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, amfetamine 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.
Adult attention deficit hyperactivity disorder (ADHD) is a developmental disorder presenting with symptoms of inattentiveness, impulsivity, and hyperactivity, persisting into adulthood. Diagnosis can be made in either adulthood or childhood by 7 years of age (age limit increased in DSM-5 to 12 years). Functional impairment is a criterion for diagnosis. Comorbid disorders are present in more than 75% of adult cases.
South West Yorkshire NHS Partnership Foundation Trust
University of Huddersfield
MA has received reimbursement for attending a symposium by Shire, fee for speaking by Janssen-Cilag, and fee for consulting by Eli Lilly.
Dr Marios Adamou would like to gratefully acknowledge Dr Bridget Craddock, Dr S. Nassir Ghaemi, and Dr Elizabeth A. Whitham, the previous contributors to this monograph. BC declares that she has no competing interests. SNG has received research grants from Pfizer. He has served on the speakers' bureaus of Astra Zeneca and Pfizer, and received honoraria from Bristol Myers Squibb. Neither he nor his family hold equity positions in pharmaceutical corporations. EAW declares that she has no competing interests.
Lucio Bini Mood Disorders Center
GF has been reimbursed by Astra Zeneca, the manufacturer of Seroquel, for attending several conferences.
Department of Psychiatry and Behavioral Sciences
Johns Hopkins School of Medicine
DWG has received research grants from Shire Pharmaceuticals. DWG has received speaking fees from Neuroscience Education Institute, Temple University, American Professional Society of ADHD and Related Disorders, Medscape, and WebMD. DWG has been a paid consultant to American Physician Institute for Advanced Professional Studies, Prescriber's Letter, Consumer Reports, Thomson Reuters, GuidePoint Global, Shire Pharmaceuticals, McNeil Pediatrics, Cephalon, Teva Pharmaceuticals, Lundbeck, Otsuka Pharmaceuticals, and Novartis.
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