Studies demonstrate that the number of adults with ADHD is rising, which could be due to many factors including overdiagnosis.
Specialists should be on the lookout for “conscious exaggeration” of ADHD symptoms to secure stimulants for diversion or disability accommodations.
Behavioral strategies are helpful in adult ADHD patients, including time and task management.
In recent years, there’s been an increase in interest in adult ADHD and how the disorder carries into adulthood.
Research numbers indicate that adult ADHD is on the rise, prompting the need for improved treatment strategies.
An upward trend
Data support a trend of an increasing number of Americans with ADHD. In one study, researchers reported a 36% increase in ADHD prevalence. This data aligned with findings in Scandinavian countries, where healthcare is universal; thus, it’s unlikely to be related to health insurance coverage.
According to population-based data, 5.2% of US adults have ADHD vs 2.8% worldwide. ADHD is more commonly diagnosed in higher-income countries.
Adult ADHD is linked to various negative outcomes, including motor vehicle accidents, unemployment, substance use disorder, STIs, relationship failure, and suicide.
In a JAMA Network Open article, investigators analyzed the rates of ADHD in White and minority patients based on data mined from the Kaiser Permanente North California (KNPC).
They found that their data supported increases in ADHD rates between 2007 and 2016, with Whites exhibiting higher rates than minorities in adults. This could be due to disparities in access to care or desire to be seen. The authors also found that adults with untreated ADHD were more likely to turn to illegal stimulants as treatment.
“Our data cannot address whether the trends in our study reflect valid diagnoses, increased treatment seeking for ADHD among adults, and/or increased recognition by clinicians in the KPNC system,” the authors stated.
"There are many challenges to diagnosing ADHD in adults compared with the well-established definitions and assessments in youth."
— Chung, et al.
Experts recognize that rates of adult ADHD diagnoses may be inflated due to various factors. According to the authors of an article published in the Journal of Clinical and Experimental Neuropsychology, one major reason underlying conscious exaggeration of symptoms could be patients seeking an ADHD diagnosis for access to stimulants or disability accommodations.
“Conscious exaggeration of symptoms and impairment can be detected through careful assessment, including the use of specialized formal measures of effort, motivation, and honesty,” the authors advised. “In addition to specialized tests and scales, exaggeration can be detected through the use of sources of data other than the client; symptom ratings from and interviews with third-party informants can be very helpful, as can review of historical records.”
Another reason why ADHD may be overdiagnosed is insufficient attention paid to childhood onset. According to the standard diagnostic criteria (DSM-5), to be diagnosed with adult ADHD, the condition must be present in childhood. According to the Journal of Clinical and Experimental Neuropsychology article, the diagnostic criteria between childhood and adult ADHD are “essentially the same.”
Overdiagnosis could also be due to an incomplete differential diagnosis in adults. Various psychiatric disorders can cause inattention or hyperactivity, and an ADHD diagnosis should not be assumed.
Treatment for adult ADHD
Effective management of adult ADHD is multi-pronged. From a pharmacotherapy perspective, stimulants such as methylphenidate and amphetamine derivatives are first-line choices. Other options are also available, such as the non-stimulant atomoxetine and antidepressants like bupropion (Aplenzin).
Non-stimulant options are good for populations that can’t tolerate stimulants due to medical conditions or adverse effects, but they are typically less effective. It can take time to determine the right medication and dose in patients.
In terms of psychotherapy, cognitive behavioral therapy, marital therapy, or family therapy may be helpful. Adult ADHD patients often experience difficulties with relationships and daily activities such as remembering appointments and deadlines. They can also make impulsive or irrational decisions, possibly impacting co-workers, family, friends, and partners.
Skill building and behavioral strategies such as time, task, finance management, and organization can be helpful. Adult ADHD patients should also be advised to turn off notifications on their smartphones and avoid texting while driving.
What this means for you
The frequency of adult ADHD is on the rise, although overdiagnosis could play a role. These patients need to be carefully evaluated for conscious exaggeration of symptoms. The successful treatment of adult ADHD extends beyond stimulants to psychotherapy and behavior modification.