Functional and psychosocial impairment in adults with undiagnosed ADHD
Abstract
Background. Identify a group of adults with ‘undiagnosed’ attention deficit hyperactivity disorder (ADHD) and compare their personal and family medical histories, psychosocial profiles, functional impairment and quality of life with non-ADHD controls. Additionally, compare adults with undiagnosed and diagnosed ADHD to investigate possible reasons why the undiagnosed avoid clinical detection. Method. ICD-9 codes for ADHD in administrative claims records and responses to a telephone-administered adult ADHD screener [the Adult ADHD Self-Report Scale (ASRS)] were used to classify approximately 21000 members of two large managed health-care plans as ‘undiagnosed’ (no coded diagnosis; ASRS positive) or ‘non-ADHD’ controls (no coded diagnosis; ASRS negative). Patients identified as ‘undiagnosed’ ADHD were compared with samples of non-ADHD controls and ‘diagnosed’ ADHD patients (ICD-9 coded ADHD diagnoses) on the basis of demographics, socio-economic status, past and present mental health conditions, and self-reported functional and psychosocial impairment and quality of life. Results. A total of 752 ‘undiagnosed’ ADHD subjects, 199 ‘non-ADHD’ controls and 198 ‘diagnosed’ ADHD subjects completed a telephone interview. Overall, the ‘undiagnosed’ ADHD cohort demonstrated higher rates of co-morbid illness and greater functional impairment than ‘non-ADHD’ controls, including significantly higher rates of current depression, and problem drinking, lower educational attainment, and greater emotional and interpersonal difficulties. ‘Undiagnosed’ ADHD subjects reported a different racial composition and lower educational attainment than ‘diagnosed’ ADHD subjects. Conclusion. Individuals with ‘undiagnosed’ ADHD manifest significantly greater functional and psychosocial impairment than those screening negative for the disorder, suggesting that ADHD poses a serious burden to adults even when clinically unrecognized.
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In a population study contrasting 950 adults with diagnosed or likely ADHD against 20,000 unaffected adults, those with ADHD had higher self-ratings of interpersonal conflict and negative, conflictual social ties.
“In a population study contrasting 950 adults with diagnosed or likely ADHD against 20,000 unaffected adults, those with ADHD had higher self-ratings of interpersonal conflict and negative, conflictual social ties (69).”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [69]
Recent clinic-based studies report impairing emotion dysregulation in between 34-70% of adults with ADHD, although population based studies are needed.
“This has been supported to some extent by recent clinic-based studies reporting impairing emotion dysregulation in between 34-70% of adults with ADHD, although population based studies are needed (69-73)–Table 1.”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [69]
Untreated ADHD often leads to severe and chronic functional impairments in major life domains.
“Especially, untreated ADHD often leads to severe and chronic functional impairments in major life domains, e.g., education, work, relationships, friendships, and leisure activities (Able et al. 2007; Arnold et al. 2020; Barkley 2006; Fayyad et al. 2007; Halmøy et al. 2009; Holst and Thorell 2020).”
From ADHD and associated psychopathology in older adults in a German community sample (2023) · cites this paper as Able et al. 2007
Long-term follow-up, epidemiological, and clinical studies have shown that adults with untreated ADHD, compared to normal controls, experience higher rates of academic failure, low occupational status, increased risk of substance use disorders, accidents, and delinquency, and have fewer social relationships or friends.
“Long-term follow-up, epidemiological and clinical studies have shown that adults with untreated ADHD, when compared to normal controls, experience higher rates of academic failure, low occupational status, increased risk of substance use disorders (tobacco, alcohol or drugs), accidents and delinquency, and have fewer social relationships or friends [18,121,127,131,243,244].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [243]
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- Authors
- ABLE, S. L., JOHNSTON, J. A., ADLER, L. A., & SWINDLE, R. W.
- Affiliations
- Eli Lilly (United States) (US)
- New York University (US)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2006-09-29
- Volume
- 37
- Issue
- 1
- Pages
- 97-107
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2112872840
- Cited by
- 257
- References
- 33
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 13 · 2023: 20 · 2022: 12 · 2021: 12 · 2020: 11 · 2019: 17 · 2018: 10 · 2017: 17 · 2016: 11 · 2015: 22 · 2014: 19 · 2013: 12 · 2012: 16
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, undiagnosed ADHD, functional disability, psychosocial impairment, quality of life, comorbidities, depression, problem drinking, educational attainment, racial differences, Adult ADHD Self-Report Scale, underdiagnosis, managed care
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Female, Health Status, Humans, Male, Mass Screening, Social Adjustment
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