Insights on the New Adult ADHD Guidelines: A Conversation With the President of APSARD

CLINICAL CONVERSATIONS

The American Professional Society of ADHD and Related Disorders (APSARD) announced in August 2026 that its US Adult ADHD Guidelines have entered stage 3, the final review stage before publication. The guidelines are the product of APSARD's multidisciplinary membership and are intended to provide comprehensive, evidence-informed recommendations for the screening, diagnosis, and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults.¹

Stage 3 follows an extensive development process and targeted expert review, and now draws in feedback from professionals across the disciplines involved in ADHD care, as well as individuals with lived experience, to help ensure the guidelines are both scientifically rigorous and clinically meaningful. Over the past 2 years, these groups conducted literature reviews, examined existing international guidelines, and weighed the benefits and harms of care options against clinician experience and patient values and preferences. Feedback gathered during Stage 3 will be evaluated and incorporated into the final manuscript before submission for publication. APSARD anticipates the completed guidelines will offer practical recommendations for clinicians, patients and families, training programs, health systems, and policymakers, with publication expected later this fall.

Ahead of the release of the guidelines, Psychiatric Times spoke with Brooke Molina, PhD, the president of APSARD.

Psychiatric Times: Can you talk to us a little bit about the new ADHD guidelines?

Brooke Molina, PhD: We are excited about the new ADHD guidelines. There are no existing guidelines in the United States for the diagnosis and treatment of ADHD in adulthood. This effort was launched 4 or more years ago. The origins were even before that, but we have a series of papers that were published in 2023 in Psychiatric Annals,² and that really marks the public presentation of when the effort began, the mission for the guidelines, the methods for the guidelines. We have been working on them ever since.

It has been a large effort with many people and quite a bit of work. We need them because in the United States there are many professionals who were not trained. It has only been in recent years that we have come to understand the ways in which ADHD persists beyond childhood and into adulthood: what it looks like, what it needs, how it needs to be diagnosed, how it needs to be treated. It is time to have guidelines so that people can wrap their heads around this.

PT: Can you speak to how the guidelines address the differential diagnosis challenge, such as distinguishing ADHD from anxiety, depression, trauma-related presentations, or even just normal executive function in adults?

Molina: I, at this time, cannot get into the actual content of the guidelines prior to the official release, but I can tell you that those kinds of things are absolutely considered. We all understand well that it's tricky to diagnose ADHD in adulthood, and an important part of this is that ADHD very commonly does not present only as ADHD. It is very common to experience other co-occurring mental health conditions, and because of that, practitioners have to understand how to sort through all of that, and not just simply focus on 1 disorder, but recognize the comorbidities that co-occur.

PT: While you cannot address the actual content of the guidelines, could you perhaps address public concerns about both over- and underdiagnosis of ADHD, for instance, based on disparities in diagnosis by sex and race and access to specialists? Is that something these guidelines take into consideration?

Molina: Absolutely. We are well aware of this, and one of the reasons why we have these problems is because we do not have standards in the United States. Everyone is concerned about the accuracy of diagnoses, and the likelihood is that there are both diagnoses occurring where they shouldn't be, as well as people not getting diagnosed when they should be. Both situations are occurring. Again, that is because practitioners are not trained to recognize ADHD. We are hopeful that we will reduce those errors over time.

PT: The release on the upcoming guidelines noted that clinicians, patients, and families, training programs, and policy makers are all part of the intended audience. Will there be derivative materials for each of those groups?

Molina: In terms of the materials that we plan to prepare out of the guidelines, there are multiple levels. The main document of the guidelines is multiple hundreds of pages long, with like a long list of citations that are the science that back up the guidelines. We know that not everyone is going to want to read that document, so in order to make it accessible to a broader audience—the full range of disciplines who recognize and treat, or potentially screen and refe—we are going to have multiple levels. We will have materials available on the APSARD website prepared at multiple levels of depth; there will be a higher-level document that people can more quickly read, then you can drill down and work your way into more in-depth materials. If you ultimately want to read that several 100-page document, you can.

We are also preparing a training certification program that will be available to licensed practitioners. They will be able to access that program and get certified in diagnosis and treatment. Now we recognize that not everyone's going to want to become an expert per se, so we are really hoping that what will be able to be well received is multiple levels of certification, if you will. We are working right now on that first pass, basically adult ADHD 101, and then we will work on having deeper levels of training that will come out in different ways: webinars, workshops, etc.

PT: You mentioned that these guidelines are a long time coming. Can you describe the process of the development of these guidelines? What was it like? You know, the back and forth. How was the thinking over time changed for these guidelines.

Molina: It has been a very involved process, which is why it has taken a while—longer than many of us expected. Nevertheless, we are almost there. The reason it takes a long time is because we have a task force for the development of the guidelines, which consists of approximately 30 experts. Those 30 experts are divided into 3 subcommittees that handle the different elements of the guidelines: (1) screening and diagnosis, (2) medication, and (3) psychosocial and other nonmedical interventions. Each of those 3 subcommittees were charged with reviewing the literature, generating the guidelines, discussing and coming to some degree of consensus on each of the guidelines, and then anonymously voting. This is called the Delphi process.

