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Cited by 189Attention Deficit Hyperactivity DisorderHistorical and Modern Theater StudiesPsychology and Mental Health

Under Diagnosis of Adult ADHD: Cultural Influences and Societal Burden

Asherson, Philip, Akehurst, Ron, Kooij, J. J. Sandra, Huss, Michael, Beusterien, Kathleen, Sasané, Rahul, Gholizadeh, Shadi, Hodgkins, Paul·2012·Journal of Attention Disorders
DOI 10.1177/1087054711435360
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Abstract

Objective: To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden. Method: A review of the literature over the past 10 years was performed using OVID. Results: Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse. Conclusion: The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.

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Crossref · 10.1177/1087054711435360

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  • The inclusion of neurodivergent people in the process of diagnosis or self-identified (only 2 out of 11 participants) is justified in that diagnosis is considered a privilege, with barriers to access psychiatric care such as lengthy wait times and administrative issues, especially for marginalised groups.

    “The inclusion of neurodivergent people in the process of diagnosis or self-identified (only 2 out of 11 participants) is also justified in that diagnosis is considered a privilege, with barriers to access psychiatric care such as lengthy wait times and administrative issues (including the type of access labour discussed in this very work), especially for marginalised groups [8, 33, 44, 75].”

    From Burnout by Design: How Digital Systems Overburden Neurodivergent Students in Higher Education (2025) · cites this paper as [8]

  • This lack of awareness has been noted in the past and has led to calls for increased public and professional training on how to diagnose adult ADHD.

    “This lack of awareness has been noted in the past and has led to calls for increased public and professional training on how to diagnose adult ADHD”

    From The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys (2017) · cites this paper as Asherson et al. 2012

  • Even within communities there is marked variability in rates of ADHD due to the subjective nature of primarily descriptive symptom-based diagnostic procedures.

    “However, even within communities there is marked variability in rates of ADHD due to the subjective nature of primarily descriptive (symptom-based) diagnostic procedures (Asherson et al., 2012; Polanczyk et al., 2014; see also recent reports by the US Center for Disease Control and Prevention).”

    From Functional neuroimaging of visuospatial working memory tasks enables accurate detection of attention deficit and hyperactivity disorder (2015) · cites this paper as Asherson et al., 2012

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Authors
Asherson, P., Akehurst, R., Kooij, J. J. S., Huss, M., Beusterien, K., Sasané, R., Gholizadeh, S., & Hodgkins, P.
Affiliations
  • Institute of Psychiatry, London, UK
  • University of Sheffield (GB)
  • PsyQ (NL)
  • University Medical Center of the Johannes Gutenberg University Mainz (DE)
  • Oxford Outcomes, Bethesda, MD, USA
  • Shire Development, Inc., Wayne, PA, USA
ORCID
Venue
Journal of Attention Disorders
Publisher
SAGE Publications
Published
2012-02-29
Volume
16
Issue
5_suppl
Pages
20S-38S
ISSN
  • 1087-0547 (ISSN-L)
  • 1557-1246
DOI
10.1177/1087054711435360
OpenAlex
W2033823360
Semantic Scholar
84af8c76ec430783bac3d9769685274983d2849f
Cited by
189
References
120
Citations by year
2026: 13 · 2025: 19 · 2024: 20 · 2023: 16 · 2022: 17 · 2021: 10 · 2020: 5 · 2019: 10 · 2018: 14 · 2017: 15 · 2016: 9 · 2015: 12 · 2014: 19 · 2013: 5 · 2012: 4
FWCI
8.99
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Attention Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
National Institute for Health and Care Research (RP-PG-0606-1045)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
Keywords
adult ADHD, underdiagnosis, social burden, quality of life, compensatory strategies, indirect costs, medical resource utilization, antisocial behavior, alcohol abuse, mood instability
MeSH terms
Adult, Attention Deficit Disorder with Hyperactivity, Culture, Humans, Cost of Illness

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