Public health aspects of adult attention-deficit hyperactivity disorder

SUMMARY Requests for assessment and treatment of attention-deficit hyperactivity disorder (ADHD) in adults have increased substantially in many countries. This trend appears to reflect increased recognition, greater public awareness and changing patterns of help-seeking, rather than a true increase in prevalence. As demand for services grows, concerns have emerged regarding access to care, long waiting times, variation in service provision and inequities in diagnosis and treatment. This article examines ADHD in adults from a public mental health perspective, reviewing epidemiology, associated comorbidities, functional and economic burdens, and adverse outcomes, including evidence of reduced life expectancy. It considers inequities in recognition, diagnosis and treatment, including those related to sex/gender and race/ethnicity. Finally, it explores how adult ADHD services are organised in different countries and reviews recent recommendations for service development from NHS England. Adult ADHD has implications that extend beyond its core symptoms, and psychiatrists have an important role in improving recognition, addressing inequities in access to care and leading the development of services that improve outcomes and reduce preventable harm.