Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders
Abstract
Many adults with a diagnosed psychiatric disorder also have attention-deficit/hyperactivity disorder (ADHD). In many cases, comorbid ADHD is unrecognized and/or undertreated. Differential diagnosis of adult ADHD can be challenging because ADHD symptoms may overlap with other psychiatric disorders and patients may lack insight into their ADHD-related symptoms. Current ADHD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision may prevent appropriate diagnosis of many patients with significant ADHD symptoms. Adults may not be able to provide a history of onset of symptoms during childhood, and it may be difficult to confirm that ADHD symptoms are not better accounted for by other comorbid psychiatric conditions. Comorbid ADHD is most prevalent among patients with mood, anxiety, substance use, and impulse-control disorders. ADHD can negatively affect outcomes of other comorbid psychiatric disorders, and ADHD symptoms may compromise compliance with treatment regimens. Furthermore, unrecognized ADHD symptoms may be mistaken for poor treatment response in these comorbid disorders. In these individuals, ADHD pharmacotherapy seems to be as effective in reducing core ADHD symptoms, as it is in patients who have no comorbidity. Limited evidence further suggests that ADHD therapy may help to improve symptoms of certain psychiatric comorbidities, such as depression. Therefore, management of ADHD may help to stabilize daily functioning and facilitate a fuller recovery.
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Psychiatric and behavioral comorbidities often co-occur with ADHD and result in increased difficulties for appropriate diagnoses and treatments.
“Psychiatric and behavioral comorbidities, such as depression, anxiety disorder, bipolar disorder, substance use, and personality disorders, often co-occur with ADHD and result in increased difficulties for appropriate diagnoses and treatments (Barkley and Brown, 2008; Rosler et al., 2010; Mao and Findling, 2014; Katzman et al., 2017).”
From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Barkley and Brown, 2008
ADHD impacts interpersonal functioning, particularly within intimate relationships.
“There is a significant recognition of ADHD's impact on interpersonal functioning, particularly within intimate relationships (Barkley and Brown 2008; Ginapp et al. 2023; Huynh‐Hohnbaum and Benowitz 2022; Ramsay 2010).”
From “I Felt Like a Burden”: An Exploration Into the Experience of Romantic Relationships for People With ADHD (2026) · cites this paper as Barkley and Brown 2008
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- Authors
- Barkley, R. A., & Brown, T. E.
- Affiliations
- Medical University of South Carolina (US)
- Venue
- CNS Spectrums
- Publisher
- Cambridge University Press (CUP)
- Published
- 2008-11
- Volume
- 13
- Issue
- 11
- Pages
- 977-984
- ISSN
- 1092-8529 (ISSN-L)
- 2165-6509
- OpenAlex
- W2412516425
- Cited by
- 163
- References
- 65
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 6 · 2023: 12 · 2022: 6 · 2021: 2 · 2020: 13 · 2019: 7 · 2018: 8 · 2017: 10 · 2016: 11 · 2015: 12 · 2014: 16 · 2013: 11 · 2012: 11
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CNS Spectrums (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, comorbidities, psychiatric comorbidity, underdiagnosis, differential diagnosis, DSM-IV-TR diagnostic criteria, mood disorders, anxiety disorders, substance use disorders, impulse control disorders, medication adherence, ADHD medication, depression
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Mental Disorders, Diagnosis, Differential, Diagnostic Errors, Humans, Neuropsychological Tests, Severity of Illness Index, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders
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