Attention-Deficit/Hyperactivity Disorder in Adults: A Survey of Current Practice in Psychiatry and Primary Care
Abstract
BACKGROUND: Recognition and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults in psychiatry and primary care have faced many obstacles. METHODS: Review by 50 psychiatrists and 50 primary care practitioners (PCPs) of 537 and 317 medical records, respectively, of adults diagnosed as having ADHD. Information on other psychiatric disorders, time of onset of ADHD, source of referral, use of referrals for diagnosis, ADHD treatment, and use of drug holidays was recorded. RESULTS: Forty-five percent of the patient records reviewed by psychiatrists and 65% reviewed by PCPs indicated previous diagnoses of ADHD. Only 25% of the adults with ADHD had been first diagnosed as having the disorder in childhood or adolescence. A diagnosis of ADHD was the initial cause for referral in 80% of psychiatric patients and 60% of PCP patients. Most patients with previously diagnosed and undiagnosed ADHD were self-referred. Among patients who had not received a prior diagnosis, 56% complained about ADHD symptoms to other health professionals without being diagnosed; PCPs were the least aggressive in diagnosing ADHD. In psychiatric and PCP settings, there was a statistical difference in the use of pharmacotherapy (91% vs 78%, respectively) and the proportion of patients taking drug holidays (24% vs 17%, respectively); most drug holidays were initiated by the patient (57%). Stimulants were the treatment of choice for adult ADHD (84% treated with stimulants). CONCLUSION: Data contained within this medical record review suggest that adult ADHD is a substantial source of morbidity in both psychiatric and PCP settings.
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In one study of psychiatric and primary care patients in the USA, only 25% had a childhood diagnosis, suggesting ~75% received their first diagnosis as adults.
“in one study of psychiatric and primary care patients in the USA, only 25% had a childhood diagnosis, suggesting that ~75% received their first diagnosis as adults”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [36]
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“Reviews of clinical records indicate even higher rates: in one study of psychiatric and primary care patients in the USA, only 25% had a childhood diagnosis, suggesting that ~75% received their first diagnosis as adults [36].”
- Authors
- Faraone, S. V., Spencer, T. J., Montano, C. B., & Biederman, J.
- Affiliations
- Harvard University (US)
- Corresponding author
- Faraone, Stephen V.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2004-06-14
- Volume
- 164
- Issue
- 11
- Pages
- 1221
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2058432412
- Cited by
- 144
- References
- 30
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 4 · 2017: 4 · 2016: 8 · 2015: 5 · 2014: 7 · 2013: 3 · 2012: 7
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- adult ADHD, ADHD diagnosis, underdiagnosis, primary care, psychiatric referral, stimulant pharmacotherapy, drug holidays, self-referral, medical records review
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Humans, Practice Patterns, Physicians', Primary Health Care, Psychiatry, Referral and Consultation
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