Medscape                                                                                                                June 25, 2003

Adult ADHD Often Undiagnosed by Primary Care Physicians, New York University School of Medicine Survey Reveals

Inexperience and Lack of Training, Resources Cited as Barriers to Diagnosis

NEW YORK –Inadequate clinical training, inexperience and the lack of a well-validated screening tool are major barriers prohibiting primary care physicians from diagnosing ADHD in adults, according to a national survey released today by New York University School of Medicine. The survey also revealed that primary care physicians would take a more active role in treating adult ADHD if these issues were addressed.

ADHD affects nearly 8 million American adults and can lead to increased healthcare costs, higher divorce rates, unemployment and motor vehicle accidents. Yet, the vast majority of these patients remain undiagnosed, with only one quarter seeking medical help for impairment associated with ADHD. Even those patients who seek help often aren’t identified as having ADHD.

"The results tell us that we need to do a better job of supporting primary care physicians who are on the front lines of diagnosing adult ADHD," said Lenard Adler, M.D., Associate Professor of Clinical Psychiatry and Neurology at New York University School of Medicine. "This disorder causes significant problems for millions of adults and yet their doctors, including internists and general practitioners, often miss it."

A new symptom assessment tool, the Adult ADHD Self-Report Scale (ASRS), may assist physicians in evaluating symptoms of ADHD. Dr. Adler and other ADHD experts, in conjunction with the World Health Organization, developed the ASRS.

Key Survey Findings

Nearly half (48 percent) of 400 primary care physicians surveyed said they do not feel confident in diagnosing ADHD in adults.

Only 34 percent of primary care physicians report being "very knowledgeable" or "extremely knowledgeable" about adult ADHD compared with 92 percent who said the same for depression and 83 percent for generalized anxiety disorder (GAD).

Sixty-four percent of survey respondents indicated they received "not at all thorough" or "not very thorough" instruction in diagnosing and treating adult ADHD, compared with 13 percent who said the same for their training in depression.

Sixty-five percent of primary care physicians defer to a specialist when diagnosing adult ADHD compared with two percent for depression and three percent for GAD.

Eighty-five percent of primary care physicians surveyed said they would take a more active role in diagnosing and treating adult ADHD if they had an easy-to-use screening tool.

"Making quality, easy-to-use screening and symptom assessment tools available to physicians and the public will help adults with ADHD receive an accurate evaluation," added Dr. Adler. "These tools could go a long way to help increase confidence among primary care physicians in diagnosing adult ADHD."

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