Diagnostic Controversies in Adult Attention Deficit Hyperactivity Disorder

Department of Psychiastry and Biobehavioral Sciences, University of California-Los Angeles, Suite 1414, 300 UCLA Medical Plaza, Los Angeles, CA 90095, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 11/2004; 161(11):1948-56. DOI: 10.1176/appi.ajp.161.11.1948
Source: PubMed


While it is increasingly recognized that attention deficit hyperactivity disorder (ADHD) persists into adulthood, there is no consensus on diagnostic criteria for adult ADHD. In this article the authors describe and contrast competing approaches for diagnosis of adult ADHD used in clinical and research practice.
The authors review the Wender Utah criteria, DSM criteria, and laboratory assessment strategies for adult ADHD. Advantages and disadvantages of each approach are described, and recommendations are made as a basis for clinical assessment and future research.
Both the Wender Utah criteria and DSM-based approaches identify significantly impaired ADHD adults with neurocognitive, biological, and treatment response patterns similar to pediatric ADHD patients. The Wender Utah criteria established the need for retrospective childhood diagnosis and recognize developmental differences in adult symptom expression. The Wender Utah criteria fail to identify patients with predominantly inattentive symptoms, exclude some patients with significant comorbid psychopathology, and diverge significantly from the DSM conception of ADHD. The DSM criteria have never been validated in adults, do not include developmentally appropriate symptoms and thresholds for adults, and fail to identify some significantly impaired adults who are likely to benefit from treatment. There are insufficient scientific data to justify use of laboratory assessment measures, including neuropsychological tests and brain imaging, in diagnosing adult ADHD.
Adult ADHD remains a clinical diagnosis. Clinicians should be flexible in application of the current ADHD criteria to adults. Additional research is required to validate adult diagnostic criteria.

673 Reads
    • "Subjects with significant medical conditions likely to become unstable during the trial or likely to be destabilized by treatment with MPH (for example, cardiovascular disease) were excluded. Whenever possible, the subjects' partners participated in all visits, a procedure employed in the development of the WRAADDS and an approach that has been endorsed by McGough and Barkley (2004). These informants were often able to view more keenly the subjects' behavior and symptoms, as well as treatment response, than were the subjects themselves. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Much recent research describes the importance of emotional symptoms in ADHD. While there is no accepted system for including emotionality in diagnosing ADHD, the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) provides a tool to facilitate this. It assesses a range of adult ADHD symptoms which load on two factors: inattentive and emotional dysregulation. The consistently high inattentive factor was used to define significant elevation on the more variable emotional dysregulation factor (which contains four WRAADDS domains: hyperactivity/restlessness, temper, affective lability, and emotional over-reactivity) allowing the definition of two ADHD diagnostic types. We compared these two types on a broad range of adult subject characteristics, including response to methylphenidate (MPH) treatment assessed during two clinical trials. Marked impairment in three of the four emotional domains reflected a symptom severity level equivalent to that of the inattentive factor. 59 % met this threshold, defining them as ADHD emotion dysregulation presentation, as opposed to 41 % with ADHD inattentive presentation. Cluster analysis validated these groups by generating similar clusters with 85 % agreement regarding membership. ADHD emotional dysregulation presentation subjects showed more childhood ADHD symptoms, adult symptoms of oppositional defiant disorder, and evidence of personality disorder. Both types showed similar improvement during the double-blind MPH arm of the trials and during a 6-month open-label phase. Based on the presence of symptoms of emotional dysregulation, ADHD in adults can be conceptualized as two types. Impairment and comorbidity in adults with ADHD are largely concentrated in ADHD emotional dysregulation presentation patients.
    ADHD Attention Deficit and Hyperactivity Disorders 05/2015; 7(2). DOI:10.1007/s12402-015-0176-z
  • Source
    • "When comorbidities are present in adults with ADHD, ADHD becomes more difficult to diagnose, as the symptom expression varies. Consequently, ADHD is not treated properly, despite deteriorating QOL.28 When adults with ADHD had low self-esteem, depression, oversensitivity, impulsivity, affective instability and uncontrolled anger, these symptoms could be misdiagnosed as borderline personality disorder or bipolar disorder. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective The aim of this study was to investigate whether depressive symptoms affect the relationship between adult attention deficit hyperactivity disorder (ADHD) and the quality of life (QOL) in Korean soldiers. Methods We evaluated past and present symptoms of adult ADHD (the Korean Adult Attention-Deficit/Hyperactivity Disorder Scale and the Wender Utah Rating Scale), depression (the Center for Epidemiological Studies Depression Scale) and QOL (the Korean version of the SmithKline Beecham 'Quality of Life' scale) in 131 soldiers during mental health screenings performed by a local mental health center. A structured equation model using AMOS 19.0 was used to evaluate the mediating effect of depression. Results In our first model (without depressive symptoms), adult ADHD significantly affected QOL (standardized regression weight=-0.51, p<0.01). After depressive symptoms were added to this model, the direct effect of adult ADHD on QOL was not significant (standardized regression weight=0.10, p=0.43). Regarding the indirect effect, adult ADHD significantly affected depression (standardized regression weight=0.78, p<0.01), and depression also affected QOL (standardized regression weight=-0.79, p<0.01). Conclusion Through structural equation modeling, the complete mediation model for the influence of depressive symptoms on ADHD and QOL was confirmed. These findings indicated that it might be important to consider comorbidities, such as depression, when adult ADHD is being evaluated.
    Psychiatry investigation 04/2014; 11(2):131-6. DOI:10.4306/pi.2014.11.2.131 · 1.28 Impact Factor
  • Source
    • "Several reasons may explain why subjects diagnosed with HD at CAMHS are less likely to be followedup in AMHS than subjects without HD at CAMHS. First, although symptoms of inattention, impulsivity, and hyperactivity present differently in adulthood, current diagnostic criteria are geared toward symptom identification during childhood [6] [24] [25]. Second, many adults with hyperactivity are seen by mental health practitioners who are not familiar with the adult presentation of the disorder or are reluctant to diagnose ADHD/HD in adults [1]. "

Show more

Similar Publications

Preview (3 Sources)

673 Reads
Available from