Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4

Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder, which starts in childhood and often persists into adulthood. It is associated with significant impairment.

The 2007, 2014 and 2023/4 APMS included the six-item Adult ADHD Self-Report Scale (ASRS). The screening tool assesses ADHD characteristics of inattention, hyperactivity and impulsivity during the six months prior to interview. Screening positive for ADHD (a score of four or more on the ASRS) does not mean that someone has the condition, rather that they warrant a more comprehensive assessment.

• One in seven (13.9%) adults screened positive for ADHD using the Adult ADHD Self-Report Scale (ASRS), with prevalence higher in women (14.9%) than men (12.4%).
• One in twenty (5.8%) adults thought that they had ADHD, and 1.8% of adults reported that they have been diagnosed with ADHD by a professional.
• Adults screening positive for ADHD were more likely to have been diagnosed. Among those screening positive for ADHD on the ASRS, 9.6% reported having been diagnosed with ADHD by a professional and 2.6% were taking ADHD medication. Among those screening negative for ADHD, 0.5% reported having been diagnosed by a professional at some point during their lives and almost none (0.0%) were taking ADHD medication.
• The proportion of adults screening positive for ADHD using the ASRS has increased, from 8.2% in 2007 and 9.7% in 2014, to 13.9% in 2023/4.
• The proportion of adults screening positive for ADHD varied between groups and was higher among younger adults, those not in employment, and adults with problem debt: 28.1% of adults experiencing problem debt screened positive for ADHD, compared with 12.7% of those with no problem debt.
• Over a third of adults with a common mental health condition (CMHC) screened positive for ADHD. Those with a CMHC were five times more likely to screen positive for ADHD (38.5%) than adults without a CMHC (7.2%).

Attention deficit hyperactivity disorder (ADHD) is widely recognised as a complex neurodevelopmental disorder in childhood. It is marked by a ‘persistent pattern (at least six months) of inattention and/or hyperactivity-impulsivity that has a direct negative impact in more than one setting on academic, occupational, or social functioning’ (ICD-11; World Health Organization 2022). The eleventh revision of the International Classification of Diseases (ICD-11) identifies more indicative symptoms but is less prescriptive about diagnostic thresholds and allows milder presentations than the tenth version (ICD-10), which brings it more in line with the definition and criteria for ADHD in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association 2013; Gomez et al. 2023).

A recent meta-analysis estimated the prevalence of childhood ADHD (in children aged 3 to 12 years) as 7.6% and adolescent ADHD (young people aged 12 to 18 years) as 5.6% (Salari et al. 2023). The persistence of ADHD into adulthood has only gained significant recognition – and become a focus for research and clinical management – over the past two decades (Nutt et al. 2007). The National Institute for Health and Care Excellence (NICE) reviewed the diagnostic construct of ADHD across the lifespan and concluded that when ADHD persists into adulthood, it is often associated with significant impairment (NICE 2008). A meta-analysis focused on adults estimated the prevalence of persistent adult ADHD (with childhood onset) as 2.58% and symptomatic adult ADHD (regardless of childhood onset) as 6.76%, translating to 139.84 million and 366.33 million affected adults in 2020 globally (Song et al. 2021). The prevalence of both were found to decrease with advancing age.

Adults with ADHD tend to have fewer academic qualifications, probably because of difficulties with distractibility and restlessness, as well as problems with organising time, prioritising tasks and meeting deadlines (Nutt et al. 2007). Academic achievement and performance, however, can be improved with intervention (Arnold et al. 2020). APMS 2007 provided the first epidemiological data on the prevalence of ADHD characteristics in the adult population in England. Findings from APMS 2007 and 2014 found that screening positive for ADHD varied by relationship and household circumstances, and was more prevalent among those who were unemployed, in receipt of out-of-work benefits, or who had substance misuse disorders (McManus et al. 2009; McManus et al. 2016). 12% of treatment-seeking patients with substance abuse disorders (van de Glind et al. 2014) and 31% of ex-prisoners (Bebbington et al. 2021) have been found to screen positive for ADHD. It is associated with increased rates of criminal convictions (Lichtenstein et al. 2012), transport accidents (Chang et al. 2014), early mortality (Dalsgaard et al. 2015) and suicidal behaviour (Forte et al. 2020; Balazs et al. 2017). Additional costs to society may be incurred through absenteeism, reduced productivity and poorer work performance (Kessler et al. 2005a).

