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Adult ADHD often undiagnosed by primary care physicians

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."

Development of the ASRS was supported in part by an unrestricted educational grant from Eli Lilly and Company. The tool will be available online from NYU at: http://www.med.nyu.edu/Psych/training/adhd.html.

Survey Methodology

Four hundred physicians completed the survey from May 14, 2003 through May 28, 2003. New York University School of Medicine Institutional Board of Research Associates approved the final survey instrument. The survey was conducted by Harris Interactive(r) for New York University School of Medicine, with support from Eli Lilly and Company. Target physicians were in family practice, general practice or internal medicine and were recruited randomly from the American Medical Association master file. In order to qualify, physicians must have been practicing for at least two years and treating at least 30 patients per week with any combination of ADHD, bipolar disorder, depression, GAD or obsessive compulsive disorder. Recruitment for the survey was completed by mail, and the survey was conducted online. Editor's note: Be wary of studies and polls supported by drug manufacturers. Although these studies are a necessity, and often the only way valuable research can be carried out, one must wonder if such studies are simply a way to sell more Ritalin. --- S. Boyer.

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