Recurrent missed appointments may be a sign of ADHD

Salisbury’s discussion of missed appointments and “missingness” in primary care is thoughtful and compassionate.1 She rightly encourages clinicians to look beyond assumptions about motivation and consider the wider circumstances that may prevent patients from engaging with healthcare.Recurrently missed appointments should also prompt clinicians to consider the possibility of undiagnosed or inadequately treated attention deficit/hyperactivity disorder (ADHD). Difficulty with organisation, time management, prospective memory, prioritisation, and planning are core manifestations of ADHD and are reflected in the Diagnostic and Statistical Manual of Mental Disorders 5 (text revision) and ICD-11 (international classification of diseases, 11th revision) diagnostic criteria. Attention deficits can make attending appointments on time or remembering them at all particularly challenging, even when patients are highly motivated to engage with care.Growing evidence shows that ADHD is associated with missed healthcare appointments. McQueenie et al found an association between ADHD and serial missed appointments in general practice, suggesting that repeated non-attendance…