Underdiagnosis of Attention-Deficit/Hyperactivity Disorder in Adult Patients

Abstract

Objective: To raise awareness of attention-deficit/hyperactivity disorder (ADHD) as an underdiagnosed, undertreated, often comorbid, and debilitating condition in adults.Data Sources: PubMed was searched using combinations of keywords, including ADHD, adult, diagnosis, identify, prevalence, and comorbid, to find articles published between 1976 and 2013.Study Selection: In total, 99 articles were selected for inclusion on the basis of their relevance to the objective and importance to and representation of ADHD research, including international guidelines for adults with ADHD.Results: 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.

Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients

“…Interpersonal relations (at work, in social situations or with relatives) are poor, often confrontational, and marked by a large degree of incomprehension. ADHD patients have thus greater professional instability, fewer work perspectives, and a lower financial income than control subjects Doshi et al, 2012;Ginsberg et al, 2014). Regarding family and attachment relations, those difficulties generate higher divorce rates than the general population.…”

“…It is estimated that 2.5-5% of the general adult population suffer from this disorder (Fayyad et al, 2007;Ginsberg et al, 2014;Kessler et al, 2006;Simon et al, 2009). The diagnosis is harder to establish for adults than it is with children since it shares numerous symptoms with other psychiatric pathologies (Ginsberg et al, 2014). Emotional dysregulation can be defined by excessive expression and experience of emotions with rapid and poorly controlled shift in emotions and abnormal allocation of attention to emotional stimuli.…”

Inter-hemispherical asymmetry in default-mode functional connectivity and BAIAP2 gene are associated with anger expression in ADHD adults

“…It has a prevalence of 5-8% in childhood (Bush, 2010), and persists in adulthood in 60% of the cases with an established prevalence of 2.5-4.9%, (Simon et al, 2009). Depending on the presence and severity of ADHD cardinal symptoms (i.e., hyperactivity, impulsiveness and inattention), predominantly hyperactive/impulsive, inattentive and combined subtypes have been described Fried et al, 2006;Babinski et al, 2011;Doshi et al, 2012;Chang et al, 2014;Ginsberg et al, 2014). Moreover, the poor regulation of emotions defines an additional dimension in ADHD characterized by a difficulty to control anger and tolerate frustration (Shaw et al, 2014).…”

Psychometric properties of the Turkish version of the Adult ADHD Self-Report Scale (ASRS-v1.1) in a sample of Inpatients with alcohol use disorder

“…Since ADHD is an underdiagnosed and undertreated debilitating condition in adults with AUD, addiction psychiatrists should familiarize themselves with the symptoms of ADHD in adults with AUD in order to diagnose and manage ADHD and addiction in these patients appropriately (41). Unfortunately, screening for adult ADHD is not a routine practice in drug and alcohol treatment services (42).…”