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Attention deficit hyperactivity disorder in adults

Last reviewed: 25 Jun 2024
Last updated: 04 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • onset prior to age 12 years
  • past or present academic dysfunction
  • present or past occupational dysfunction
  • familial and relationship dysfunction
  • drug and alcohol use disorders
  • thrill-seeking behavior
  • driving accidents
  • unable to pay attention to details resulting in "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 behavior)
  • has organizational difficulties
  • avoids, dislikes, or is reluctant to engage in tasks that require maintaining mental effort
  • frequently loses things needed for tasks or activities
  • frequently forgetful in daily activities
  • 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 "on the go," acting as if "driven by a motor"
  • often talks excessively
  • often interrupts with answers before questions have been completed
  • often has difficulty waiting for his/her turn (e.g., while waiting in line)
  • often interrupts or intrudes on others (e.g., interrupting conversations)
  • increased criminal justice system involvement
  • distracted easily by surroundings and external stimuli
Full details

Other diagnostic factors

  • mild mood symptoms (dysphoria, mood lability, irritability, boredom)
  • anxiety
  • difficulty with peer interactions
  • low self-esteem
  • working memory (i.e., short-term memory) impairment
  • processing speed impairment (i.e., the rate at which information is dealt with)
Full details

Risk factors

  • family history of ADHD
  • male sex
  • low birth weight
  • psychosocial adversity
  • obstetric complications in pregnancy or labor
  • lead exposure
Full details

Diagnostic tests

1st tests to order

  • Conners Adult ADHD Rating Scale
  • Brown Attention Deficit Disorder Scale
  • World Health Organization Adult ADHD Self-Report Scale
  • Wender Utah Rating Scale
  • Diagnostic Interview for ADHD in adults, third edition (DIVA 5)
  • neuropsychologic testing
Full details

Tests to consider

  • urine drug screen
  • electroencephalogram
  • brain imaging (CT or MRI)
  • polysomnography
  • computer-based program
Full details

Treatment algorithm

ONGOING

ADHD without concomitant mood, anxiety, or substance use disorder

ADHD with concomitant substance use disorder

ADHD with depression (with or without prominent anxiety)

ADHD with bipolar disorder

ADHD with anxiety disorder alone

Contributors

Authors

Marios Adamou, MD, MSc, LL.M, MA, MBA, PhD, FRCPsych, FFOM

Consultant Psychiatrist

South West Yorkshire NHS Partnership Foundation Trust

University of Huddersfield

Huddersfield

UK

Disclosures

None to declare.

Acknowledgements

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.

Disclosures

BC declares that she has no competing interests. SNG has received research grants from Pfizer, served on the speakers' bureaus of Astra Zeneca and Pfizer, and received honoraria from Bristol Myers Squibb. Neither SNG nor his family hold equity positions in pharmaceutical corporations. EAW declares that she has no competing interests.

Peer reviewers

Gianni Faedda, MD

Lucio Bini Mood Disorders Center

New York

NY

Disclosures

GF has been reimbursed by Astra Zeneca, the manufacturer of Seroquel, for attending several conferences.

David W. Goodman, MD

Assistant Professor

Department of Psychiatry and Behavioral Sciences

Johns Hopkins School of Medicine

Baltimore

MD

Disclosures

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.

  • Differentials

    • Depression in adults
    • Bipolar disorder in adults
    • Borderline personality disorder
    More Differentials
  • Guidelines

    • Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)
    • World Federation of ADHD International consensus statement
    More Guidelines
  • Patient information

    ADHD: what is it?

    Coping strategies for teenagers and adults with ADHD

    More Patient information
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