The unmet needs of all adults with ADHD are not the same: a focus on Europe

Abstract

This review discusses the unmet needs in adult ADHD subgroups in Europe: adolescents in transition, adult patients, employees, older adults, and those in the criminal justice system. Analysis of the literature and an ADHD web forum was conducted. The visibility of adult ADHD remains low, and finding professionals able to diagnose is difficult for both adolescents as well as adults. Many ADHD cases go undiagnosed and untreated; ADHD may be mistaken for other common mental health conditions or missed in the presence of comorbidities. Pharmacological and psychosocial treatment services are very limited. Most employers do not understand how to address ADHD, and employees fear stigmatization. Older age individuals (>60 years) may feel worse with unrecognized ADHD, and those incarcerated with ADHD are likely to cost disproportionately more than their peers, with high recidivism rates. Strategies to address unmet needs and accommodate ADHD adults need not be expensive or time consuming to implement.

Keywords::

• adolescents
• adult ADHD
• Europe
• health services
• unmet needs

Financial & competing interests disclosure

Y Ginsberg served as a primary investigator, consultant and speaker for Janssen-Cilag and Novartis, and as a speaker for Eli-Lilly and HB Pharma. K Beusterien works at ORS Health, which provides consulting services to Shire. K Amos is a subcontractor for ORS Health, which provides consulting services to Shire. P Asherson received honoraria for consultancy to Shire, Eli-Lilly and Novartis. P Asherson has received educational/research awards from Shire, Eli-Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech. P Asherson has been a speaker at sponsored events for Shire, Eli-Lilly and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Adults with ADHD experience substantial impairments in both personal and professional areas of life, but confront major challenges in obtaining adequate support and treatment.

• Although numerous studies describe adult ADHD and its impacts, few have examined unmet needs in this population focused on Europe.

• ADHD in adults often goes under recognized and untreated due to a lack of resources and qualified treatment professionals, misunderstandings about the lifelong nature of the disorder, and misdiagnosis due to comorbidities.

• Even when ADHD is diagnosed in adults, they experience difficulty accessing appropriate resources, including support groups, cognitive behavior therapy, and physicians willing to prescribe medications.

• Although the effectiveness of medications for adult ADHD has been demonstrated and replicated, there is high discordance between the numbers who are prescribed medication versus estimated prevalence rates.

• Young adults, particularly those for whom ADHD is their primary diagnosis, transitioning from adolescent mental health clinics to adult providers often have difficulty meeting the criteria for acceptance to adult clinics.

• Moreover, young adults with ADHD frequently are unable to access the same treatments (medication, support groups, cognitive behavior therapy) that were available throughout their youth.

• Adults with ADHD commonly struggle with finding and maintaining employment and often have lower lifetime earnings than their peers; in addition, they are reluctant to disclose the diagnosis to their employers.

• Employers lack understanding on the implications of ADHD and thus do not implement approaches such as enclosed workspaces, advanced notice, flexibility, and so on that could improve productivity and reduce frustrations.

• ADHD among the incarcerated population is higher than the general population but often is undiagnosed or untreated even though it has been shown that treating ADHD in this population is associated with a reduction in criminality.