The Burden of Undiagnosed Adults With Attention-Deficit/Hyperactivity Disorder Symptoms in Japan: A Cross-Sectional Study

Abstract

Background Symptoms experienced by adult patients with attention-deficit/hyperactivity disorder (ADHD) frequently result in functional impairment across academic/occupational functioning, daily life, and social functioning. A substantial proportion of undiagnosed and untreated ADHD has been suggested in Japan. This study aims to better understand the potential undiagnosed ADHD population in Japan by quantifying the burden associated with ADHD symptoms through a comparison of the prevalence of comorbidities, health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), and healthcare resource utilization (HRU) between undiagnosed potential ADHD respondents who were screened positive and negative using Adult ADHD Self-Report Scale (ASRS)-v1.1. Methodology Respondents from Japan National Health and Wellness Survey 2016 who answered ASRS-v1.1 without an ADHD diagnosis were included. Respondents checking ≥4 items from ASRS-A and ≥9 from ASRS-A+B were classified as ASRS A+ (n = 309) and ASRS AB+ (n = 227), respectively. ASRS negative (n = 9,280) were respondents who were neither ASRS A+ nor ASRS AB+. Data on the presence of comorbidities, HRQoL, WPAI, and HRU were compared. Results ASRS A+ and ASRS AB+ respondents reported higher coexistence of mental comorbidities (depression, generalized anxiety disorder, bipolar disorder, obsessive-compulsive disorder, etc.), sleep problems (insomnia, narcolepsy, sleep apnea, etc.), and physical comorbidities (non-alcoholic steatohepatitis, allergy, and asthma). They also reported greater WPAI and HRU and lower HRQoL than matched ASRS-negative respondents. Conclusions A significantly higher burden was identified among undiagnosed adults with potential ADHD symptoms. Appropriate diagnosis may help those at risk or those who present with symptoms overlapping with ADHD.

Keywords: adhd symptoms with comorbidities; asrs; quality of life; resource utilization; undiagnosed adhd; work productivity.

Figure 1. Respondent flow chart.

Screened positive figures using Part A and using Part A+B are not exclusive. A total of 173 respondents were screened positive using both Part A and Part A+B. ASRS-negative are those who were screened negative for both Part A and Part A+B. ADHD: attention-deficit hyperactivity disorder; ASRS-v1.1: Adult ADHD Self-Report Scale version 1.1; NHWS: National Health and Wellness Survey

Figure 2. Crude odds ratio of experiencing selected comorbidities among respondents screened positive using ASRS-v1.1 compared to respondents screened negative.

Error bar represents 95% confidence interval for the crude odds ratio. ASRS-v1.1: Adult ADHD Self-Report Scale version 1.1