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Challenges in Identifying and Managing Attention-Deficit/Hyperactivity Disorder in Adults in the Primary Care Setting: A Review of the Literature

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Challenges in Identifying and Managing Attention-Deficit/Hyperactivity Disorder in Adults in the Primary Care Setting: A Review of the Literature

Larry Culpepper et al. Prim Care Companion J Clin Psychiatry.

Abstract

Objective: To examine how to screen for and establish a correct diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults and to identify the outcomes associated with untreated ADHD.

Data sources: PubMed was searched using the key words ADHD, adult, diagnosis, and primary care from the years 1999 to 2009.

Study selection: This search produced 50 publications.

Data extraction: Publications were screened for data specific to the diagnosis or management of adult patients with ADHD in the primary care setting.

Data synthesis: The estimated prevalence of ADHD in adults throughout the United States is 4.4% or approximately 10 million adults. Adults with ADHD by definition must experience impairment from the symptoms of ADHD in at least 2 areas of their life. Despite significant impairment, only 1 in 10 adults with ADHD have received ADHD treatment within the past year. Given the high rates of undertreatment, primary care physicians, who provide much of the general adult mental health care in the United States, are increasingly charged with making the diagnosis of ADHD in adults. ADHD symptoms are often masked by comorbid psychiatric conditions or patient adaptations such as choice of occupation. One of the ADHD assessment tools, a short 6-item screener, can simplify identification and management of ADHD in adults and help identify which patients may require further evaluation.

Conclusions: Primary care physicians should consult with other members of the health care community such as psychiatrists and psychologists when necessary, but should also develop a level of comfort with diagnosing and treating ADHD.

Figures

Figure 1
Figure 1
Flow of Clinical Experience Relevant to the Recognition of Mental Health Conditions aReprinted with permission from Baik et al.
Figure 2
Figure 2
Adult Self-Report Scale (ASRS) Screenera aReprinted with permission from Kessler et al.

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