Objective: Despite guidelines providing detailed recommendations for the assessment of ADHD in adults and increasing clinician awareness of the persistence of ADHD into adulthood, ADHD remains under diagnosed in many countries. Method: A survey of 178 clinicians who regularly perform assessments for adult ADHD was conducted between February 2015 and 2016 to identify possible causes of underdiagnosis related to assessment practices. Results: There was a lack of consensus among clinicians regarding which symptoms are relevant to adult ADHD. Only “difficulties concentrating” was endorsed as a core feature of adult ADHD by a majority of respondents. Few clinicians used (semi-)structured interviews. Psychologists were less likely than physicians to recommend medication. Conclusion: Further clinician training on core symptoms of adult ADHD and diagnostic practices congruent with guideline recommendations may improve symptom recognition among clinicians and diagnostic accuracy. Identification of barriers to the implementation of diagnostic practices recommended by guidelines is needed.
AdlerL. A.FaraoneS. V.SpencerT. J.MichelsonD.ReimherrF. W.GlattS. J.. . . BiedermanJ. (2008). The reliability and validity of self- and investigator ratings of ADHD in adults. Journal of Attention Disorders, 11, 711-719. doi:10.1177/1087054707308503
2.
AdlerL. A.ShawD.SittD.MayaE. (2009). Issues in the diagnosis and treatment of adult ADHD by primary care physicians. Primary Psychiatry, 16, 57-64.
3.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
4.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
5.
AragonèsE.Lluís PiñolJ.Ramos-QuirogaJ. A.López-CortacansG.CaballeroA.BoschR. (2010). Prevalence in adults of attention deficit hyperactivity disorder using the medical records of primary care. Revista Espanola de Salud Publica, 84, 417-422.
6.
AshersonP.AkehurstR.KooijJ. J. S.HussM.BeusterienK.SasanéR.. . . HodgkinsP. (2012). Under diagnosis of adult ADHD: Cultural influences and societal burden. Journal of Attention Disorders, 16, 20S-38S. doi:10.1177/1087054711435360
BachmannC. J.PhilipsenA.HoffmannF. (2017). ADHD in Germany: Trends in diagnosis and pharmacotherapy: A country-wide analysis of health insurance data on attention-deficit/hyperactivity disorder (ADHD) in children, adolescents and adults from 2009-2014. Deutsches Ärtzeblatt International, 114, 141-148. doi:10.3238/arz-tebl.2017.0141
9.
BredaV.RohdeL. A.MenezesA. M. B.AnselmiL.CayeA.RovarisD. L.. . . GrevetE. H. (2019). Revisiting ADHD age-of-onset in adults: To what extent should we rely on the recall of childhood symptoms?Psychological Medicine. doi:10.1017/S003329171900076X
10.
BrodM.PohlmanB.LasserR.HodgkinsP. (2012). Comparison of the burden of illness for adults with ADHD across seven countries: A qualitative study. Health and Quality of Life Outcomes, 10, Article 47. doi:10.1186/1477-7525-10-47
De ZwaanM.GrußB.MüllerA.GraapH.MartinA.GlaesmerH.. . . PhilipsenA. (2012). The estimated prevalence and correlates of adult ADHD in a German community sample. European Archives of Psychiatry and Clinical Neuroscience, 262, 79-86. doi:10.1007/s00406-011-0211-9
FaraoneS. V.SpencerT.AleardiM.PaganoC.BiedermanJ. (2004). Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology, 24, 24-29. doi:10.1097/01.jcp.0000108984.11879.95
15.
FayyadJ.SampsonN. A.HwangI.AdamowskiT.Aguilar-GaxiolaS.Al-HamzawiA.. . . KesslerR. C. (2017). The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Attention Deficit and Hyperactivity Disorders, 9, 47-65. doi:10.1007/s12402-016-0208-3
16.
FrenchB.SayalK.DaleyD. (2018). Barriers and facilitators to understanding of ADHD in primary care: A mixed-method systematic review. European Child and Adolescent Psychiatry, 28, 1037-1064. doi:10.1007/s00787-018-1256-3
17.
GoodmanD. W.SurmanC. B.SchererP. B.SalinasG. D.BrownJ. J. (2012). Assessment of physician practices in adult attention-deficit/hyperactivity disorder. The Primary Care Companion for CNS Disorders, 14(4), PCC.11m01312. doi:10.4088/pcc.11m01312
18.
KaramR. G.RovarisD. L.BredaV.PiconF. A.VictorM. M.SalgadoC. A. I.. . . BauC. H. D. (2017). Trajectories of attention-deficit/hyperactivity disorder dimensions in adults. Acta Psychiatrica Scandinavica, 136, 210-219. doi:10.1111/acps.12757
19.
KarlsdotterK.BusheC.HakkaartL.SobanskiE.KanC. C.LebrecJ.. . . DeberdtW. (2016). Burden of illness and health care resource utilization in adult psychiatric outpatients with attention-deficit/hyperactivity disorder in Europe. Current Medical Research and Opinion, 32, 1547-1556. doi:10.1080/03007995.2016.1189892
20.
