title: Under diagnosis of adult ADHD: cultural influences and societal burden.
abstract: OBJECTIVE
  To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden.
  
  
  METHODS
  A review of the literature over the past 10 years was performed using OVID.
  
  
  RESULTS
  Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse.
  
  
  CONCLUSIONS
  The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.
authors.affiliation: Institute of Psychiatry, London, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Asherson
authors.forename: Ron
authors.initials: R
authors.lastname: Akehurst
authors.forename: J J Sandra
authors.initials: JJ
authors.lastname: Kooij
authors.forename: Michael
authors.initials: M
authors.lastname: Huss
authors.forename: Kathleen
authors.initials: K
authors.lastname: Beusterien
authors.forename: Rahul
authors.initials: R
authors.lastname: Sasané
authors.forename: Shadi
authors.initials: S
authors.lastname: Gholizadeh
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000191:economics / Q000523:psychology; D017281:Cost of Illness; D003469:Culture; D006801:Humans