Adult ADHD Underdiagnosed?

Researchers Say Some Criteria for Diagnosis Was Developed for Kids, Not Adults

By Charlene Laino
WebMD Health News

Reviewed By Louise Chang, MD

May 6, 2008 (Washington) — The criteria used to diagnose adult ADHD are outdated, and as a result, many cases could be missed or misdiagnosed, researchers say.

The problem, says James J. McGough, MD, is that the criteria are based in large part on diagnosing attention deficit hyperactivity disorder in school-aged children.

"These may not be the right criteria for identifying adults, who also may be quite impaired," he tells WebMD.

McGough is on a mission to have the criteria updated in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered the bible of mental disorders. But it's not due out until 2012.

McGough is a professor clinical psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior. He lectured on adult ADHD at the annual meeting of the American Psychiatric Association.

Critique of ADHD Criteria

ADHD afflicts about 3% to 5% of school-age children; in 30% to 60% of them, the disorder will persist into adulthood. Overall, more than four in 100 U.S. adults have the disorder, according to McGough.

So what's wrong with the current criteria?

For starters, they state that patients should shows signs of hyperactivity, impulsivity, or inattentive behavior before age 7, he says.

"That's extremely impractical and not based on clinical evidence. Research suggests that the age of onset should be changed to age 16 or 18 years, or abandoned entirely," McGough says.

Also, many symptoms used to diagnose the disease don't apply to adults, he says. For example, one hallmark symptom is "running and climbing incessantly. For adults, better criteria might be frequently driving too fast or having trouble making appointments," he says.

Temple University's David Baron, DO, chairman of the committee that chose which studies to highlight at the meeting, says many adults — and their doctors — don't realize they have ADHD.

"Many other psychiatric disorders such as anxiety and depression come and go, but ADHD is more of a constant," he tells WebMD. "Because of that, people don't label it. Or they dismiss it. They say, 'Oh, I've been this way since the second grade.'"

"I think adult ADHD is underdiagnosed," he says.

Baron says that anyone who suffers from symptoms of ADHD should be checked out by a health care professional with training in the field.

The good news: Once the diagnosis is made, the same drugs used to treat children with ADHD are very effective in adults, he says.

"The drug therapies available now will not just improve symptoms, but also quality of life," Baron says.

SOURCES: American Psychiatric Association 2008 Annual Meeting, Washington, D.C., May 3-8, 2008. James McGough, MD, professor of clinical psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior. David Baron, DO, chairman, American Psychiatric Association program committee; Temple University, Philadelphia.

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