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ADHD IN ADULTS OFTEN
REMAINS UNDIAGNOSED

With potential negative effects on patients’ lives.

ADHD symptoms may interfere with social and occupational functioning.1,2

ADHD in Lifestages

ADHD symptoms logo

IN 50%-66% OF CASES, THE SYMPTOMS OF ADHD

may continue from childhood
to adulthood.3-5

ADHD diagnosis logo

YET, MANY ADULTS WITH ADHD MAY NOT RECEIVE A
DIAGNOSIS.6-9

Estimated prevalence in US adults is 4.4% or ~10.5 MILLION.*9,10

*Based on the National Comorbidity Survey Replication of 3,199 adults aged 18 to 44 years conducted from 2001 to 2003. Data extrapolated to the full US population in 2011 aged 18 years and older.

SYMPTOMS OF ADHD MAY MANIFEST DIFFERENTLY AS PATIENTS AGE1,11,12

CHILDHOOD

School-aged children may often have difficulty remaining seated or squirm in their seats

LATE CHILDHOOD/
EARLY ADOLESCENCE

Overt behavioral symptoms usually become less conspicuous

Excessive gross motor activity may be less common

Hyperactivity may be confined to fidgetiness or an inner feeling of jitteriness or restlessness selecting a very active job or being a workaholic

LATE ADOLESCENCE/
ADULTHOOD

Motor hyperactivity attenuates, although a subgroup experience the full complement of ADHD symptoms into mid-adulthood

Hyperactivity can often take the form of feelings of restlessness.

These are not all of the symptoms of ADHD, according to DSM-5® criteria. Diagnosis should be based on a complete history and evaluation of the patient.

Seeking Diagnosis

ADHD in adulthood may cause patients to experience impairment in their home, social, and work life.1

ADHD IN ADULTS MAY NEGATIVELY IMPACT QUALITY OF LIFE13

In a case-controlled family study, adults with ADHD (n=150) reported significantly lower quality of life compared to non-ADHD control participants (n=134), based on Q-LES-QSF maximum percentage scores (59.2% vs. 76.5%).

Q-LES-QSF=Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form
Based on a 2008 study evaluating adults with ADHD based on DSM-IV® criteria aged 18-55 years compared to non-ADHD controls using the Q-LES-QSF, an extensively used 16-item questionnaire that assesses quality of life in several domains.

48% of adults

One study estimated that up to 48% of adults who meet criteria for ADHD may fail to have a conversation about their symptoms with a healthcare provider14‡

Proportion estimated from a cumulative lifetime probability curve in a weighted number of respondents with a lifetime history of ADHD (n=253) using data collected from the National Comorbidity Survey Replication of 9,282 adults aged 18 to 44 years conducted from 2000 to 2003. These individuals met the criteria for ADHD according to the World Mental Health-Composite Internal Diagnostic Interview (WMH-CIDI).14

A Neurodevelopmental Disorder

ADHD & THE BRAIN

Similar regions of the brain are involved in psychiatric disorders and ADHD. The exact cause of ADHD is unknown, but research suggests several factors are associated with ADHD, including neurobiology, genetics, and environment. The exact nature and functional significance of its possible etiology is still under debate.15,16

NEUROBIOLOGY

ADHD is thought to be associated with dysregulation of various regions in the prefrontal cortex (PFC).17-20

Other brain regions may be involved in the pathophysiology of ADHD.

Norepinephrine (NE) and dopamine (DA) play a critical role in PFC function§18,21

NE enhances PFC function by increasing appropriate signals18,21

DA enhances PFC function by decreasing inappropriate signals or "noise"18,21

Norepinephrine (NE), dopamine (DA), and the postsynaptic neuron.

Insufficient NE and DA levels, which impair PFC function, have been associated with symptoms of ADHD.17,22

§Other neurotransmitters may be involved in the pathophysiology of ADHD.

The exact cause of ADHD is unknown.

QandADHD Fact Sheet

Use the QandADHD Fact Sheet for a deeper look at how your patients’ ADHD symptoms extend beyond the workday.

Get the Fact Sheet

References:

  1. American Psychiatric Association. Attention-deficit/hyperactivity disorder. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
  2. Goodman DW, Lasser RA, Babcock T, Pucci ML, Solanto MV. Managing ADHD across the lifespan in the primary care setting. Postgrad Med. 2011;123(5):14-26. doi:10.3810/pgm.2011.09.2456.
  3. Lara C, Fayyad J, de Graaf R, et al. Childhood predictors of adult attention-deficity/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry. 2009;65(1):46-54.
  4. Ebejer JL, Medland SE, van der Werf J, et al. Attention deficit hyperactivity disorder in Australian adults: prevalence, persistence, conduct problems and disadvantage. PLoS One. 2012;7(10):e47404.
  5. Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol. 2002;111(2):279-289.
  6. Asherson P, Akehurst R, Kooij JJ, et al. Underdiagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord. 2012;16(5 Suppl):20S-38S.
  7. Feifel D, MacDonald K. Attention-deficit/hyperactivity disorder in adults: recognition and diagnosis of this often-overlooked condition. Postgrad Med. 2008;120(3):39-47.
  8. Kooij JJ, Huss M, Asherson P, et al. Distinguishing comorbidity and successful management of adult ADHD. J Atten Disord. 2012;16(5 Suppl):3S-19S.
  9. Newcorn JH, Weiss M, Stein MA. The complexity of ADHD: diagnosis and treatment of the adult patient with comorbidities. CNS Spectr. 2007;12(8 Suppl 12):1-14.
  10. US Census Bureau, Population Division. Annual estimates of the resident population for selected age groups by sex and age for the United States: April 1, 2010 to July 1, 2011. May 2012.
  11. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157:816-818.
  12. Culpepper L, Mattingly G. A practical guide to recognition and diagnosis of ADHD in adults in the primary care setting. Postgrad Med. 2008;120(3):16-26.
  13. Mick E, Faraone SV, Spencer T, Zhang HF, Biederman J. Assessing the validity of the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form in adults with ADHD. J Atten Disord. 2008;11(4):504-509.
  14. Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):603-613. doi:10.1001/archpsyc.62.6.603.
  15. Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17:302. doi10.1186/s12888-017-1463-3.
  16. Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet. 2005;366(9481):237-248.
  17. Arnsten AF. The use of α-2A adrenergic agonists for the treatment of attention-deficit/hyperactivity disorder. Expert Rev Neurother. 2010;10(10):1595-1605. doi10.1586/ern.10.133.
  18. Arnsten AF. Toward a new understanding of attention-deficit hyperactivity disorder pathophysiology: an important role for prefrontal cortex dysfunction. CNS Drugs. 2009;23(Suppl 1):33-41.
  19. Chao LL, Knight RT. Human prefrontal lesions increase distractibility to irrelevant sensory inputs. Neuroreport. 1995;6(12):1605-1610.
  20. Aron AR, Robbins TW, Poldrack RA. Inhibition and the right inferior frontal cortex. Trends Cogn Sci. 2004;8(4):170-177.
  21. Levy F. Dopamine vs noradrenaline: inverted-U effects and ADHD theories. Aust N Z J Psychiatry. 2009;43(2):101-108.
  22. Volkow ND, Wang GJ, Kollins SH, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA. 2009;302(10):1084-1091.