Findings from the 2007 and 2014 surveys indicated strong associations between screening positive for ADHD and other mental health conditions (McManus et al. 2009; McManus et al. 2016). Substantial increased risk for a range of other secondary mental health conditions has been found in people with ADHD (Nigg et al. 2020). These include meeting criteria for personality disorders, particularly those characterised by emotional instability such as antisocial personality disorder and borderline personality disorder. ADHD symptoms also commonly co-occur with other neurodevelopmental disorders such as autism and intellectual (learning) disability, and specific learning difficulties (Rong et al. 2021). This may result in additional or alternative diagnoses (Nutt et al. 2007; Asherson et al. 2022). ADHD in adults may also go unrecognised or be misdiagnosed by mental health professionals (Asherson 2005; Asherson et al. 2022) given that some characteristic features of ADHD are also seen in other psychiatric conditions, such as the disrupted concentration or agitation that can occur with depression, bipolar disorder, and generalized anxiety disorder (Choi et al. 2022; Milberger et al. 1995). If ADHD in adulthood is unrecognised due to comorbidity, service provision and treatment of other comorbid mental health conditions may be ineffective. Undiagnosed adults with ADHD have been found to experience worse general health than their diagnosed peers (Able et al. 2007).

Timely detection and treatment may moderate risks and improve outcomes in individuals diagnosed with ADHD (Shaw et al. 2012). Service provision and treatment for ADHD in childhood is now well established, but is much less available for adults with the condition including those seeking a diagnosis in adulthood (Smith et al. 2024; Price et al. 2024). In 2024, NHS England launched a new ADHD taskforce, bringing together expertise from across a range of sectors, including health, education and justice, to better understand the challenges affecting those with ADHD and help provide a joined-up approach in response to concerns around rising demand for services. ADHD was the second most viewed health condition on the NHS website in 2023, after COVID-19, with 4.3 million page views over the course of the year (NHS England 2024).

Information about the prevalence of screening positive for possible ADHD and the use of mental health services by adults presenting with characteristic features of ADHD in the population is essential for planning improvements in diagnosis and service provision. This chapter describes the general population distribution of characteristic behavioural symptoms associated with ADHD and changes over time, examines their association with age, gender, and sociodemographic characteristics, and profiles the use of mental health treatment and services.

Attention deficit hyperactivity disorder (ADHD)

ADHD is a neurodevelopmental disorder described by ICD-11 (World Health Organization (WHO) 2022) as being characterised by a persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity that has a direct negative impact on academic, occupational, or social functioning. The role of ancillary characteristics has been highlighted in recent years; these include emotional dysregulation, sleep onset insomnia and problems with the self-regulation of behaviour (Asherson et al. 2016). While these are not used to define ADHD, they are commonly seen in the condition and often lead to impairment. They are also seen in other mental disorders.

The relevant sets of diagnostic criteria are the World Health Organization’s (WHO) official International Classification of Diseases (ICD) 10th and 11th Revision (WHO 1993, 2022) and the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) of the American Psychiatric Association (APA 2013; Gomez et al. 2023). The ICD-10 has used a more restricted set of criteria, for hyperkinetic disorder when all three characteristics of inattention, hyperactivity and impulsivity must be present and lead to impairment across multiple domains (such as home and work). The narrowness of this definition has been seen as a limitation, as it did not identify people with all the features of adult ADHD if the criteria for other conditions are also met and will only detect the most severe cases. On the other hand, given the severity of ICD-10 hyperkinetic disorder, people meeting these criteria represent a clear priority for service providers. DSM-5 in contrast sets out a broader definition of the disorder and allows the presence both of comorbid disorders and of impairing symptoms in the inattentive or hyperactive-impulsive domains. This approach might therefore be seen as overidentifying ADHD in individuals who are primarily suffering from other disorders (Nutt et al. 2007). The ICD-11 provided an update on the diagnostic guidelines for ADHD and this is more aligned with DSM-5 (WHO 2022; Gomez et al. 2023). Despite changes in diagnostic systems, the way in which ADHD characteristics have been measured on APMS since 2007 has remained consistent.

