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Objective: Adult attention deficit hyperactivity disorder (ADHD) can be an extremely debilitating neurodevelopmental disorder that often persists beyond childhood, affecting 2.5-5% of adults in the general population. Aim of this study was to provide data about the presentation of adult ADHD in clinical practice in Turkey and about treatment strategies of Turkish adult psychiatrists in different hospital settings.
Method: A cross-sectional online survey to be filled out by Turkish adult psychiatrists was designed in May 2014. The survey was administered through the Turkish Psychiatry Association (PAT) mail group which covers over 90% of the Turkish adult psychiatry population. It included 10 questions focusing on treatment environment, patterns of patient applications, and treatment strategies.
Results: A total of 124 psychiatrists with a homogenous range of different treatment settings (public hospitals, university hospitals, private clinics etc.) completed the survey. Although most participants (53.6%) reported that they treated more than 20 patients in a day, most of them were following fewer than 10 adult ADHD patients in their clinics. Transition rate from child to adolescent psychiatrists were found to be very low (<10% as reported by 77.3% of participants). Media and the restraint by the social environment turned out to be effective factors for treatment application. There were significant differences of attitudes about the treatment of adult ADHD. Rating questions were asked to survey respondents to compare treatment strategies in order of frequency. 62.6% of the participants reported that they always prefer psychoeducation in addition to medication treatment, whereas only 9.59% of the participants reported that they always combine psychotherapy with medication in the treatment of adult ADHD. The most favored medical treatment was stimulants (31.9% reported as using it “always” and 57.4% reported as using it “frequently”). The other frequently preferred medications were antidepressants (56.6%) and non-stimulants (37.4%). Anxiety disorders have been reported as the most common comorbid disorder with adult ADHD (40.4%), followed by alcohol/substance abuse disorders (29.7%) and depression (15.9%).
Conclusion: The outcomes of this survey show that despite the presence of a rapidly expanding literature on diagnosis and treatment of ADHD in adulthood, there are still only few psychiatrists in Turkey working on adult ADHD. A very low percentage of patients who were diagnosed in childhood are being referred to adult psychiatrists and most of the psychiatrists do not describe themselves as competent enough to diagnose and treat adult ADHD. Psychoeducation seems to be a more widely embraced treatment choice than psychotherapy in daily clinical practice. Adult ADHD is still a clinical entity that has a lower degree of awareness even among psychiatrists compared to ADHD in childhood and adolescence. We suggest a more comprehensive and standardized training to improve the management of adult ADHD and also to develop the cooperation between child and adolescent psychiatrists and adult psychiatrists for the transition of patients.