ADHD Diagnosis in Adults

First-Ever Adult ADHD Guidelines Forthcoming

ADHD diagnosis and treatment guidelines for adults in the U.S. will be published in 2024, says APSARD President, Ann Childress, in an interview with ADDitude.

A doctor explains to his adult patient with ADHD that some medication safety doubts haven't been proven.
A doctor explains to his adult patient with ADHD that some medication safety doubts haven't been proven.

ADHD diagnoses among adults are growing faster than ever in the U.S. despite the absence of formal clinical guidelines for the accurate evaluation and treatment of the condition after childhood. Finally, a task force commissioned by the American Professional Society of ADHD and Related Disorders (APSARD) is developing adult ADHD guidelines.

In an interview with ADDitude, APSARD President Ann Childress, M.D., discussed the importance and implications of the first-ever U.S. guidelines for ADHD in men and women. Here are excerpts from that interview.

Why are clinical guidelines to diagnose and treat ADHD in adults necessary?

Recent data published by the Centers for Disease Control and Prevention found an increase in stimulant prescriptions for adults with ADHD between 2016 and 2021. Greater recognition of ADHD symptoms and improved access to care through telemedicine have contributed to this increase in the recognition and treatment of adult ADHD.

Guidelines give evidence-based recommendations for the assessment and treatment of medical disorders. We have U.S. guidelines for the treatment of ADHD in children and adolescents, but none for adults. Guidelines will help practitioners who previously may have felt uncomfortable evaluating and treating adults with ADHD, and these will improve access to high-quality care.

ADHD in adults is not just a minor inconvenience — it is a major public health problem. Consequences of adult ADHD can include lower educational achievement, increased risk of unemployment, financial instability, higher rates of divorce, and increased risky behaviors resulting in higher rates of traffic infractions and unplanned pregnancies compared to peers without ADHD.

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How do ADHD symptoms in adults generally differ from those in children?

Symptoms generally become more subtle as people age. For example, running and climbing at inappropriate times as a child may present as restlessness in an adult. ADHD symptoms may also be more difficult to recognize in adults because of coexisting conditions, such as depression and anxiety.

Many people believe that ADHD medication is no longer necessary once a student with ADHD has graduated from high school or college. With the development of these guidelines for adults, is this belief being debunked?

Although some adult patients manage well using behavioral techniques to control symptoms, many still need medication to reduce symptom severity and improve their quality of life. The guidelines will review the existing evidence for treating adult ADHD and make recommendations based on those findings.

What are the risks for older adults taking ADHD medication? Do the benefits of medication outweigh the risks?

Many older adults with ADHD have comorbid medical conditions, including cardiovascular disease. It is important for practitioners to work with their colleagues in primary care, cardiology, and internal medicine to treat patients collaboratively. For many, the benefits often outweigh the risks, but it is important for all specialists to work together to ensure that patient risks are appropriately managed.

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Just as many adults are discovering they have ADHD that went undiagnosed for years, many girls and women continue to be misdiagnosed or undiagnosed by clinicians. Might APSARD consider new or expanded guidelines for girls and women?

Many women do not recognize that they have ADHD or seek evaluations until their children are diagnosed. They are often treated for anxiety or depression that developed secondarily to ADHD. Helping clinicians recognize the difference in presentation of ADHD symptoms in women is important.

How can we educate clinicians and researchers to mitigate this?

An expert consensus statement providing guidance for the recognition and treatment of ADHD in girls and women was published in BMC Psychiatry in 2020. 1  Since then, interest in understanding the nuances associated with ADHD in girls and women has continued to increase.

When will the APSARD guidelines for adults be completed and what will happen following their release?

The APSARD Task Force is working diligently on the guidelines, and I expect that we will have a draft in 2024. After the APSARD guidelines are published, we will work with CHADD to expand them for specific populations and specialties. There is much interest from colleagues in other agencies, and we plan to partner with them to educate providers.

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Ann Childress, M.D., is a board-certified child, adolescent, and adult psychiatrist specializing in research and treatment of ADHD.  

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1 Young, S., Adamo, N., Ásgeirsdóttir, B.B. et al. (2020). Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women. BMC Psychiatry.