Effort Underway to Develop First U.S. Guidelines for ADHD in Adults

Noah Warren
August 9, 2023

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults has been on the rise in the United States, leading to concerns about overdiagnosis and underdiagnosis. While there are established guidelines for diagnosing and treating childhood ADHD, there has been a significant gap in guidelines specifically tailored for adult ADHD.

In an effort to address this critical need, the American Society of ADHD and Related Disorders (APSARD) has undertaken a special committee to develop the first-ever, authoritative guidelines for adult ADHD in the United States. This initiative aims to improve the quality of care for adults with ADHD and ensure accurate diagnosis and effective treatment interventions.

ADHD in adults
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The Growing Recognition of Adult ADHD

Recent research, as highlighted in a JAMA study, indicates that the diagnosis of ADHD in adults is growing at a rate four times faster than in children. However, this surge in diagnoses comes with its own set of challenges. Clinicians may overlook or misdiagnose ADHD in adults, resulting in fewer than 20% of individuals with ADHD receiving appropriate diagnosis and treatment. The absence of U.S. guidelines specifically designed for the diagnosis and evaluation of adult ADHD has contributed to these issues.

Addressing the Diagnosis Gap

Frances R. Levin, MD, the Kennedy-Leavy Professor of Psychiatry at Columbia University and an internationally recognized expert in adult ADHD, acknowledges that both underdiagnosis and overdiagnosis of adult ADHD are valid concerns. Without clear guidelines for diagnosis and evaluation, it becomes difficult to estimate the number of individuals in the country who meet the clinical definition of ADHD. However, studies suggest that between 2.5% and 4.4% (11 million) of Americans over the age of 18 are affected by ADHD, with diagnoses being nearly three times higher among men than women.

The Need for Adult ADHD Guidelines

The absence of guidelines for adult ADHD hampers accurate identification, evaluation, and treatment of the condition. According to Dr. Levin, the lack of training and experience among older and even younger clinicians in evaluating and treating adults with ADHD is a substantial concern.

Primary care practices, which often serve as the first point of contact for adults seeking ADHD care, would benefit greatly from uniform standards for diagnosis and treatment. The development of these guidelines will address the critical needs of healthcare providers, patients, and the general public.

Symptoms and Behavioral Patterns in Adult ADHD

ADHD is a neurodevelopmental disorder characterized by ongoing patterns of inattention, hyperactivity, and impulsiveness in both children and adults. While hyperactivity is often the predominant symptom in children, adult ADHD may manifest differently.

In women, ADHD symptoms may be more quietly inattentive, leading to underdiagnosis and missed treatment opportunities. Adults diagnosed with ADHD later in life may have experienced symptoms before the age of 12, which might have been masked by protective influences such as good grades or parental guidance.

Untreated ADHD in adults often leads to various co-occurring conditions, such as depression, anxiety disorders, and addiction, resulting in profound personal and societal consequences.

The Role of Stimulant Medications and Treatment Options

Prescription stimulant medications are considered the first line of treatment for ADHD. They work by increasing dopamine and norepinephrine levels in the brain, enabling improved attention, focus, and motivation. However, concerns have been raised regarding the increasing diagnoses and prescription rates of stimulant medications. The potential for misuse and diversion necessitates a careful evaluation of their use in treating ADHD.

It is crucial to weigh the benefits against the risks, particularly for individuals with a substance use disorder. Nonstimulant medications may be considered for those who are at risk of misusing or diverting their medication. Additionally, a comprehensive treatment approach for adult ADHD should include not only medication but also education, cognitive-behavioral skills training, psychotherapy, coaching, and mindfulness meditation.

The Anticipated Guidelines and Their Implications

The APSARD committee, led by Dr. Frances R. Levin and Dr. Thomas Spencer, is working diligently to develop comprehensive guidelines based on critical literature review, professional recommendations, and the APSARD Adult ADHD Quality Measures initiative. These guidelines will provide primary care practitioners and mental health specialists with necessary information and tools to accurately diagnose and effectively treat adult ADHD. Their release later this year is eagerly anticipated, as it is expected to significantly enhance the quality of care, improve outcomes, and address the economic impact of ADHD on individuals and society.


The effort to develop the first U.S. guidelines for ADHD in adults is a crucial step towards ensuring accurate diagnosis and effective treatment for this often overlooked and misunderstood condition. By bridging the gap in knowledge and understanding, these guidelines will empower healthcare providers, enhance patient care, and mitigate the personal and societal consequences of untreated adult ADHD. The anticipated release of the guidelines holds promise for a brighter future for those living with ADHD, providing them with the recognition, support, and treatment they deserve.

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Noah Warren
Director of Business Development