Prevalence
This guideline provides an overview of the recommended Adult ADHD assessment steps, differentials to be considered and options for treatment according to the best available evidence based guidelines.
ADHD is the most common psychiatric disorder in children – affecting 2.0% – 16.0% of the school-age population.6 The population prevalence for ADHD is estimated as 3.0% – 5.0%. 7 It is now widely accepted that an estimated 60.0% – 70.0% of patients’ symptoms persist into adulthood,8 with estimates of the prevalence of adult ADHD between 2.5% – 4.3%. 9,10,11 ADHD is more frequent in men than in women in the general population, with a ratio of approximately 1.6:1 in adults. Women are more likely than men to present primarily with inattentive features. The increased diagnosis of ADHD over the past decade seems to reflect improved criteria for the identification of ADHD in adults and female patients.12,13,14,15,16
The specific lifetime prevalence of ADHD in South Africa (SA) is unknown. The South African Stress and Health study, a nationally representative household survey of 4351 adults, conducted between 2002 and 2004, investigated the prevalence and treatment access and use for mental health disorders. Unfortunately, results were grouped as anxiety disorders, mood disorders, substance use disorders (SUD), and ‘any other disorder’. ADHD would be included within the last group, with a prevalence of 30.3%. 17,18
In the first South African study exploring the situation with regard to the prevalence and treatment of adult ADHD,19 extrapolating the known prevalence information to the South African context, the expected number of adults between the age of 20 and 50 years affected by ADHD was calculated to be between 771 264 (3%) and 1 285 439 (5%). In this triangulated study (consisting of a database analysis of one of the largest medical scheme administrators in SA in terms of medical, pharmaceutical and claims data for the treatment of ADHD over a 2-year period; a survey with psychiatrists in private practice who manage adult ADHD; and a qualitative analysis of in-depth interviews with key opinion leaders on their experiences in working with adults with ADHD), the population prevalence of adult ADHD was estimated at 1.09%, whereas the prevalence in clinical psychiatric settings was as high as 52.5%, of which 13.68% were patients with newlydiagnosed ADHD. Conditions comorbid with adult ADHD are common with psychiatric conditions in up to 20.43% of individuals. In this study, lack of knowledge of adult ADHD and lack of funding for the treatment thereof were identified as the two main barriers to diagnosis and treatment. It is therefore possible that these prevalence rates are underestimating the true prevalence of adult ADHD in SA.
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Schoeman R, Liebenberg R. The South African Society of Psychiatrists/Psychiatry Management Group Management Guidelines for Adult Attention-Deficit/ Hyperactivity Disorder. S Afr J Psychiat. 2017;23(0), a1060. https://doi.org/10.4102/sajpsychiatry.v23i0.1060 - An Update on the ADHD Treatment Armamentarium in South Africa., Prof Renata Schoeman
South African Journal of Psychiatry; The South African Society of Psychiatrists/Psychiatry Management Group the Management Guidelines for Adult Attention-Deficit/ Hyperactivity Disorder, 28 April 2017_An Update on the ADHD Treatment Armamentarium in South Africa, 2023