Addressing Diagnosis and Treatment Gaps in Adults With Attention-Deficit/Hyperactivity Disorder

Abstract

Attention-deficit/hyperactivity disorder (ADHD) was originally defined in children but is now recognized to persist into adulthood for some patients. Despite this recognition, adult ADHD remains underdiagnosed. This narrative review describes the negative impact of ADHD across multiple functional domains, diagnostic guidelines for adult ADHD and its clinical features, the importance of screening tools and clinical interviews to help evaluate adults for ADHD, and adult ADHD treatment options. Diagnostic guidelines for ADHD now incorporate adult-specific symptoms and behavioral manifestations, which may aid in diagnosing adult ADHD. However, diagnosis of ADHD is complicated by symptom overlap between ADHD and psychiatric disorders that might be comorbid with ADHD. Screening tools, such as the Adult ADHD Self-Report Screening Scale for DSM-5, can identify adults requiring evaluation for ADHD. However, clinical interviews and longitudinal family histories provide critical information that diagnoses ADHD and differentiates ADHD from psychiatric comorbidities. Various pharmacologic and nonpharmacologic treatments are available for adults diagnosed with ADHD. First-line pharmacologic treatment of ADHD usually consists of treatment with a psychostimulant, and a variety of short-acting and long-acting formulations are available for use in adults. When developing a treatment plan for adults with ADHD, it is important to recognize that the demands of adult life, both at work and at home, necessitate symptom control throughout the entire day and into the evening and indicate that a long-acting medication formulation is often preferable. Furthermore, there are important safety concerns, including the potential for drug dependence and serious cardiovascular events, which must be considered before prescribing stimulants.​.