Adult ADHD Self-Report Scale-v1.1 (ASRS)

The Adult ADHD Self-Report Scale (ASRS), developed in collaboration with the WHO, has been used on APMS 2007, 2014 and 2023/4 to estimate the prevalence of possible ADHD (WHO 2003). The scale is referred to in this chapter as a screening test for reasons of convention, although it is not currently recommended as part of an official screening programme in England.

The ASRS is based on the WHO Composite International Diagnostic Interview (2003), and the questions are consistent with both DSM-IV and DSM-5-TR criteria (APA 1994, 2013) specifically worded to reflect symptom manifestation in adults (Kessler et al. 2005b).The six-item ASRS is a shortened version of the 18-item Symptom Checklist scale, which measures the frequency of recent symptoms of adult ADHD. This short screen appears to out-perform the full 18-question ASRS in terms of sensitivity (68.7% versus 56.3%), specificity (99.5% versus 98.3%), and total classification accuracy (97.9% versus 96.2%) (Kessler et al. 2007). Its use and validity have been established predominantly in community samples, although it has been suggested that the scale could also prove to be a useful complement to more accurate clinical diagnostic assessments (Kessler 2005b). However, it may lack sufficient predictive validity in some populations, such as those with substance use disorders (van de Glind et al. 2013).

The ASRS screen was administered face-to-face to all participants. The six questions assess the ADHD characteristics of inattention, hyperactivity and impulsivity during the six months prior to interview. Participants were asked to rate the frequency of these characteristics using a five-point response scale: ‘never’, ‘rarely’, ‘sometimes’, ‘often’ and ‘very often’. In this chapter we report 1) the proportion of adults reporting four or more characteristics at or above the specified frequency threshold described below, and 2) the proportion reporting all six characteristics. The four-item threshold is the threshold recommended for indicating a need for a clinical assessment for ADHD (Fayyad et al. 2007). However, the developers of the scale also emphasise that the higher the score the more likely it is that ADHD is present, and for this reason we also show the proportion of the sample meeting the threshold frequency for all six items. This reveals subgroups with the greatest likelihood of a positive diagnosis at clinical assessment.

The questions in the ASRS scale used to screen for possible adult ADHD and the threshold frequencies are displayed below.

Adult Self-Report Scale-v1.1 (ASRS-V1.1) Screen

Although the ASRS screen shows strong concordance with clinical diagnosis in US population surveys (Adler et al. 2019), caution is required in interpreting ASRS-based findings. First, self-reported information is always subject to some social desirability biases (Greenfield et al. 2001). Second, adults may under-report their ADHD symptoms in comparison to informant observations (Abrams et al. 2018; Cheung et al. 2016; Moffitt et al. 2015). Third, the age of onset, the level of impairment resulting from the symptoms of hyperactivity and inattention, and the degree of pervasiveness across situations such as home and work are criteria informing the diagnosis of ADHD, and the ASRS does not include an assessment of these.

It is important to note that for the purposes of this chapter, scoring four or more on the ASRS is counted as a ‘positive screen for ADHD’ (Dunlop et al. 2018). Proportions are also presented for those who endorsed all six items on the ASRS. Screening positive for ADHD (with a score of four or more) indicates that an individual has sufficient symptoms to warrant a further and more detailed ADHD assessment. The prevalence of ADHD is likely to be considerably lower than the proportion screening positive for ADHD.

Screening positive for ADHD in past 6 months, by age and gender

One in seven (13.9%) adults scored four or more on the ASRS screen, the threshold at which clinical assessment for ADHD may be warranted. If all adults in the household population had been screened it is likely (95% confidence) that the proportion screening positive would be between 12.8% and 15.1%. This equates to an estimated 6.5 million adults in England. The proportion reporting all six characteristics was one in fifty (1.9%). Women were more likely than men to screen positive for ADHD; 14.9% (95% CI 13.5, 16.4) of women and 12.4% (CI 10.8, 14.2) of men scored four or more on the ASRS.

The proportion of adults screening positive for ADHD broadly decreased with age. This was true for both women and men. The proportion was highest among adults aged 16 to 24 (25.0%, CI 20.4, 30.2), and lowest among those aged 75 and over (3.7%, 2.5, 5.5).

For more information: Table 9.1 and Table A1 for confidence intervals

Trends in screening positive for ADHD, 2007, 2014 and 2023/4

Note that the trend data analyses were carried out by sex (male and female) rather than gender (men and women) to allow for comparison back to 2007. See How to interpret the findings for information on how changes over time were assessed.

