Perceived Stress Is Associated With Lifetime ADHD Symptom Reporting Over and Above Anxiety and Depression: Implications for Psychiatric Evaluation and Treatment

Introduction: Diagnosing attention deficit/hyperactivity disorder (ADHD) among adults is challenging, given reliance on retrospective symptom reporting and the overlap of core, nonspecific diagnostic symptoms with other psychiatric disorders such as depression and anxiety. This study examined the effect of perceived stress on ADHD symptom reporting. Methods: Cross-sectional data from 638 diverse adult outpatients referred for ADHD neuropsychological evaluation, who were administered the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Perceived Stress Scale (PSS), and Clinical Assessment of Attention Deficit–Adult (CAT-A), were analyzed. Linear regressions were conducted with BDI-II/BAI (block 1) and PSS (block 2) as predictor variables and ADHD symptom endorsement in childhood and adulthood (CAT-A) as the dependent variable. Results: PSS/BDI-II ( r =0.648) and PSS/BAI ( r =0.523) were moderately correlated. BDI-II and BAI significantly predicted overall ADHD symptom endorsement and current/adult symptom reporting, whereas only BAI predicted childhood symptoms. After entering the PSS in block 2, all models remained significant ( P <0.001; R 2 =0.03 to 0.08), but BDI-II and BAI became nonsignificant; only perceived stress remained a significant predictor. The results were replicated after excluding those with potentially invalid ADHD symptom reporting, so that the PSS again was the only significant predictor of ADHD symptom endorsement ( R 2 =0.02 to 0.06). Conclusions: Patients’ subjective experience of stress was significantly associated with nonspecific inattention symptom endorsement among adults undergoing ADHD evaluation and shared more variance with attention complaints than active depression and anxiety symptoms. Findings emphasize routinely assessing perceived stress during psychiatric evaluation of ADHD, as high stress levels may masquerade as nonspecific inattention symptoms and contribute to misdiagnosis of ADHD if not considered/assessed, and high stress levels may also exacerbate genuine ADHD symptoms.