Kassenärztliche Bundesvereinigung [The National Association of Statutory Health Insurance Physicians]. (2014). Eckpunkte zum AD(H)S-Vertragskonzept. Retrieved from https://www.kbv.de/html/7404.php
21.
KazdinA. E. (2017). Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions. Behaviour Research and Therapy, 88, 7-18. doi:10.1016/j.brat.2016.06.004
22.
KnutsonK. C.O’MalleyM. (2010). Adult attention-deficit/hyperactivity disorder: A survey of diagnosis and treatment practices. Journal of the American Academy of Nurse Practitioners, 22, 593-601. doi:10.1111/j.1745-7599.2010.00546.x
23.
KooijJ. J. S. (2013). Adult ADHD: Diagnostic assessment and treatment (3rd ed.). London, England: Springer-Verlag.
24.
KooijJ. J. S.BijlengaD.SalernoL.JaeschkeR.BitterI.BalázsJ.. . . AshersonP. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14-34.
25.
KooijJ. J. S.FranckenM. H. (2010). Diagnostisches Interview für ADHS bei Erwachsenen [Diagnostic interview ADHD in adults]. DIVA Foundation, Den Haag, Netherlands.
26.
LebowitzM. S. (2016). Stigmatization of ADHD: A developmental review. Journal of Attention Disorders, 20, 199-205. doi:10.1177/1087054712475211
27.
LudererM.Kaplan-WickelN.RichterA.ReinhardI.KieferF.WeberT. (2019). Screening for adult attention-deficit/hyperactivity disorder in alcohol dependent patients: Underreporting of ADHD symptoms in self-report scales. Drug and Alcohol Dependence, 195, 52-58. doi:10.1016/J.DRUGALCDEP.2018.11.020
28.
National Institute for Health and Care Excellence. (2018). Attention deficit hyperactivity disorder: Diagnosis and management [NICE Guideline NG87]. Retrieved from https://www.nice.org.uk/guidance/ng87
29.
PetterssonR.SöderströmS.NilssonK. W. (2018). Diagnosing ADHD in adults: An examination of the discriminative validity of neuropsychological tests and diagnostic assessment instruments. Journal of Attention Disorders, 22, 1019-1031. doi:10.1177/1087054715618788
30.
Ramos-QuirogaJ. A.BoschR.RicharteV.ValeroS.Gómez-BarrosN.NogueiraM.. . . CasasM. (2012). Criterion and concurrent validity of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) Spanish version. Revista de Psiquiatría y Salud Mental, 5, 229-235. doi:10.1016/J.RPSMEN.2012.05.002
31.
Ramos-QuirogaJ. A.NasilloV.RicharteV.CorralesM.PalmaF.IbáñezP.. . . KooijJ. J. S. (2019). Criteria and concurrent validity of DIVA 2.0: A semi-structured diagnostic interview for adult ADHD. Journal of Attention Disorders, 23, 1126-1135. doi:10.1177/1087054716646451
32.
SalehA.FuchsC.TaylorW. D.NiarhosF. (2018). Evaluating the consistency of scales used in adult attention deficit hyperactivity disorder assessment of college-aged adults. Journal of American College Health, 66, 98-105. doi:10.1080/07448481.2017.1377206
33.
SchlanderM.SchwarzO.TrottG. E.ViapianoM.BonauerN. (2007). Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)? Insights from Nordbaden (Germany) on administrative prevalence and physician involvement in health care provision. European Child and Adolescent Psychiatry, 16, 430-438. doi:10.1007/s00787-007-0616-1
34.
SchneiderB. C.ThoeringT.CludiusB.MoritzS. (2015). Self-reported symptoms of attention-deficit/hyperactivity disorder: Rate of endorsement and association with neuropsychological performance in an adult psychiatric sample. Archives of Clinical Neuropsychology, 30, 186-191. doi:10.1093/arclin/acv015
35.
SibleyM. H.PelhamW. E.MolinaB. S. G.GnagyE. M.WaxmonskyJ. G.WaschbuschD. A.. . . KuriyanA. B. (2012). When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. Journal of Consulting and Clinical Psychology, 80, 1052-1061. doi:10.1037/a0029098
36.
SibleyM. H.SwansonJ. M.ArnoldL. E.HechtmanL. T.OwensE. B.StehliA.. . . SternK. (2017). Defining ADHD symptom persistence in adulthood: Optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58, 655-662. doi:10.1111/jcpp.12620
37.
ThomasM.RostainA.CorsoR.BabcockT.MadhooM. (2015). ADHD in the college setting: Current perceptions and future vision. Journal of Attention Disorders, 19, 643-654. doi:10.1177/1087054714527789
38.
ZhuY.LiuW.LiY.WangX.WintersteinA. G. (2018). Prevalence of ADHD in publicly insured adults. Journal of Attention Disorders, 22, 182-190. doi:10.1177/1087054717698815
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