There has been an increase in the prevalence of adults screening positive for ADHD over time. The proportion of adults scoring four or more on the ASRS rose from 8.2% in 2007 and 9.7% in 2014, to 13.9% in 2023/4 (95% CIs: 2007: 7.6, 8.9; 2014: 8.9, 10.6; 2023/4: 12.8, 15.2).

The increase over time was evident in both males (8.8% in 2007, CI 7.8, 9.8; 10.0% in 2014, CI 8.8, 11.4; 13.0% in 2023/4, CI 11.3, 14.9) and females (7.7% in 2007, CI 6.8, 8.7; 9.5% in 2014, CI 8.5, 10.5; 14.8% in 2023/4, CI 13.4, 16.4).

All age groups under 65 increased in prevalence of screening positive for ADHD between 2007 and 2023/4, while no increase over time was evident for those aged 65 and over.

For more information: Table 9.2 and Table B1 for confidence intervals

Variation in screening positive for ADHD by other characteristics

Ethnic group

There were differences between ethnic groups in age-standardised prevalence of screening positive for ADHD. Those identifying as White British were most likely to score four or more on the ASRS (16.2%, 95% CI 14.8, 17.8), and those identifying as Asian/Asian British were least likely to screen positive (7.5%, CI 4.8, 11.4). It should be noted that the confidence intervals for some estimates were wide and overlapping, so apparent differences between ethnic groups should be treated with caution.

For more information: Table 9.3 and Table A2 for confidence intervals

Employment status

Screening positive for ADHD varied by employment status in age-standardised analyses. Working-age adults (aged 16 to 64) who were unemployed (29.6%) or economically inactive (26.1%) were more likely to screen positive than those in employment (14.1%).

For more information: Table 9.4

Problem debt

Adults reporting being seriously behind on at least one debt repayment or having their utilities cut off were more likely to screen positive for ADHD (age-standardised). 28.1% of adults with problem debt scored four or more on the ASRS, compared with 12.7% of those without problem debt. See the APMS 2023/4 Methods documentation for more information on how problem debt was derived.

For more information: Table 9.5

Area-level deprivation

Screening positive for ADHD did not vary significantly by area-level deprivation.

For more information: Table 9.6

Region

Prevalence of screening positive for ADHD did not vary significantly across regions.

For more information: Table 9.7

Comorbidity

Physical health conditions

Adults with a limiting physical health condition were more likely to screen positive for ADHD than adults without a limiting physical health condition. 21.2% of adults with a limiting physical health condition scored four or more on the ASRS compared with 10.2% of adults without a limiting physical health condition.

For more information: Table 9.8

Common mental health conditions

More than one in three (38.5%) adults with a common mental health condition (CMHC) screened positive for ADHD. Those with a CMHC were five times more likely to screen positive for ADHD than adults without a CMHC (38.5% and 7.2% respectively).

For more information: Table 9.8

Self-diagnosis and professional diagnosis of ADHD

Participants were asked whether they thought they had ever had ADHD and, if so, whether they had been diagnosed by a professional. If participants reported they had been diagnosed, they were asked if they had symptoms in the past 12 months.

One in twenty (5.8%) adults reported they thought they had ADHD, 1.8% of adults reported that they had been diagnosed with ADHD by a professional, and 1.5% of adults reported they also had symptoms present in the past 12 months.

Men (5.8%) and women (5.5%) were equally likely to think they have had ADHD, to have had ADHD diagnosed by a professional (men 1.7%, women 1.7%), and to have had symptoms present in the past 12 months (men 1.4%, women 1.4%).

Among people scoring four or more on the ASRS, one in four (27.1%) reported that they thought they had ADHD. Among those scoring six on the ASRS, 55.9% reported that they thought they had ADHD, compared with 2.3% of adults with a score of 0 to 3.

Adults scoring four or more (9.6%) or six (27.1%) on the ASRS were also more likely to report having received a professional diagnosis for ADHD than those who did not screen positive for ADHD (0.5%).

For more information: Table 9.9

Treatment

Treatment and service use

Participants were asked about different types of mental health treatment and service use. Two types of mental health treatment were asked about: current medication and psychological therapy for a mental or emotional problem. A range of health, community and day care services over the past year were also asked about. This treatment and service use could have been for any mental health condition, not necessarily ADHD.

