Screen-positive adult attention-deficit/hyperactivity disorder (ADHD) symptoms and associated functional impairments: a cross-sectional study in Peshawar
TL;DR
A substantial proportion of university-educated adults and medical trainees in Peshawar exhibit screen-positive adult ADHD symptoms accompanied by marked functional impairments, and implementation of routine institutional screening and accessible mental health support services is strongly indicated.
Abstract
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that frequently persists into adulthood. In low-resource settings, symptoms often go unrecognized due to limited mental health awareness, sociocultural stigma, and a lack of routine screening infrastructure. Our aim was to evaluate the frequency of screen-positive adult ADHD symptoms and identify associated self-reported functional impairments among an adult urban cohort. Methods: A cross-sectional study was conducted in urban Peshawar from February to June 2025. A total of 349 adults aged 20–40 years were recruited via convenience sampling. Participants completed the World Health Organization Adult Self-Report Scale (ASRS v1.1) screener alongside a validated supplementary section (α = 0.84) assessing functional difficulties in daily responsibilities, social interactions, emotional regulation, and task persistence. Data were analyzed using IBM SPSS v25, employing descriptive statistics, Pearson’s Chi-square tests (χ2), degrees of freedom (df), Fisher’s exact tests, and multinomial logistic regression. Results: Screen-positive ADHD symptoms were identified in 50.4% (n = 176, borderline) and 4.6% (n = 16, high symptom / moderate ADHD) of participants. Statistically significant associations were observed between ADHD symptom levels and educational attainment (χ2 = 7.34, df = 2, p = 0.025) as well as occupational groups (χ2 = 7.72, df = 2, p = 0.021). Elevated symptom frequencies were observed among undergraduate medical students (64.2%) and postgraduate medical trainees (16.0%). Functional impairments were significantly more prevalent among screen-positive individuals (p < 0.001), with emotional dysregulation reported by 94.1% (n = 16) of participants in the high symptom burden tier. Age and gender were not significantly associated with symptom classification. Conclusion: A substantial proportion of university-educated adults and medical trainees in Peshawar exhibit screen-positive adult ADHD symptoms accompanied by marked functional impairments. Implementation of routine institutional screening and accessible mental health support services is strongly indicated.