Functional and psychosocial impairment in adults with undiagnosed ADHD
Functional and psychosocial impairment in adults with undiagnosed ADHD
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DOI：
10.1017/s0033291706008713
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发表时间：
2007-01-01
影响因子：
6.9
通讯作者：
Swindle, Ralph W.
中科院分区：
文献类型：
--
作者：
Able, Stephen L.;Johnston, Joseph A.;Swindle, Ralph W.
背景。确定一组患有“未确诊的”注意力缺陷多动障碍（ADHD）的成年人，并将他们的个人和家庭病史、社会心理状况、功能障碍和生活质量与非注意力缺陷多动障碍对照组进行比较。此外，比较未确诊和确诊的成人ADHD，探讨未确诊者避免临床检测的可能原因。使用ICD-9行政索赔记录中的ADHD代码和对电话管理的成人ADHD筛查者的回应[成人ADHD自我报告量表（ASRS）]将两个大型管理医疗保健计划的大约21000名成员分类为“未诊断”（无编码诊断；ASRS阳性）或“非ADHD”对照组（无编码诊断；ASRS阴性）。在人口统计学、社会经济地位、过去和现在的精神健康状况、自我报告的功能和心理障碍以及生活质量的基础上，将“未确诊”ADHD患者与“未确诊”ADHD对照和“确诊”ADHD患者（ICD-9编码ADHD诊断）进行比较。共有752名“未确诊”ADHD受试者、199名“未确诊”ADHD对照组和198名“确诊”ADHD受试者完成了电话采访。总体而言，“未确诊”ADHD组比非ADHD组表现出更高的共病率和更大的功能损害，包括明显更高的当前抑郁症、饮酒问题、更低的受教育程度、更大的情感和人际关系困难。“未确诊”ADHD受试者报告的种族构成和受教育程度与“确诊”ADHD受试者不同。患有“未确诊”ADHD的个体比筛查结果为阴性的个体表现出更大的功能和心理障碍，这表明即使在临床未被发现的情况下，ADHD也会给成年人带来严重的负担。
Background. Identify a group of adults with 'undiagnosed' attention deficit hyperactivity disorder (ADHD) and compare their personal and family medical histories, psychosocial profiles, functional impairment and quality of life with non-ADHD controls. Additionally, compare adults with undiagnosed and diagnosed ADHD to investigate possible reasons why the undiagnosed avoid clinical detection.Method. ICD-9 codes for ADHD in administrative claims records and responses to a telephone-administered adult ADHD screener [the Adult ADHD Self-Report Scale (ASRS)] were used to classify approximately 21000 members of two large managed health-care plans as 'undiagnosed' (no coded diagnosis; ASRS positive) or 'non-ADHD' controls (no coded diagnosis; ASRS negative). Patients identified as 'undiagnosed' ADHD were compared with samples of non-ADHD controls and 'diagnosed' ADHD patients (ICD-9 coded ADHD diagnoses) on the basis of demographics, socio-economic status, past and present mental health conditions, and self-reported functional and psychosocial impairment and quality of life.Results. A total of 752 'undiagnosed' ADHD subjects, 199 'non-ADHD' controls and 198 'diagnosed' ADHD subjects completed a telephone interview. Overall, the 'undiagnosed' ADHD cohort demonstrated higher rates of co-morbid illness and greater functional impairment than non-ADHD' controls, including significantly higher rates of current depression, and problem drinking, lower educational attainment, and greater emotional and interpersonal difficulties. 'Undiagnosed' ADHD subjects reported a different racial composition and lower educational attainment than 'diagnosed' ADHD subjects.Conclusion. Individuals with 'undiagnosed' ADHD manifest significantly greater functional and psychosocial impairment than those screening negative for the disorder, suggesting that ADHD poses a serious burden to adults even when clinically unrecognized.