Most (62.2%) adults scoring four or more on the ASRS, and half (51.1%) of those scoring six, reported that they were not currently receiving any treatment for a mental or emotional problem. Where adults screening positive for ADHD did receive treatment, this was more likely to be medication (31.5%) than psychological therapy (12.3%).

A third (34.7%) of adults screening positive for ADHD reported using health care services for a mental or emotional problem, compared with one in ten (10.1%) adults who did not screen positive for ADHD.

A fifth (19.3%) of adults screening positive for ADHD used community care services in the past year, and 7.1% used day care services, compared with 5.7% and 3.3% of those scoring 0 to 3 on the ASRS, respectively.

For more information: Table 9.10

Psychotropic medication

Participants were asked which psychotropic medications (used to treat mental health related symptoms and conditions) they currently take (not necessarily for symptoms relating to ADHD). The most common medication types reported were those primarily used to treat depression (11.7%) and anxiety (10.7%). See Chapter 2 Mental health treatment and service use for more details. For further information about how medication data was collected, see the APMS 2023/4 Methods documentation.

The most frequently reported types of psychotropic medication taken by adults screening positive for ADHD were those for depression (28.7%) and anxiety (25.5%).

2.6% of adults who scored four or more on the ASRS, and 8.0% of adults who scored six, were currently taking medication specifically indicated for ADHD (Amfexa, atomoxetine, Concerta XL, Delmosart, dexamfetamine, Medikinet, methylphenidate, Tranquilyn, Xaggitin XL or Xenidate XL). However, it is possible that some participants may have been taking an ADHD medication not asked about, may have taken an ADHD medication in the past, or could be currently taking ADHD medication and not reported it (either because they chose to withhold this information or because they were unaware). Among those screening negative for ADHD, 0.0% reported taking ADHD medication.

For more information: Table 9.11

The APMS provides unique data on possible ADHD among adults in England.  This chapter presents results on the prevalence of possible ADHD as measured by the six-item ASRS screen used in the 2007, 2014 and 2023/4 APMS. The ASRS does not take account of whether the symptoms persist across different aspects of a person’s life, nor how impairing the symptoms are. Despite these limitations, the APMS findings are valuable in identifying the population distribution of characteristics associated with possible ADHD and provide comparable data spanning almost two decades. The results presented in this chapter indicate that there have been shifts in prevalence, recognition, service response, and in the characteristics of adults screening positive.

The proportion of adults screening positive for ADHD has increased. There has been an increase this decade in the proportion of adults in England screening positive for possible ADHD as indicated by reporting four or more of the items on the ASRS. This rose from one in ten in 2014 to one in seven in 2023/4. There may be reasons other than an increase in ADHD for why an increase in screening positive on the ASRS has been found. For example, reduced stigma related to neurodevelopmental conditions such as ADHD might contribute to an increased likelihood that people feel able to report symptoms (Speerforck et al. 2019). It is also possible that increased awareness of ADHD characteristics might have led to a change in recognition and reporting. Further, the 2023/4 APMS had a lower response rate than the previous surveys in the series, and there may have been changes in the profile of the sample that participated.

People have become more likely to think that they have ADHD. The results in this chapter show that adults have become more likely to think that they have ADHD. In the 2023/4 survey, among those screening positive on the ASRS, over one in four thought they had ADHD. While in the 2014 survey, this had been one in twenty-five (Brugha et al. 2016). This suggests there may have been a shift this decade in awareness and recognition of the condition among adults in England.

Professionals appear to be more likely to diagnose and treat ADHD. The findings suggest that there has also been an increase in professional diagnosis of ADHD. In the 2023/4 survey, among people screening positive on the ASRS, one in ten had an ADHD diagnosis from a health professional. The comparable figure from the 2014 survey was one in forty. Alongside the increased recognition by health professionals, those screening positive for ADHD were also more likely to be in receipt of ADHD medication. In the 2023/4 survey, 2.6% were being prescribed medication for ADHD, five times the rate reporting this in 2014 (0.5%) (Brugha et al. 2016). Note that the method of collecting medications data was revised in 2023/4 (see APMS 2023/4 Methods documentation). However, the results in this chapter indicate that very few adults who screened negative for ADHD thought that they might have it, very few of those in turn had ever been diagnosed by a professional with ADHD, and almost none of them were taking ADHD medication.

