; Anat Rotstein; Abraham Reichenberg; Robert B Wallace

doi:10.1017/S0033291725101347

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Unraveling the phenotypic expression of ADHD symptoms in middle- and older-aged adults: insights from confirmatory factor analysis of the US Health and Retirement Study

Journal article

Peer reviewed

Unraveling the phenotypic expression of ADHD symptoms in middle- and older-aged adults: insights from confirmatory factor analysis of the US Health and Retirement Study

Stephen Z Levine, Anat Rotstein, Abraham Reichenberg and Robert B Wallace

Psychological medicine, Vol.55, e225

08/07/2025

DOI: 10.1017/S0033291725101347

PMCID: PMC12360687

PMID: 40772440

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Abstract

Few studies have examined attention-deficit/hyperactivity disorder (ADHD) symptoms in middle- and older-aged adults. We aim to examine the phenotypic expression of ADHD symptoms in these age groups. This study comprised a random sample ( = 1,562) from the US Health and Retirement Study 2016, a representative US sample aged 50 years and over. ADHD symptoms were assessed based on the Adult ADHD Self-Report Scale. In the primary analysis, 10 competing confirmatory factor analytic models of ADHD symptoms in middle- and older-aged adults were compared. The best-fitting model was hierarchical with a general ADHD factor at the apex and underneath symptom factors of inattention, hyperactivity, and impulsivity ( = 319.34, df = 91.71, = 0.00, TLI = 0.98, CFI = 0.96, RMSEA = 0.04, 95% CI = 0.04-0.05). In complementary analyses, this model was a satisfactory fit to the data: (1) in individuals without a history of cognitive impairment or dementia, and when the general ADHD factor was specified to load on (2) cognitive function, (3) depressive symptoms (which showed adequate fit), and (4) ADHD polygenic scores, (5) in middle- and older-aged adults, and (6) when weighted to represent the US population. These results imply a hierarchical representation of ADHD symptoms in middle- and older-aged adults consisting of a general factor at the apex with neurocognitive and genetic correlates and underneath symptom factors of inattention, hyperactivity, and impulsivity. Collectively, this model offers a novel framework to study the mechanisms of ADHD symptoms in middle- and older-aged adults and points to treatment targets.

Aging

Phenotype

Aged

Aged, 80 and over

Attention Deficit Disorder with Hyperactivity - diagnosis

Attention Deficit Disorder with Hyperactivity - epidemiology

Attention Deficit Disorder with Hyperactivity - physiopathology

Factor Analysis, Statistical

Female

Humans

Impulsive Behavior - physiology

Male

Middle Aged

United States - epidemiology

Details

Title: Subtitle: Unraveling the phenotypic expression of ADHD symptoms in middle- and older-aged adults: insights from confirmatory factor analysis of the US Health and Retirement Study
Creators: Stephen Z Levine - University of Haifa
Anat Rotstein - University of Haifa
Abraham Reichenberg - Icahn School of Medicine at Mount Sinai
Robert B Wallace - University of Iowa
Resource Type: Journal article
Publication Details: Psychological medicine, Vol.55, e225
DOI: 10.1017/S0033291725101347
PMID: 40772440
PMCID: PMC12360687
NLM abbreviation: Psychol Med
ISSN: 0033-2917
eISSN: 1469-8978
Publisher: CAMBRIDGE UNIV PRESS
Grant note: University of MichiganNational Institute on Aging: NIA U01AG009740 Ann Arbor, MI
Health and Retirement Study (HRS 2016 Core Final Release (Version 2.0), Module 1, Symptom Prevalence of Adult Attention Deficit Hyperactivity Disorder) public use dataset. Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740). Ann Arbor, MI (2016).
Language: English
Date published: 08/07/2025
Academic Unit: Epidemiology; Injury Prevention Research Center
Record Identifier: 9984944724002771

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