Ron Kessler talks with
ScienceWatch.com and answers a few questions about
this month's Fast Moving Fronts paper in the field of
Neuroscience & Behavior.
Article: The prevalence and correlates of adult ADHD in
the United States: Results from the National Comorbidity Survey
Authors: Kessler, RC;Adler, L;Barkley,
R;Biederman, J;Conners, CK;Demler, O;Faraone, SV;Greenhill,
LL;Howes, MJ;Secnik, K;Spencer, T;Ustun, TB;Walters,
Journal: AMER J PSYCHIAT, 163 (4): 716-723 APR 2006
Addresses: Harvard Univ, Sch Med, Dept Hlth Care Policy, 180
Longwood Ave, Boston, MA 02115 USA.
Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115
NYU, Med Ctr, Dept Neurol, New York, NY 10016 USA. (addresses have been
Why do you think your paper is highly
Although it was traditionally believed that attention-deficit/hyperactivity
disorder (ADHD) spontaneously remits in adolescence, evidence has been
accumulating to suggest that a substantial proportion of children with
ADHD continue to be symptomatic as adults and that
adult ADHD causes substantial problems (e.g., high rates of auto
accidents) that might be prevented with treatment.
Prior to our study, though, most epidemiological evidence on this issue
came from follow-up studies into adulthood of people who had been in ADHD
treatment studies when they were children. Our national general household
survey data provided much more compelling evidence than these earlier
studies of the high prevalence of adult ADHD.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
The value of the paper lies in the use of an improved methodology to
address a basic descriptive question.
Would you summarize the significance of your paper
in layman’s terms?
"...the integrity of the field of psychiatric treatment
research has been shaken in recent years by accusations
that researchers have made false claims about the
effectiveness of treatments."
The paper shows that more than 4% of adults in our national sample met
criteria for ADHD, that many of these people also had other co-occurring
emotional problems that started subsequent to the ADHD, that treatment of
the co-occurring problems was comparatively high, but that few of these
people were receiving treatment for their ADHD.
The high prevalence estimate in the sample suggests that ADHD is one of the
most commonly occurring adult mental disorders. The high rate of
co-occurrence suggests that persistent ADHD might be a causal of secondary
emotional disorders. The low rate of treatment tells us that there is a
problem of recognition of adult ADHD.
How did you become involved in this research and
were any particular problems encountered along the way?
We originally included ADHD in our survey only as a way for our adult
respondents to give us retrospective information about their experiences in
childhood. It was really no more than an afterthought to add a few
questions about persistence of the symptoms into adulthood.
When the survey was completed, though, we were struck by the high
proportion of respondents who reported adult persistence. It was only at
this late date in the research process that I became familiar with the
literature on adult ADHD.
Based on consultation with a number of experts in the field, who
subsequently became coauthors of the paper, I came to realize that a
follow-up of the sample to obtain more detailed information about their
current ADHD symptoms would be valuable. I consequently obtained funding
for the follow-up survey that is reported in this paper.
Where do you see your research leading in the
We subsequently developed a screening scale to detect adult ADHD
efficiently and we have administered this scale in a number of large
community surveys as well as workplace surveys that studied the prevalence
and societal burden of adult ADHD.
We documented substantial burden in the workplace in terms of increased
workplace accidents and injuries along with decreased work performance.
A model workplace screening, outreach, and best-practices treatment program
was developed in response to this evidence and we are now in the process of
evaluating the cost-effectiveness of that intervention.
Do you foresee any social or political
implications for your research?
There are always social implications of health research, but probably more
so for this line of work than many others because of the high prevalence of
the condition, the availability of interventions (which include not only
medication but also social-skills training of people who have lived for
many years with untreated ADHD), and the current low rate of treatment.
The potential exists to improve the lives of many people by making them
aware of their ADHD and encouraging them to get treatment. There are also
political implications, though, in that the integrity of the field of
psychiatric treatment research has been shaken in recent years by
accusations that researchers have made false claims about the effectiveness
I believe that it is very important to carry out effectiveness studies in
real-world settings with community collaborators—in my own case,
experimental treatment studies implemented in large corporations with the
active collaboration of corporate medical directors—to provide
accurate information about the true effectiveness of treatments as they are
provided in practice in real-world settings. That, in my view, is the only
way to address political concerns about bias in industry-sponsored
Ronald C. Kessler, Ph.D. Professor Department of Health Care Policy Harvard Medical School Boston MA, USA