The changes are consistent with a picture of increased demand for treatment and services for people with ADHD symptoms. People screening positive for ADHD were more likely than those screening negative to get mental health treatment in general. This may reflect the fact that adults screening positive for ADHD often have comorbid diagnoses of other psychiatric conditions; in 2023/4 more than one in three adults screening positive for ADHD were also identified with a common mental health condition such as depression or an anxiety disorder. Alternatively, their ADHD characteristics may be misdiagnosed by doctors who are not trained to recognise and treat adult ADHD. This interpretation is supported by the lower levels of ADHD medication currently being taken by participants screening positive for ADHD, compared with their higher levels of anxiolytic and antidepressant use. It is worth noting, however, that the APMS cannot be used to estimate how many adults would be likely to benefit from treatment. Progress is being made with the development of best practice advice and guidelines on care for adults with ADHD, which identifies key priorities for treatment and management of the disorder (Adamou et al. 2024; Nutt et al. 2007). These APMS findings may indicate a need for further work in improving the diagnosis and treatment of adult ADHD, both at the population level where precise screening tools need to be developed in relation to clinical assessments of the general population, and in clinical practice.

Some groups are more likely than others to screen positive for ADHD. The survey provides unique insight into the characteristics and circumstances of people screening positive for ADHD. The results confirm several established and expected associations, for example with socioeconomic disadvantage and comorbidity with other mental health conditions. Although no significant variation by area-level deprivation or region was observed, screening positive for ADHD was found to be higher in younger age groups, White British adults, the unemployed and in those with problem debt. Many factors might contribute to the higher prevalence in younger people, including adapting to symptoms over the course of life. However, one factor that has been highlighted by O’Nions and colleagues (2025) is the reduced life expectancy for people with ADHD relative to the general population; around 7 years for males and 9 years for females.

Changes in the profile of people screening positive for ADHD have emerged. In the 2007 and 2014 surveys, men and women were equally likely to screen positive for ADHD. This has also been found in community-based surveys in other parts of the world (Kessler et al. 2006), while in 2023/4 women were more likely than men to screen positive on the ASRS. Despite the probable under recognition of ADHD by health services in girls and women, most research has found that they are indeed less likely to meet diagnostic criteria. Russell and colleagues in analysis of community cohort data found that girls with the same symptoms as boys were less likely to access services, but also more likely to be prescribed medication if they do (Russell et al. 2014). Martin and colleagues (2024) examined Welsh health survey data and found that females with ADHD tend to experience later recognition and treatment of ADHD. Their results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis.

There is a lack of survey data describing the presence of possible ADHD in the general adult population in England and the circumstances of adults with ADHD are poorly understood. The APMS series helps to address these data gaps.

Able, S. L., Johnston, J. A., Adler, L. A., & Swindle, R. W. (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine, 37(1), 97-107.

Abrams, J., Faraone, S. V., Woodworth, K. Y., Spencer, T. J., Biederman, I., & Biederman, J. (2018). Are adult ADHD patients good informants of their symptoms? A qualitative literature review of concordance between clinician and self-report ADHD symptoms. The Journal of Nervous and Mental Disease, 206(9), 739-743.

Adamou, M., Arif, M., Asherson, P., Cubbin, S., Leaver, L., Sedgwick-Müller, J., Müller-Sedgwick U.,van Rensburg K., & Kustow, J. (2024). The adult ADHD assessment quality assurance standard. Frontiers in Psychiatry, 15, 1380410.

Adler, L. A., Faraone, S. V., Sarocco, P., Atkins, N., & Khachatryan, A. (2019). Establishing US norms for the Adult ADHD Self‐Report Scale (ASRS‐v1.1) and characterising symptom burden among adults with self‐reported ADHD. International Journal of Clinical Practice, 73(1), e13260.

American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. 

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Publishing, Inc..

Arnold, L. E., Hodgkins, P., Kahle, J., Madhoo, M., & Kewley, G. (2020). Long-term outcomes of ADHD: academic achievement and performance. Journal of Attention Disorders, 24(1), 73-85.

