Objective: To examine the prevalence of comorbid Axis I (current and lifetime) and II disorders in adult men and women with attention-deficit hyperactivity disorder (ADHD). Method:Adult patients (n = 447; 266 men, 181 women) received comprehensive assessments for ADHD and Axis I and II disorders. Adults were aged between 17 and 74 years. Among the patients diagnosed with ADHD (n = 335), there were those with ADHD inattentive subtype (ADHD-I) (n = 199), hyperactive-impulsive subtype (ADHD-H) (n = 24), or combined ADHD subtype (ADHD-C) (n = 112). Chi-square and logistic regression analyses were performed to examine associations between adults with and without ADHD on Axis I and II disorders.Results: Adults with ADHD, compared with those without ADHD, had higher rates of Axis I (46.9% and 27.31%) and Axis II (50.7% and 38.2%) disorders. Adults with ADHD-C were more likely to have mood disorder, anxiety, conduct disorder, and substance use disorder as well as obsessive-compulsive personality disorder, passive-aggressive personality disorder, depressive personality disorder, narcissistic personality disorder, and borderline personality disorder (BPD).Men with ADHD were more likely to have antisocial personality disorder and had higher rates of current drug abuse than women with ADHD. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia. Women with ADHD were more likely to have BPD than men with ADHD. Conclusions:Adults with ADHD have very high rates of comorbid Axis I and II disorders, with differences found between men and women on certain comorbid disorders.Can J Psychiatry. 2009;54(10):673-683. Clinical Implications· In diagnosing and treating adults with ADHD, the assessment and treatment of other conditions that may be comorbid with ADHD is crucial to adequately treat patients and promote optimal outcome. · One-third of patients referred for ADHD diagnosis do not have ADHD but may have other conditions. · Comprehensive, systematic evaluations are crucial for accurate diagnosis and comprehensive treatment. Limitations· Exclusion criteria, which included current substance abuse and psychiatric conditions, and which required urgent treatment, might have resulted in a decrease in the level of comorbidity found. · Sources of referral (for example, self-and physician-referral) might also have selected for a less comorbid patient population.

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CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.

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ADHD is increasingly being diagnosed in adulthood. The current criteria for diagnosis of ADHD (DSM-IV) have been developed and validated for children and are inappropriate for adults. However, since DSM-IV criteria are currently the main recognized diagnostic criteria in use, clinicians are left with little alternative. This review explores the issues that complicate the diagnosis of ADHD in adulthood. It outlines the limitations of the DSM-IV regarding the diagnosis of ADHD in adults, describes how DSM-V proposes to address some of these limitations and discusses the challenges of differential diagnosis and comorbidity. Suggestions for dealing with these challenges and future perspective for improving the diagnostic validity of ADHD in adults are provided.