Summary

• A common adult disorder, thought to be persistence of childhood attention deficit hyperactivity disorder (ADHD). Prevalence of 2% to 5% in the general population and 10% to 20% in those with a common mental health disorder.
• Characterised primarily by inner restlessness rather than hyperactivity; impatience; sensation seeking and excessive spending rather than impulsivity; inattention; and functional impairment with underachievement and disorganisation.
• Among those diagnosed with ADHD as children, by age 25 years only 15% retain the full ADHD diagnosis, although a much larger proportion (65%) fulfil the DSM criteria for ADHD in partial remission.
• Diagnosed by clinical history. Self-report should not be the main source of information. Collateral history is extremely useful. Neuropsychological testing can be of use in some cases.
• About 75% of adults with ADHD will have at least one other mental health disorder, often anxiety, mood disorders, personality disorder, substance misuse, and other neurodevelopmental conditions. The interdependency of the conditions is presently being discussed.
• ADHD as a primary condition is most clearly diagnosed when mood or anxiety disorders are not active. Treat obvious psychiatric disorders as normal and assess the effects of that treatment to cognition (attention, concentration, memory) carefully.
• Stimulant medications (methylphenidate, amphetamine derivatives) are presently first-line treatment and non-stimulant medications, including atomoxetine, are effective and form a second-line management.
• Psychological therapies including cognitive behaviour therapy, metacognitive therapy, and dialectic behaviour therapy can be effective in reduction of symptoms in combination with medication.