Challenges in Diagnosing Attention-Deficit Hyperactivity Disorder in Adults – Underdiagnosed, Misdiagnosed, or Overdiagnosed: a Case Report

Case report

Amin Mehmedović, Milutin Kostić

89–92

https://doi.org/10.5937/medrec2502089M

Challenges in Diagnosing Attention-Deficit Hyperactivity Disorder in Adults – Underdiagnosed, Misdiagnosed, or Overdiagnosed: a Case Report

Abstract

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is sometimes undiagnosed, misdiagnosed, or overdiagnosed, particularly in adults. Although ADHD is typically diagnosed in childhood, its symptoms often persist into adulthood, complicating diagnosis, especially in women. The aim of this case report was to highlight the challenges in diagnosing ADHD in adults. We present a 30-year-old woman with a complex psychiatric history, in whom the diagnosis of ADHD was considered in adulthood. Initially diagnosed with depression and borderline personality disorder, her symptoms of lack of motivation and poor concentration persisted for over a decade. Despite various psychiatric approaches, her functioning remained impaired. After the latest treatment attempts, her symptoms, including impulsivity, showed partial improvement, but her prognosis remains uncertain. The diagnosis of ADHD in adults should be approached with caution, considering the risks of underdiagnosis, misdiagnosis, and overdiagnosis, especially in patients with overlapping symptoms of other mental health disorders.

Key words: attention-deficit hyperactivity disorder in adults, diagnostic challenges, suicide attempt

Ful text

Literatura

  1. Posner J, Polanczyk GV, Sonuga-Barke E. Attention-deficit hyperactivity disorder. Lancet 2020;395(10222):450-62.
  2. Bonvicini C, Faraone SV, Scassellati C. Attention-deficit hyperactivity disorder in adults: A systematic review and meta-analysis of genetic, pharmacogenetic and biochemical studies. Mol Psychiatry 2016;21(7):872-84.
  3. Sibley MH, Arnold LE, Swanson JM, et al. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. Am J Psychiatry 2022;179(2):142-51.
  4. Ayano G, Demelash S, Gizachew Y, Tsegay L, Alati R. The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. J Affect Disord 2023;339:860-6.
  5. Song P, Zha M, Yang Q, et al. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. J Glob Health 2021;11:04009.
  6. Palladino VS, McNeill R, Reif A, Kittel-Schneider S. Genetic risk factors and gene-environment interactions in adult and childhood attention-deficit/hyperactivity disorder. Psychiatr Genet 2019;29(3):63-78.
  7. Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Netw Open 2018;1(4):e181471.
  8. Attoe DE, Climie EA. Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. J Atten Disord 2023;27(7):645-57.
  9. Johnson J, Morris S, George S. Misdiagnosis and missed diagnosis of adult attention-deficit hyperactivity disorder. BJPsych Advances 2021;27(1):60-1.
  10. Paris J, Bhat V, Thombs B. Is Adult Attention-Deficit Hyperactivity Disorder Being Overdiagnosed?. Can J Psychiatry 2015;60(7):324-28.
  11. Kopp S, Gillberg C. Symtom, diagnostik och förlopp vid ADHD hos flickor och kvinnor [Symptoms, diagnostic process and outcome in girls and women with ADHD]. Lakartidningen 2022;119:21132.
  12. MacDonald L, Sadek J. Management Strategies for Borderline Personality Disorder and Bipolar Disorder Comorbidities in Adults with ADHD: A Narrative Review. Brain Sci 2023;13(11):1517.
  13. Fairman KA, Peckham AM, Sclar DA. Diagnosis and Treatment of ADHD in the United States: Update by Gender and Race. J Atten Disord 2020;24(1):10-9.
  14. Collins KP, Cleary SD. Racial and ethnic disparities in parent-reported diagnosis of ADHD: National Survey of Children’s Health (2003, 2007, and 2011). J Clin Psychiatry 2016;77(1):52-9.
  15. Robison LM, Skaer TL, Sclar DA, Galin RS. Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS Drugs 2002;16(2):129-37.
  16. Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis?. Mo Med 2022;119(5):467-73.
  17. Yeung A, Ng E, Abi-Jaoude E. TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality. Can J Psychiatry 2022;67(12):899-906.
  18. Shen Y, Chan BSM, Huang C, et al. Suicidal behaviors and attention deficit hyperactivity disorder (ADHD): a cross-sectional study among Chinese medical college students. BMC Psychiatry 2021;21(1):258.
  19. Ljung T, Chen Q, Lichtenstein P, Larsson H. Common etiological factors of attention-deficit/hyperactivity disorder and suicidal behavior: a population-based study in Sweden. JAMA Psychiatry 2014;71(8):958-64.