By Mary Fetzer
A recent study in the journal JAMA Network Open found that, in the United States, diagnoses of ADHD in adults have increased significantly and are growing at a rate four times faster than diagnoses of ADHD in children. Currently, however, practice guidelines — research-based recommendations for doctors and other healthcare professionals on how to diagnose and treat a medical condition — exist only for childhood ADHD. To address this, the American Society of ADHD and Related Disorders is writing the nation’s first authoritative guidelines for adult ADHD.
ADHD is not just for children
ADHD is characterized by a pattern of symptoms — inattention, impulsivity and, in some cases, hyperactivity — that may occur individually or together. These symptoms are evident in both children and adults with ADHD. But how they are expressed differs from one person to another, which make diagnoses challenging.
Until the mid-1990s, experts thought that children with ADHD would outgrow their symptoms. But as diagnoses of childhood ADHD increased, so did the public’s awareness of ADHD symptoms. More adults, recognizing their own symptoms, began seeking diagnosis and treatment for themselves.
Adult ADHD — for people ages 17 and older — was added to the updated version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) that was released in 1994. The manual (the latest version is now DSM-5) provides the criteria for a clinician to use to diagnose metal health conditions.
But formal practice guidelines for diagnosing adult ADHD do not exist. Because of that, medical providers — young and old alike — may not have the knowledge they need to diagnose and treat the adult population for ADHD.
ADHD in adults may be both overdiagnosed and underdiagnosed
Adults with untreated ADHD can develop co-occurring conditions, such as depression, anxiety or substance use disorder. They have a high risk of dropping out of school, losing their job, getting into debt and getting divorced. But to be treated, a person must first be diagnosed.
While some research has suggested the possibility that ADHD is being overdiagnosed in adults, other research suggests that ADHD in adults is being misdiagnosed or missed altogether, and that fewer than 20% of individuals with ADHD are diagnosed and treated.
The American Society of ADHD and Related Disorders has appointed a special committee, which includes national and international ADHD researchers and clinicians, to create diagnostic guidelines for adult ADHD. Frances R. Levin, a professor of psychiatry at Columbia University, will serve as co-chair of the committee.
“It’s difficult to get a clear picture of how many individuals in this country fit a clinical definition for ADHD when there are no U.S. guidelines for diagnoses and evaluation of ADHD in adults,” Levin says in an interview with Columbia Psychiatry News.
What will the new guidelines look like?
The group’s new guidelines will be based on a 2019 study that evaluated metrics for assessing quality care for diagnosing and treating ADHD in adults. The guidelines will also be driven by the recommendations of hundreds of ADHD experts in collaboration with professional organizations.
Levin tells Columbia Psychiatry News that diagnosing adult ADHD is a complex process because it expresses differently from one patient to another, and symptoms can range from mild to severe. Additionally, adults with ADHD may have learned to cope with or mask their symptoms, which can further complicate the diagnosis process. The assessment must include a thorough medical history, an evaluation of potential co-occurring conditions — such as coexisting psychiatric disorders or substance abuse — and input from family members.
“We expect the guidelines will be accessible and useful for the primary care practitioners and mental health specialists later this year,” she says in the interview.
Levin adds: “Primary care practices are typically the first point of contact when adults with ADHD need care, and the creation of uniform standards will address a critical need for health providers, patients and the public.”