Do You Zone Out? Procrastinate? Might Be Adult ADHD

Do you pop up from your seat during meetings and finish other people's sentences? And maybe you also procrastinate, or find yourself zoning out in the middle of one-on-one conversations?

It's possible you have adult ADHD.

Six simple questions can reliably identify adults with attention-deficit/hyperactivity disorder, according to a World Health Organization advisory group working with two additional psychiatrists.

The questions are:

1. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
2. How often do you leave your seat in meetings and other situations in which you are expected to remain seated?
3. How often do you have difficulty unwinding and relaxing when you have time to yourself?
4. When you're in a conversation, how often do you find yourself finishing the sentences of the people you are talking to before they can finish them themselves?
5. How often do you put things off until the last minute?
6. How often do you depend on others to keep your life in order and attend to details?

The response options are "never," "rarely," "sometimes," "often" or "very often."

"It's very important to look at the questions in their totality, not each individual symptom," says Dr. David Goodman, an assistant professor of psychiatry at Johns Hopkins School of Medicine who was not involved in the study. "No single question stands out as indicating ADHD."

Using data from the National Comorbidity Survey, the authors found that the six questions appear to reliably, and specifically, screen for ADHD in adults. That could allow primary care physicians who have limited time with each patient to quickly and easily determine whether to recommend patients for further psychiatric evaluation, or even to prescribe medication.

"Especially among adults in the U.S., a lot of people with ADHD are still undiagnosed," says Goodman. "The fact that WHO is involved puts substantial weight behind this."

The six questions are based on the updated definition of the condition under psychiatry's "Bible," the Diagnostic and Statistical Manual of Mental Disorders. The most recent edition, known by the shorthand DSM-5, was published in 2013, and included new diagnostic criteria for ADHD.

Versions of the six-question survey have been around for over a decade, and researchers and clinicians frequently tweak it and test its efficacy. The newest edition reflects the DSM-5 changes, which include reducing the number of symptoms needed to diagnose ADHD in people over 17 years old from six to five.

The report was published Wednesday in JAMA Psychiatry, accompanied by a commentary by three researchers at the National Institutes of Health. They note that where earlier guidelines had suggested doctors look for more serious impairment, the DSM-5 says only that symptoms "interfere" or "lower quality" of day-to-day functioning.

The authors of the commentary also write that the inclusion of questions five and six, about chronic procrastination and a dependence on others, are "not ADHD symptoms per se" in the DSM-5, which raises the possibility that the current DSM criteria are not particularly well-suited to diagnosing adults.

The new study also suggests that the rate of ADHD among adults may be significantly higher than previously thought. The authors found a prevalence of 8.2 percent, which is almost double the 4.4 percent rate reported in a 2006 study.

For adults diagnosed with ADHD, the treatment options are similar to those available for children, including medication and psychotherapy, although stimulants like Adderall or Ritalin can be problematic for those with high blood pressure or heart disease.

And as NPR's Patti Neighmond has reported, ADHD comes with different challenges for adults:

"For adults, the problem is not disruptive behavior or keeping up in school. It's an inability to focus, which can mean inconsistency, being late to meetings or just having problems managing day-to-day tasks. Adults with ADHD are more likely than others to lose a job or file for bankruptcy. ... They may overpay bills, or underpay them. They may pay bills late, or not at all."

For those who wonder whether they have ADHD, the best option is to see a doctor.

There are lots of free ADHD-screening questionnaires on the Internet, which include a range of past and current diagnostic criteria. The advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder says on their website, "Most of these questionnaires are not standardized or scientifically validated and should not be used to self-diagnose or to diagnose others with ADHD."

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