ADHD in adults — KFP-style written assessment

KFP 1 (10 marks)

A 31-year-old woman has had three antidepressant trials for 'treatment-resistant depression' with ongoing poor concentration, disorganisation and chronic lateness. Her sister was recently diagnosed with ADHD. ^{[16] [17]}

1. Quantify the probability that she has ADHD, citing the comorbidity data. (4) ^[16]
2. Why might her ADHD have been missed to date? (3) ^{[17] [4]}
3. What assessment adaptations does the evidence recommend for women? (3) ^[17]

Model answers

1. In a cohort of women presenting with depression or anxiety, ADHD was identified in 19.6%, and 45.5% of those cases were previously undiagnosed. Prevalence was highest in social anxiety disorder (46.4%) and double depression (40.6%). Her profile — treatment-resistant mood disorder with lifelong disorganisation — sits squarely in the screen-positive stratum. ^[16]
2. Diagnostic accuracy in women is complicated by symptom masking, comorbid anxiety/depression, and referral biases; ADHD is also overlooked in people of high intellectual capacity, and negative consequences follow both underdiagnosis and overdiagnosis. Internalising symptoms typically bring women to care, where the developmental disorder underneath is missed. ^{[17] [4]}
3. Assess hormonal impact as part of the ADHD assessment: a protocol including menstrual cycle tracking and validated questionnaires for mood and sleep disturbances, with attention to premenstrual exacerbation of symptoms and hormonal status at diagnosis. ^[17]