Asherson, P. (2005). Clinical assessment and treatment of attention deficit hyperactivity disorder in adults. Expert Review of Neurotherapeutics, 5(4), 525-539.

Asherson, P., Buitelaar, J., Faraone, S. V., & Rohde, L. A. (2016). Adult attention-deficit hyperactivity disorder: key conceptual issues. The Lancet Psychiatry, 3(6), 568-578.

Asherson, P., Leaver, L., Adamou, M., Arif, M., Askey, G., Butler, M., ... & Skirrow, C. (2022). Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry, 22(1), 640.

Balazs, J., & Kereszteny, A. (2017). Attention-deficit/hyperactivity disorder and suicide: A systematic review. World Journal of Psychiatry, 7(1), 44.

Bebbington, P. E., McManus, S., Coid, J. W., Garside, R., & Brugha, T. (2021). The mental health of ex-prisoners: analysis of the 2014 English National Survey of Psychiatric Morbidity. Social Psychiatry and Psychiatric Epidemiology, 1-11

Brugha, T., Asherson, P., Strydom, A., Morgan, Z., Christie, S. (2016). ‘Chapter 8: Attention-deficit/hyperactivity disorder’ in McManus S, Bebbington P, Jenkins R, Brugha T. (eds) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.

Chang, Z., Lichtenstein, P., D’Onofrio, B. M., Sjölander, A., & Larsson, H. (2014). Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study. JAMA Psychiatry, 71(3), 319-325.

Cheung, C. H., Rijsdijk, F., McLoughlin, G., Brandeis, D., Banaschewski, T., Asherson, P., & Kuntsi, J. (2016). Cognitive and neurophysiological markers of ADHD persistence and remission. The British Journal of Psychiatry, 208(6), 548-555.

Choi, W. S., Woo, Y. S., Wang, S. M., Lim, H. K., & Bahk, W. M. (2022). The prevalence of psychiatric comorbidities in adult ADHD compared with non-ADHD populations: A systematic literature review. PLoS One, 17(11), e0277175.

Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. The Lancet, 385(9983), 2190-2196.

Dunlop, B. W., Wu, R., & Helms, K. (2018). Performance of the adult ADHD self-report scale-v1. 1 in adults with major depressive disorder. Behavioral Sciences, 8(4), 37.

Fayyad, J., De Graaf, R., Kessler, R., Alonso, J., Angermeyer, M., Demyttenaere, K., ... & Jin, R. (2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. The British Journal of Psychiatry, 190(5), 402-409.

Forte, A., Orri, M., Galera, C., Pompili, M., Turecki, G., Boivin, M., Tremblay, R.E. and Côté, S.M. (2020). Developmental trajectories of childhood symptoms of hyperactivity/inattention and suicidal behavior during adolescence. European Child & Adolescent Psychiatry, 29, pp.145-151.

Gomez, R., Chen, W., & Houghton, S. (2023). Differences between DSM-5-TR and ICD-11 revisions of attention deficit/hyperactivity disorder: a commentary on implications and opportunities. World Journal of Psychiatry, 13(5), 138.

Greenfield, B., Hechtman, L., Bouffard, R., Minde, K., Looper, K., Ochs, E., & Eakin, L. (2001). Correspondence between self and “significant other” reports of childhood and current adult ADHD symptoms. Poster presented at the International Society for Research in Child and Adolescent Psychopathology, Vancuover.

Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self‐Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52-65.

Kessler, R. C., Adler, L., Ames, M., Barkley, R. A., Birnbaum, H., Greenberg, P., ... & Üstün, T. B. (2005a). The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. Journal of Occupational and Environmental Medicine, 47(6), 565-572.

Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E. V. A., ... & Walters, E. E. (2005b). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine, 35(2), 245-256.

Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., ... & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716-723.

Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., ... & Larsson, H. (2012). Medication for attention deficit–hyperactivity disorder and criminality. New England Journal of Medicine, 367(21), 2006-2014.

Martin, J., Langley, K., Cooper, M., Rouquette, O. Y., John, A., Sayal, K., ... & Thapar, A. (2024). Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales. Journal of Child Psychology and Psychiatry.

