A sociolinguistic analysis of in-office dialogue between psychiatrists and adult patients with depression and possible comorbid ADHD

Objective: To study the tone, content, and structure of in-office discussions between psychiatrists and adults with depression and possible comorbid attention-deficit/hyperactivity disorder (ADHD). Methods: Patients with a pre-existing diagnosis of depression, but not ADHD, and screening results indicating the possible presence of ADHD, were selected. Office visits were videotaped and analyzed for tone, content, and structure, using sociolinguistic techniques. Separate postvisit interviews were conducted with patients and psychiatrists. Results: The study sample comprised 14 patients and eight psychiatrists, although data on the possibility of ADHD were available for only 13 patients. The possibility of an ADHD diagnosis was not discussed in any office visit. Psychiatrist- or patient-driven language suggesting possible ADHD symptoms occurred during five (36%) visits. In post-visit interviews of 13 patients, nine (69%) felt they had or might have ADHD. In contrast, psychiatrists felt that 12 patients (92%) did not have ADHD. Nine psychiatrist-patient pairs (69%) disagreed about the possibility of ADHD. Conclusion: Psychiatrists and their patients diagnosed with depression showed low levels of agreement regarding the possibility of comorbid ADHD. Psychiatrists frequently missed or misinterpreted patient cues regarding potential ADHD symptoms, suggesting psychiatrists may need to be more vigilant in screening for ADHD in this at-risk population.