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Attention-Deficit/Hyperactivity Disorder in Adults
A Survey of Current Practice in Psychiatry and Primary Care
Stephen V. Faraone, PhD;
Thomas J. Spencer, MD;
C. Brendan Montano, MD;
Joseph Biederman, MD
Arch Intern Med. 2004;164:1221-1226.
Background Recognition and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults in psychiatry and primary care have faced many obstacles.
Methods Review by 50 psychiatrists and 50 primary care practitioners (PCPs) of 537 and 317 medical records, respectively, of adults diagnosed as having ADHD. Information on other psychiatric disorders, time of onset of ADHD, source of referral, use of referrals for diagnosis, ADHD treatment, and use of drug holidays was recorded.
Results Forty-five percent of the patient records reviewed by psychiatrists and 65% reviewed by PCPs indicated previous diagnoses of ADHD. Only 25% of the adults with ADHD had been first diagnosed as having the disorder in childhood or adolescence. A diagnosis of ADHD was the initial cause for referral in 80% of psychiatric patients and 60% of PCP patients. Most patients with previously diagnosed and undiagnosed ADHD were self-referred. Among patients who had not received a prior diagnosis, 56% complained about ADHD symptoms to other health professionals without being diagnosed; PCPs were the least aggressive in diagnosing ADHD. In psychiatric and PCP settings, there was a statistical difference in the use of pharmacotherapy (91% vs 78%, respectively) and the proportion of patients taking drug holidays (24% vs 17%, respectively); most drug holidays were initiated by the patient (57%). Stimulants were the treatment of choice for adult ADHD (84% treated with stimulants).
Conclusion Data contained within this medical record review suggest that adult ADHD is a substantial source of morbidity in both psychiatric and PCP settings.
From the Pediatric Psychopharmacology Unit, Massachusetts General Hospital (Drs Faraone, Spencer, and Biederman), Department of Psychiatry, Harvard Medical School (Drs Faraone, Spencer, and Biederman), and Harvard Institute of Psychiatric Epidemiology and Genetics (Dr Faraone), Boston, Mass; and Department of Family Practice, University of Connecticut, Farmington (Dr Montano). Dr Faraone has received research grants and served on the speakers' bureau and as a consultant for Abbott Laboratories, Boston Life Sciences, Bristol-Myers Squibb Co, Cephalon, Celltech, Eisai, GlaxoSmithKline, Eli Lilly & Company, McNeil Consumer & Specialty Pharmaceuticals, Novartis Pharmaceuticals Corp, Pfizer, Shire, and Wyeth.
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