Adult ADHD: Diagnostic and treatment challenges
Childhood ADHD lasts into adulthood
Once thought only to affect children, attention-deficit hyperactivity disorder (ADHD) is now known to persist into adulthood.1-3 Almost half (46%) of adults who had ADHD as children continue to have symptoms of the disorder as they age, with almost all of them (95%) experiencing attention-deficit symptoms and about 35% of them experiencing hyperactivity-impulsivity symptoms.4
Although the disease is highly treatable, 90% of those with symptoms of ADHD are untreated and continue to have major impairments in multiple domains of functioning.5 In a survey of 500 adults diagnosed with ADHD that compared their functioning with a comparable non-ADHD sample representative of the U.S. population, adults with ADHD were significantly:6
- Less likely to have graduated high school (83% vs. 93% of controls; P≤0.001), obtained a college degree (19% vs. 26%; P<0.01), be currently employed (52% vs. 72%; P≤0.001), and satisfied with their lives in general (P≤0.001)
- More likely to have multiple job changes (5.4 vs. 3.4 jobs over 10 years), to have been arrested, (37% vs. 18%), and to have been divorced (28% vs. 15%; P≤0.001 for all comparisons).
Comorbidities can complicate the diagnostic picture
Because no objective, laboratory-based tests exist that can establish a clinical diagnosis of adult ADHD, and because ADHD is often comorbid with other psychiatric problems,7 the DSM-IV, is used to evaluate adult patients who exhibit ADHD-like symptoms. Diagnostic indicators include the results of a clinical interview, rating scales to assess current symptoms, reports from parents, siblings, or significant others about childhood or adulthood behaviors and poor psychosocial outcomes (eg, relationship problems, employment gaps).
Adults with ADHD often have DSM-IV comorbidities, which blur ADHD symptoms, making diagnosis and treatment difficult. The National Comorbidity Survey Replication (NCSR) study, a nationally representative household survey that assessed 3,199 people ages 18–44 years showed that of adults with ADHD:5
- Almost 1 in 2 also had an anxiety disorder, typically social phobia
- Over 1 in 3 had a coexisting mood disorder, mainly depression and bipolar disease
- One in 5 had intermittent explosive disorder
- Almost 1 in 6 had a substance use disorder
Thus, adults presenting with ADHD symptoms, or any concurrent psychiatric symptoms, should receive a full spectrum clinical interview to unveil comorbidities.