by Federico Mucci, Donatella Marazziti, Jonathan Mennucci, Giulio Vannini, Francesca Diolaiuti, Francesco Casamassima, Riccardo Dalle Luche, Paolo Iazzetta, Riccardo Gurrieri, Claudio Lorenzetti, Luigi Valoroso, Angelo Cerù, Siham Bouanani

Abstract

Objective: the clinical management of adult attention-deficit/hyperactivity disorder (ADHD) in Italy takes place without consolidated national guidelines and within a regulatory framework originally designed for paediatric populations. This study aimed to describe psychiatrists' knowledge, diagnostic and therapeutic practices, regulatory awareness, and training needs regarding adult ADHD, and to test whether specific ADHD training, rather than general clinical experience, predicted perceived preparedness.
Method: a cross-sectional online survey (AUTO-SAG: ADHD Understanding of Treatment and Orientation: Self-Assessment on Guidance), comprising 57 items across six domains, was distributed to board-certified psychiatrists practising in Tuscany between August 2025 and January 2026.
Results: of the 93 respondents, 68 (73.1%; 95% CI: 63.3–81.1) rated their preparedness to manage adult ADHD as poor or absent, and the majority reported limited familiarity with validated diagnostic instruments. Two thirds (66.7%) had never prescribed ADHD-specific medication, with poor pharmacological knowledge cited as the primary reason. The sample was nearly evenly divided between those perceiving underdiagnosis (53.8%) and overdiagnosis (40.9%) as the predominant diagnostic risk. Specific ADHD training was significantly associated with perceived preparedness (OR = 6.27; p < 0.001), whereas years of clinical experience showed no association (ρ = −0.120; p = 0.25); preparedness did not differ significantly across age groups. Despite these gaps, 89.2% expressed willingness to participate in training.
Conclusions: targeted education, rather than clinical seniority, may be the most modifiable determinant of perceived preparedness, though structural and regulatory barriers constrain the translation of knowledge into practice.

Key words: adult ADHD, psychiatrist preparedness, continuing medical education, prescribing barriers, diagnostic tool familiarity, Italian mental health services