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Background: Knowledge about attention-deficit/hyperactivity disorder (ADHD) and autismspectrum disorders (ASD) in adult psychiatry is scant. Aims: Estimate prevalence, psychiatricmorbidity patterns and impact of ADHD/ASD diagnoses in general adult psychiatry services.Material and methods: Two adult psychiatric out-patient groups were screened and clinicallyexamined for ADHD and ASD. A new screening instrument, the Autism Spectrum Disorders inAdults Screening Questionnaire (ASDASQ) was developed for ASD. The Wender Utah RatingScale was used for retrospective screening of childhood ADHD symptoms. A new questionnairewas used in an attempt to measure the subjective impact of receiving an ADHD or ASDdiagnosis in adulthood in a group of consecutively clinically evaluated adult patients and theirsignificant others. A very large data-set of all registered psychiatric patients at one clinic over a20-year-period was used to assess time trends in clinical diagnoses of ADHD and ASD and“comorbidities”/psychiatric service use. Results: Of screened adult psychiatric patients 1.4%had ASD and most of these were treated at a centre for chronic disorders. The rate of ASD inthis centre was 3.2%. A quarter of the patients with ASD had previous diagnoses ofschizophrenia. The ASDASQ showed good psychometric properties. The rate of ADHD in thescreened group of general psychiatric out-patients was 21.9%. These patients had been variablydiagnosed, often with affective disorder. Greater subjective impact of the diagnosis for patientswith ADHD than ASD was suggested. Perceived positive post-diagnosis change was reportedby patients and significant others, and as regards medication (ADHD), housing and habilitationservice contact (ASD). The rate of ADHD diagnoses increased from 1990 to 2009, but onlyabout 2.7% of the whole adult psychiatric patient group received this diagnosis. ASD diagnosisrates also went up but only to about 1.3% of all registered patients. Discussion: In adultpsychiatry, many patients have ADHD or ASD, developmental disorders that underlie or areovershadowed by “psychiatric illness”. Some patients seek help for problems related to theformerly unrecognized ADHD or ASD rather than for “psychiatric disorder”. ADHD seems tobe much more common than ASD, and in both disorders concomitant psychiatric illness isusually present. It is important not to rely only on self-assessment questionnaires for diagnosis.An essential part of diagnostic work-up is a detailed history taking and testing of cognitive andadaptive development/capacity, currently not standard in adult psychiatric practice. Measuringthe subjective impact of ADHD or ASD diagnoses proved to be difficult. The rate of diagnosedADHD/ASD in adult psychiatry went up over the past two decades but was, by 2010, far belowthe likely “real” rate. The underdiagnosis of ADHD/ASD in adult psychiatry remains a hugeclinical problem.Key words: Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder(ASD), adults, psychiatry, Autism Spectrum Disorder in Adults Screening Questionnaire(ASDASQ

clinical audit

Is it possible to measure the impact of a developmental disorder diagnosis received in adulthood? An attempt at follow-up and discussion of difficulties encountered in the process