Underdiagnosis of Attention-Deficit/Hyperactivity Disorder in Adult Patients

Summary & key facts

This review found that ADHD often continues from childhood into adulthood but is commonly missed and untreated in grown-ups. It estimates adult ADHD affects about 2.5%–5% of the general population and says fewer than 20% of adults with ADHD are diagnosed or treated. Adults with ADHD often have other mental health problems, and treating ADHD (with some approved medicines and psychotherapy) can improve symptoms and daily functioning.

Key facts:

• The authors reviewed 99 articles published from 1976 to 2013 to draw their conclusions.
• Between about one-third and two-thirds of children with ADHD have symptoms that persist into adulthood (reported range: ~33%–66%).
• Reported prevalence is about 2.5%–5% of adults, compared with about 5%–7% of children.
• Fewer than 20% of adults with ADHD are currently diagnosed and/or treated by psychiatrists, according to the review.
• High rates of ADHD have been reported in specific groups: up to 40% of imprisoned men, and 17%–22% of adults attending psychiatric outpatient clinics for conditions other than ADHD.
• ADHD commonly occurs with other psychiatric disorders such as major depressive disorder, anxiety disorders, and substance use disorders; adults are more likely to seek treatment for those comorbid conditions than for ADHD itself.
• The review notes that untreated ADHD in adults who have psychiatric comorbidities is linked to worse clinical and functional outcomes, even if the comorbid conditions are treated.
• Studies cited in the review suggest treatment with ADHD medications was associated with reduced criminality risk rates of about 32%–41% in a sample of 25,656 patients, and combined medication plus psychotherapy has shown benefits for sympto
• The DSM-5 changes are noted: for people aged 17 and older the symptom threshold was lowered to 5 of 9 criteria in each symptom domain and examples for adults were added, because applying child-focused criteria to adults can lead to underdia

Abstract

In a large proportion of children with ADHD, symptoms persist into adulthood. However, although adults with ADHD often experience chaotic lifestyles, with impaired educational and vocational achievement and higher risks of substance abuse and imprisonment, many remain undiagnosed and/or untreated. ADHD is usually accompanied by other psychiatric comorbidities (such as major depressive disorder, anxiety disorder, and alcohol abuse). Indeed, adults with ADHD are more likely to present to a psychiatric clinic for treatment of their comorbid disorders than for ADHD, and their ADHD symptoms are often mistaken for those of their comorbidities. Untreated ADHD in adults with psychiatric comorbidities leads to poor clinical and functional outcomes for the patient even if comorbidities are treated. Effective treatment of adults' ADHD improves symptoms, emotional lability, and patient functioning, often leading to favorable outcomes (eg, safer driving, reduced criminality). A few medications have now been approved for use in adults with ADHD, while a multimodal approach involving psychotherapy has also shown promising results. Conclusions General psychiatrists should familiarize themselves with the symptoms of ADHD in adults in order to diagnose and manage ADHD and comorbidities appropriately in these patients.

Topics

Attention Deficit Hyperactivity Disorder Autism Spectrum Disorder Research Functional Brain Connectivity Studies

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Anxiety Attention deficit hyperactivity disorder Clinical psychology Comorbidity Medicine Psychiatry Psychology Substance abuse