Diagnostic delay in ADHD: Duration of untreated illness and its socio‐demographic and clinical predictors in a sample of adult outpatients

Abstract

Aim: To investigate the Duration of Untreated Illness (DUI) and its sociodemographic and clinical predictors in a sample of adult ADHD outpatients. Methods:The DUI of 150 adult outpatients with a confirmed diagnosis of DSM-IV ADHD was calculated. Non-parametric tests were used to evaluate differences in DUI among subgroups and to build a correlation matrix. Subsequently, a multiple linear regression model was performed.Results: The median DUI was 17 years (interquartile range [IQR] = 14). DUI was longer in employed patients, those with a family history of ADHD, those with a history of major depressive disorder and those who had predominantly inattentive ADHD in childhood. The current age, age at administration of the first proper treatment and education level were correlated with DUI. Current age (63.3% of total variance), family history of ADHD and the presence of a predominantly inattentive type in childhood (together, 2.6% of total variance) were all predictors of DUI.Conclusions: Information programmes for caregivers and training for health care professionals should be promoted to foster the early recognition of covert inattentive symptoms and shorten DUI.

Prevalence of Metabolic Syndrome and Insulin Resistance in a Sample of Adult ADHD Outpatients

“…Only over recent years, some authors have remarked the importance of underdiagnosis and untreated ADHD consequences in old adults and elderly people (56)(57)(58)(59). A recent epidemiological study conducted on a Swedish national register (56) has shown that ADHD persists in elderly taking along psychiatric and metabolic comorbidity (over nine and two-fold prevalence than subjects without ADHD, respectively).…”

Economic burden of attention-deficit/hyperactivity disorder among adults in the United States: a societal perspective

“…31,32 This incremental caregiver burden translates to One area of unmet need that may contribute to the large burden of ADHD is that the condition is commonly undiagnosed in adults, thus leaving symptoms untreated, which points to insufficiencies at both the patient and physician levels. 35,36 At the patient level, some adults may present with ADHD that was not diagnosed during childhood and thus may be more difficult to diagnose during adulthood because of changes in clinical presentation associated with age, such as adults' internalization of the typical hyperactivity symptoms. [35][36][37][38] In addition, adults may develop better compensation strategies to further mask recognizable symptoms of ADHD.…”

“…35,36 At the patient level, some adults may present with ADHD that was not diagnosed during childhood and thus may be more difficult to diagnose during adulthood because of changes in clinical presentation associated with age, such as adults' internalization of the typical hyperactivity symptoms. [35][36][37][38] In addition, adults may develop better compensation strategies to further mask recognizable symptoms of ADHD. 38 ADHD among adults may also be undiagnosed because it is instead misdiagnosed as another comorbid condition; ADHD symptoms are often mistaken for those of mood and anxiety disorders or personality disorders, among others.…”

“…Accordingly, additional education and information programs to increase visibility around ADHD among the medical community may be of particular benefit for physicians to facilitate the identification, diagnosis, and treatment of this condition. 36,39 With other mental illnesses such as SUD and posttraumatic stress disorder, intervention programs have been successfully introduced to raise awareness, reduce social stigma around seeking support, and help reintegrate individuals into employment settings. [62][63][64] Similar efforts may be helpful to address the current underrecognition of ADHD in adults.…”

Screening for Adulthood ADHD and Comorbidities in a Tertiary Mental Health Center Using EarlyDetect: A Machine Learning-Based Pilot Study

“…The detrimental outcomes are similar between adult and childhood ADHD ( Ginsberg et al, 2014 ), including negative physical health consequences such as obesity, smoking, asthma, migraines, emergency room visits, and injury-related insurance claims and accidental deaths ( Agnew-Blais et al, 2016 ; Catalá-López et al, 2022 ; Dalsgaard et al, 2015 ; Lundervold et al, 2019 ; Sadeghi-Bazargani et al, 2019 ); and poor socio-economical outcomes such as higher chance to drop out of school ( Fleming & McMahon, 2012 ), financial problems from ADHD-associated impulsivity at work ( Asherson et al, 2012 ; Pinna et al, 2019 ) and increased chance to involve in criminal activities or live in detention centers ( Baggio et al, 2018 ). Despite the diagnostic challenges, accurate early diagnoses and appropriate treatment of ADHD could be effective to curb the negative outcomes ( Oliva et al, 2021 ).…”