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Diagnosing ADHD in Adults With Substance Use Disorder: DSM-IV Criteria and Differential Diagnosis

J Clin Psychiatry 2007;68(7):e18

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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