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ADHD CAN BE MISSED

Because of symptom complexity and overlap

ADHD DIAGNOSIS MAY BE COMPLICATED BY FREQUENT OVERLAP WITH OTHER PSYCHIATRIC SYMPTOMS

ADHD symptoms

ADHD symptoms may mimic those of anxiety, depression, and other mood disorders.1-4

ADHD DIAGNOSIS MAY BE MASKED BY OTHER COMORBID PSYCHIATRIC DISORDERS

Prevalence of ADHD among adults with other psychiatric and substance abuse disorders in the past 12 months*4

Any anxiety disorder

9.5%

Any mood disorder

13.1%

Any substance use disorder

10.8%

Any impulse control disorder

12.3%

In a separate study including adults with ADHD and a comorbid psychiatric disorder+5:

72%

retained a diagnosis of ADHD when overlapping symptoms of major depression were subtracted

75%

retained a diagnosis of ADHD when overlapping symptoms of generalized anxiety disorder were subtracted

*Based on the National Comorbidity Survey Replication of 3,199 adults aged 18 to 44 years conducted from 2001 to 2003 using DSM-IV®.
Based on a study that included 146 clinically referred adults with ADHD. Diagnostic assessments were made in referred adults using the Structured Clinical Interview for DSM-III-R®. DSM-III-R® and DSM-IV® are registered trademarks of the American Psychiatric Association.

COMORBID ADHD CAN BE IDENTIFIED BY CAREFUL SYMPTOM EVALUATION

There are clear differences between ADHD and psychiatric disorders‡6

PSYCHIATRIC DISORDER

FEATURES SHARED
WITH ADHD

DIFFERENTIAL FEATURES

Major Depressive Disorder

Poor concentration, attention, and memory; difficulty with task completion

Enduring dysphoric mood or anhedonia; sleep and appetite disturbance

Bipolar Disorder

Hyperactivity; difficulty with attention and focus; mood swings

Enduring dysphoric or euphoric mood; insomnia; delusions

Generalized Anxiety Disorder

Fidgeting; difficulty concentrating

Exaggeration, apprehension, and worry; somatic symptoms of anxiety

Substance Abuse or Dependence

Difficulties with attention, concentration, and memory; mood swings

Pathologic pattern of substance use with social consequences; physiologic and psychologic tolerance and withdrawal

MAJOR DEPRESSIVE DISORDER
Features shared with ADHD

Poor concentration, attention, and memory; difficulty with task completion

Differential features

Enduring dysphoric mood or anhedonia; sleep and appetite disturbance

BIPOLAR DISORDER
Features shared with ADHD

Hyperactivity; difficulty with attention and focus; mood swings

Differential features

Enduring dysphoric or euphoric mood; insomnia; delusions

GENERALIZED ANXIETY DISORDER
Features shared with ADHD

Fidgeting; difficulty concentrating

Differential features

Exaggeration, apprehension, and worry; somatic symptoms of anxiety

SUBSTANCE ABUSE OR DEPENDENCE
Features shared with ADHD

Difficulties with attention, concentration, and memory; mood swings

Differential features

Pathologic pattern of substance use with social consequences; physiologic and psychologic tolerance and withdrawal

Figure adapted from Searight HR, et al. Adult ADHD: evaluation and treatment in family medicine. Am Fam Physician. 2000;62(9):2077-2086, with permission from American Family Physician.

QandADHD Fact Sheet

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

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References:

  1. 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.
  2. Asherson P, Buitelaar J, Faraone SV, Rohde LA. Adult attention-deficity hyperactivity disorder: key conceptual issues. Lancet Psychiatry. 2016;3:568-578.
  3. Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014;16(3):doi:10.4088/PCC.13r01600.
  4. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/appi.ajp.163.4.716.
  5. Milberger S, Biederman J, Faraone SV, Murphy J, Tsuang MT. Attention deficit hyperactivity disorder and comorbid disorders: issues of overlapping symptoms. Am J Psychiatry. 1995;152:1793-1799.
  6. Searight HR, Burke JM, Rottnek F. Adult ADHD: evaluation and treatment in family medicine. Am Fam Physician. 2000;62(9):2077-2086.