Diagnosing ADHD in Adults With Substance Use Disorder: DSM-IV Criteria and Differential Diagnosis
J Clin Psychiatry 2007;68(7):e18
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Individuals with ADHD have a high rate of comorbid psychiatric disorders, especially
substance use disorders. Similarly, ADHD is overrepresented in the SUD
population. This high rate of comorbidity can make ADHD difficult to diagnose
and treat. Comorbid SUD in individuals with ADHD can have a negative impact on
course of illness and quality of life. The stringent DSM-IV criteria for ADHD
may make diagnosing ADHD in adults difficult, which may lead to an
underdiagnosis of ADHD in the adult population. This may be especially true for
patients with SUD, because cognitive deficits associated with substance abuse
can hinder their ability to recall ADHD symptoms for appropriate diagnostic
purposes. On the other hand, SUD symptoms may mimic ADHD symptoms, which can
lead to an overdiagnosis of ADHD in the SUD population. If proper attention is
paid to age-appropriate symptoms of ADHD, and careful longitudinal data are
obtained from patients presenting with ADHD or SUD, proper treatment can be
given to patients with these comorbid disorders.
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