Dopamine Reward Pathway in Adult ADHD—Reply

In Reply: In response to Dr Zametkin, we agree that ADHD may be overdiagnosed in adults because of symptom overlap with mood and anxiety disorders; however, we were cautious to avoid this and explicitly ruled out patients with psychiatric comorbidities (axis I or II diagnosis other than ADHD). In our study, experienced clinicians performed clinical interviews at both the referring sites (Drs Kollins, Wigal, and Newcorn) and imaging sites (Drs Wang and Telang). A semistructured interview was used to diagnose ADHD, which we believe is the preferred method in adults.^1- 2 The Hamilton rating scales were used to assess severity of anxiety and depression, and clinical judgment was used to interpret this information in ruling out anxiety and depression as comorbid disorders. Additionally, patients were excluded who had been treated for any psychiatric disorder. Although a structured approach such as the Structured Clinical Interview for DSM-IV may have been preferable to rule out comorbidity, our diagnostic approach was consistent with that of other studies of adult ADHD. Controls were also evaluated by a semistructured interview administered by an experienced clinician at the imaging location and met the same exclusion criteria but not the inclusion criteria for ADHD.