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: 13.56). 11/2004; 161(11):1948-56. DOI: 10.1176/appi.ajp.161.11.1948
Source: PubMed

ABSTRACT 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.

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Available from: Russell A Barkley, Jan 21, 2014
    • "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. "
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    ADHD Attention Deficit and Hyperactivity Disorders 05/2015; 7(2). DOI:10.1007/s12402-015-0176-z
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    • "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]. "
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    • "This includes efforts to consider how best to identify and describe adult ADHD (e.g. McGough & Barkley, 2004; Faraone, Biederman & Spencer, 2010). It makes sense that, in conjunction with a basic tendency to argue and act in defiance, a failure to think through to likely outcomes and to act impulsively rather than deliberately may lead to difficulties finding appropriate interpersonal negotiation strategies that work or being able to give thought as to why past strategies have not been successful. "
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