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 Diagnostic and Statistical Manual of Mental Disorders 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.
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 on cognition (attention, concentration, memory) carefully.
Stimulant medications (methylphenidate, amfetamine derivatives) are first-line treatment and non-stimulant medications, including atomoxetine, form 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 neurodevelopmental disorder presenting with 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 the Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] to 12 years). Functional impairment is a criterion for diagnosis. Comorbid disorders are present in more than 75% of adult cases.
History and exam
- presence of risk factors
- onset prior to age 12 years
- past or present academic dysfunction
- present or past occupational dysfunction
- familial and relationship dysfunction
- drug and alcohol misuse
- thrill-seeking behaviour
- driving accidents
- fails to pay attention to details and careless mistakes at work, school, etc.
- has difficulty maintaining attention in tasks
- seems not to listen when being spoken to
- does not follow instructions and does not finish duties and assigned tasks (not due to misunderstanding or oppositional behaviour)
- has organisational difficulties
- avoids and/or dislikes tasks that require maintaining mental effort
- frequently loses things needed for tasks or activities
- frequently forgetful in daily tasks
- fidgets often with hands or feet and moves in seat
- frequently leaves situations, rises from chair when remaining seated is expected
- often feels restless
- has difficulty engaging in leisure activities quietly
- often acts as though 'on the go'
- often talks excessively
- often interrupts with answers before questions have been completed
- often has difficulty waiting for his/her turn
- often interrupts or intrudes on others (e.g., interrupting conversations)
- increased criminality
- distracted easily by surroundings and external stimuli
South West Yorkshire NHS Partnership Foundation Trust
University of Huddersfield
MA is a board member of the East Riding Clinical Commissioning Group.
Professor Marios Adamou would like to gratefully acknowledge Dr Bridget Craddock, Dr S. Nassir Ghaemi, and Dr Elizabeth A. Whitham, the previous contributors to this topic.
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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