Attention deficit hyperactivity disorder in adults

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.

Characterized primarily by inner restlessness rather than hyperactivity; impatience; sensation seeking and excessive spending rather than impulsivity; inattention; and functional impairment with underachievement and disorganization.

Among those diagnosed with ADHD as children, by age 25 years only 15% retain the full ADHD diagnosis, although a much larger proportion (65%) fulfill 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, amphetamine derivatives) are first-line treatment and nonstimulant medications, including atomoxetine, form second-line management.

Psychological therapies, including cognitive behavior therapy, metacognitive therapy, and dialectic behavior 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.