[ADHD in adults: more questions for the general practitioner]

The diagnosis of ADHD remains shrouded in controversy, resulting in alarming reports in (social) media. Danger of underdiagnosis, risk of overdiagnosis, and medicalization of social problems are all mentioned. The diagnostic uncertainty is largely due to the non-specific nature of ADHD symptoms. Yet, an ADHD diagnosis is more than an excuse: its chronic nature makes it a disabling condition when appropriate treatment is not provided. In most cases the general practitioner decides who is referred for further diagnosis; the controversial reporting can contribute to doubt and reluctance. The task in referring, however, is not to make a diagnosis, but to recognize the likelihood of psychiatric problems. This is done by inquiring about the presence and severity of symptoms and the existence of resulting distress. Knowledge of the context (such as work and living situation, family composition) and the patient's life history helps in distinguishing between temporary overload and chronic dysfunction.