Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed- Method Systematic Review

Blandine French, David Daley, Madeleine Groom, Sarah Cassidy American Journal of Psychiatry 179:12, December 2022

Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review

Commentary by Dr. Doron Almagor*: The paper “Risks Associated with Undiagnosed ADHD and/or  Autism: A Mixed-Method Systematic Review” by French et al., 2023, investigates the challenges faced by  individuals with undiagnosed ADHD and/or ASD. Their research aims to elucidate the challenges and  repercussions faced by individuals living with undiagnosed ADHD and ASD. The primary findings revealed  three major areas of concern: pronounced academic underachievement, heightened mental health  complications, and a conspicuous increase in risky behaviours among the undiagnosed cohort. To arrive  at these conclusions, the researchers conducted a systematic review, sourcing data databases such as  PubMed, PsycINFO. Their approach was bifurcated into qualitative and quantitative analyses. Qualitative  data offered a deeper understanding of personal experiences, feelings of isolation, and internal struggles of  undiagnosed individuals. On the other hand, quantitative data provided measurable metrics on academic  outcomes, mental health statistics, and engagement in potentially harmful behaviours. For clinicians and  healthcare professionals, this study presents several actionable takeaways. The results accentuate the  necessity of early diagnosis and the adoption of an interdisciplinary approach. Regular screenings,  particularly tailored for high-risk demographics, are of paramount importance. Despite the rise in  ASD/ADHD diagnoses and better awareness in recent years, many remain undiagnosed. Research  consistently shows that early diagnosis and treatment can mitigate mental health risks associated with  these conditions. The study underscores the profound impact of not diagnosing, particularly on mental  health, substance use and markers of educational and social well-being. 



Background: The two most prevalent neurodevelopmental disorders—Attention Deficit Hyperactivity  Disorder (ADHD) and Autism (ASD)—(ASD/ADHD) strongly impact individuals’ functions. This is  worsened when individuals are undiagnosed and risks such as increased imprisonments,  depression or drug misuse are often observed. This systematic review synthesizes the risks  associated with late/undiagnosed ASD/ADHD.  

Methods: Four databases were searched (Medline, Scopus, PsychInfor, and Embase). Published  studies exploring the impact of undiagnosed ASD/ADHD were included. Exclusion criteria included,  lack of diagnosis status, studies not solely on ASD or ADHD, gray literature and studies not in  English. The findings were summarize through a narrative synthesis. 

Results: Seventeen studies were identified, 14 on ADHD and three on ASD. The narrative synthesis  identified three main themes: (1) Health, (2) Offending behavior, and (3) Day-to-day impact. The risks  highlighted a significant impact on mental wellbeing and social interactions, higher risks of  substance abuse, accidents and offending behavior as well as lower levels of income and education. Discussion: The findings suggest that undiagnosed ASD/ADHD is linked to many risks and negative  outcomes affecting individuals, their families, and the wider society. The restricted number of  studies on ASD are a limitation to the generalization of these findings Implications for research and  practice are discussed, highlighting the importance of screening and acknowledging the possibility of  ASD/ADHD in many settings such as psychiatric and forensic. 


* Doron Almagor MD, FRCPC, Chair of CADDRA’s Advisory Council member, is a Child, Adolescent,  and Adult Psychiatrist and Director of the Possibilities Clinic, headquartered in Toronto. 


Journal articles are selected based on their clinical relevance. The commentary reflects the reviewer’s own opinion and is not approved, or necessarily representative, of the opinion of the CADDRA Board.