Diagnosing adult attention-deficit hyperactivity disorder: the importance of establishing daily life contexts for symptoms and impairments.

This integrative literature review examines the complexity of diagnosing attention-deficit hyperactivity disorder (ADHD) in adults with regard to the presence of symptoms and comorbidities common to mood, anxiety and other disorders. In adults, symptoms are often masked by the patient's learned compensatory mechanisms. Misdiagnosis, and subsequent treatment, can moderate common symptoms without relieving the core difficulties of inattention, hyperactivity and impulsivity. This review was conducted to identify methods of improving diagnostic clarity. The literature reveals the importance of evaluating both retrospective and current symptoms and impairments in the context of the individual's life. Careful, nuanced assessment of the relationship between symptom expression and impairment in daily living offers diagnostic clarity. Symptoms common to multiple disorders will be distinguished by illuminating the context in which they arise and are experienced. Well-supported assessments, sensitive to the context in which symptoms and impairments present, will result in greater diagnostic accuracy, better treatment outcomes and enhanced quality of life. Accurate diagnoses will contribute to the understanding of adult ADHD and remind both clinicians and the public that this disorder is often present in adults as well as children.