Attention-Deficit/Hyperactivity Disorder, or ADHD, conjures images of young children jumping up and down, running around in the classroom, and not being able to concentrate on their schoolwork. But ADHD affects adults, too: the majority of children with the disorder never outgrow it.

Adults with ADHD often have difficulty finding or keeping a job, and they frequently experience problems in their social relationships as well. Studies also show that a large percentage of adults with ADHD develop addictions or major depression, and a disproportionately large number get into traffic accidents or run into legal problems. 

Diagnostic Dilemma

Currently, there is no gold standard or laboratory test to confirm the diagnosis of ADHD, so physicians must rely on behavioral characteristics when making a diagnosis, says Christopher Kratochvil, an associate professor in the department of psychiatry at the University of Nebraska Medical Center. At this year’s annual meeting of the American Psychiatric Association, held in May in Toronto, he listed several reasons why ADHD in adults may go undiagnosed and untreated.

Historically, physicians—including psychiatrists—have received limited training in diagnosing and treating ADHD in adults, he said. Doctors may not be aware that, while children usually show overt hyperactivity, aggressiveness, and low frustration tolerance, grownups rarely show these symptoms.

Instead, adults with ADHD may be restless, impatient, and become bored easily, Kratochvil said at the Toronto meeting. Because these characteristics are quite common and seem fairly innocuous, some physicians may be reluctant to make a diagnosis and prescribe treatment such as stimulant medication, he added.

What makes diagnosing adults with ADHD especially hard is that, in the current (fourth) edition of the Diagnostic and Statistical Manual (DSM-IV) of psychiatric disorders, all clinical descriptions and diagnostic criteria relating to ADHD are based on children, points out Stephen Faraone, a professor of psychiatry at State University of New York in Syracuse.