McManus, S., Bebbington, P., Jenkins, R., Brugha, T. (eds). (2016). Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and-wellbeing-england-2014 

McManus, S., Meltzer, H., Brugha, T., Bebbington, P., Jenkins, R. (eds). (2009). Adult Psychiatric Morbidity in England 2007: results of a household survey. The NHS Information Centre. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-in-england-2007-results-of-a-household-survey

Milberger, S., Biederman, J., Faraone, S. V., Murphy, J., & Tsuang, M. T. (1995). Attention deficit hyperactivity disorder and comorbid disorders: issues of overlapping symptoms. American Journal of Psychiatry, 152(12), 1793-1799.

Moffitt, T. E., Houts, R., Asherson, P., Belsky, D. W., Corcoran, D. L., Hammerle, M., ... & Caspi, A. (2015). Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. American Journal of Psychiatry, 172(10), 967-977.

National Institute for Health and Clinical Excellence. (2008). Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. (Clinical guideline 72.) www.nice.org.uk/CG72

NHS England. (2024). NHS to launch cross-sector ADHD taskforce to boost care for patients in England https://www.england.nhs.uk/2024/03/nhs-to-launch-cross-sector-adhd-taskforce-to-boost-care-for-patients-in-england/

Nigg, J.T., Sibley, M.H., Thapar, A. and Karalunas, S.L. (2020). Development of ADHD: Etiology, heterogeneity, and early life course. Annual Review of Developmental Psychology, 2(1), pp.559-583.

Nutt, D. J., Fone, K., Asherson, P., Bramble, D., Hill, P., Matthews, K., ... & Young, S. (2007). Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 21(1), 10-41.

O'Nions, E., El Baou, C., John, A., Lewer, D., Mandy, W., McKechnie, D. G., ... & Stott, J. (2025). Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. British Journal of Psychiatry, 1-8.

Price, A., Becker, K., Ward, J., Ukoumunne, O., Gudka, R., Salimi, A., ... & Newlove-Delgado, T. (2024). Support for primary care prescribing for adult ADHD in England: national survey. British Journal of General Practice.

Rong, Y., Yang, C. J., Jin, Y., & Wang, Y. (2021). Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis. Research in Autism Spectrum Disorders, 83, 101759.

Russell, G., Rodgers, L.R., Ukoumunne, O.C., & Ford, T. (2014). Prevalence of Parent-Reported ASD and ADHD in the UK: Findings from the Millennium Cohort Study. J Autism Dev Disord 44, 31–40.

Salari, N., Ghasemi, H., Abdoli, N., Rahmani, A., Shiri, M. H., Hashemian, A. H., ... & Mohammadi, M. (2023). The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis. Italian Journal of Pediatrics, 49(1), 48.

Shaw, M., Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A.G. and Arnold, L.E. (2012). A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Medicine, 10, pp.1-15.

Smith, M. C., Mukherjee, R. A., Müller-Sedgwick, U., Hank, D., Carpenter, P., & Adamou, M. (2024). UK adult ADHD services in crisis. BJPsych Bulletin, 48(1), 1-5.

Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X. and Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11.

Speerforck, S., Stolzenburg, S., Hertel, J., Grabe, H. J., Strauß, M., Carta, M. G., ... & Schomerus, G. (2019). ADHD, stigma and continuum beliefs: A population survey on public attitudes towards children and adults with attention deficit hyperactivity disorder. Psychiatry Research, 282, 112570.

van de Glind, G., Konstenius, M., Koeter, M. W., van Emmerik-van Oortmerssen, K., Carpentier, P. J., Kaye, S., ... & IASP Research Group. (2014). Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria. Drug and Alcohol Dependence, 134, 158-166.

van de Glind, G., van den Brink, W., Koeter, M. W., Carpentier, P. J., van Emmerik-van Oortmerssen, K., Kaye, S., ... & IASP Research Group. (2013). Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients. Drug and Alcohol Dependence, 132(3), 587-596.

World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders. World Health Organization.

World Health Organization. (2003). Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) Screen. WHO Composite International Diagnostic Interview.

World Health Organization. (2022). Attention deficit hyperactivity disorder. In International classification of diseases (11th ed). Available from: https://icd.who.int/

Please cite this chapter as: 

Ridout, K., O'Shea, C., Morris, S., Brugha, T., Ford, T., McManus, S., Tromans, S., & Morgan, Z. (2025). Attention deficit hyperactivity disorder. In Morris, S., Hill, S., Brugha, T., McManus, S. (Eds.), Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England.