In the course of then reviewing those guidelines and voting on them, usually it's the case that we don't always have immediate consensus, right? And part of this is because we're multidisciplinary committees, and part of this is because they're just different opinions on how to apply the science to clinical care. The beauty of the process is that it's iterative, so once we vote, if we don't reach a threshold of agreement, it comes back to the table for revision, discussion, revising the guideline, voting again. We do that over and over until we get to done. Then we have 3 stages of review. Stage 1 is internal; it goes to the steering committee based on the comments, and it goes back to the subcommittees to repeat the process. Stage 2, it goes out to an external set of invited experts. We took those comments that we received from them, repeated the process. It is now in stage 3. Stage 3 is yet another set of invited experts, again as multidisciplinary as we can manage. We have generated a very long list of all the potential disciplines that we think might want to make use of these guidelines, and invited experts from those disciplines to provide feedback. We are also working closely with CHAD to provide a panel of people with lived experience to be part of that stage 3. It is not that we expect them to be experts in the same way, but we want their review of the guidelines to be able to tell us ways that those guidelines might affect them personally. It is unknown what their reactions might be, so we are looking forward to getting those reactions from them.

All the individuals who have participated in this process are volunteers. None of these panels of people, subcommittees, or task force subcommittees invited reviewers are paid. That also lengthens the process because we are all doing it on top of our employment responsibilities. If you put all that together, you can see how it quickly adds up to multiple year process. We are happy that we are halfway through the period of time that we have given stage 3 reviewers to provide their feedback. We are looking forward to getting that back sometime by the end of September, and then we will launch into our final set of revisions.

PT: This is the first guideline of its kind in the United States. Can you offer any insight on how it compares with or builds on existing international guidelines like the World Federation of ADHD?

Molina: So there are guidelines published by in Europe the NIC guidelines NICE. Also in Australia the Australians generated guidelines. We reviewed those in the course of generating our guidelines. And so in cases where the literature had changed, there might be tweaks, you know, where it is different as applied in the United States might be different. Those are examples.

PT: What is the biggest unmet net unmet need in adult ADHD care today that you are hoping this guideline will address?

Molina: Generally speaking, there are so many providers out there who do not know what to do when someone comes to them and says, "Do I have ADHD?” It is, in many ways, no fault of their own. It is only in recent decades where we have come to understand that ADHD continues into adulthood and fluctuates throughout the course of life. That is confusing, but we have other mental health conditions that are like that. Depression is like that; it comes and goes.

Practitioners need to have the opportunity to learn. They need accessible training programs, which is what APSARD is developing: We are developing a certification program that should make it easier for providers in the United States to understand how to recognize it, how to screen for it, how to diagnose it themselves, or when to refer.

PT: Can you discuss how APSARD specifically decided to address adult ADHD vs pediatric ADHD with these guidelines?

Molina: There have been plenty of guidelines for children with ADHD. The American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics have developed them for children. But there is a complete absence of guidelines in the United States for adult ADHD.

PT: Do you think these guidelines are going to have any relevance to workplace or academic accommodations for adults who have been newly diagnosed later in life, do you anticipate that those could be a boon to those people who are for the first time receiving their ADHD diagnosis?

Molina: It is hard to say for sure how it will play out over time, but I think the ability to have evidence-based information out there could certainly affect perception about the reality of ADHD in adulthood. It could certainly help employers and individuals who experience it recognize that this is a real entity, that it actually does affect people's functioning. What I am more comfortable saying is that we hope is treatment access will improve, and that hopefully will then lead to people having better functioning, as well as happier and healthier lives throughout their personal and work lives.

PT: What is 1 thing you want psychiatric clinicians to know ahead of the release about these guidelines?

Molina: We are working hard to make these materials accessible to all providers across disciplines. We want a wide range of care providers to access these materials, not just within the armamentarium of psychiatry and psychology. We want nurse practitioners, social workers, counselors, educators—all disciplines where this could make a difference. Our hope is through the preparation of these products, generated from the guidelines for people to learn at multiple levels, as well as the certification programs in development, that we will educate people across the board, which will then elevate the quantity and the level of care for adult ADHD.

Dr Molina is a professor of Psychiatry, Clinical and Translational Science, Pediatrics, and Psychology at the University of Pittsburgh. She is also the President of the American Professional Society of ADHD and Related Disorders.

Reference

1. APSARD announces launch of final review stage for U.S. Adult ADHD Guidelines; publication anticipated this fall. News release. August 2026. Accessed September 14, 2026. https://apsard.org/Web/News/News-Guideline-Update.aspx

2. Adler LA. Development of United States guidelines for the diagnosis and treatment of adults with ADHD. Psychiatric Annals. 2023;53(10):440-441.