Attention deficit hyperactivity disorder in adults

Descripción general 
Teoría 
Diagnóstico 
Manejo 
Seguimiento 
Recursos 

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Evidencia revisada por última vez: 27 May 2026

Tema actualizado por última vez: 04 Jun 2024

Adult attention deficit hyperactivity disorder (ADHD) is a common adult disorder, thought to be persistence of childhood ADHD.

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 disorders, or substance use disorders. There is also an association with autism spectrum disorder, dyslexia, dyscalculia, and dyspraxia.

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.

Definición

ADHD is a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity.[1] ADHD has a chronic course with symptoms that begin in early childhood but often persist into adult life.[1] Diagnosis of ADHD in adulthood requires ancillary information supporting onset of symptoms in childhood (before 12 years of age).[1] Another key element of the definition is that symptoms manifest in two or more settings, for example both at home and in work.[1] Symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. Comorbid disorders are present in more than 75% of adults with ADHD.[2]

Presentation in adulthood can be different to that in children; hyperactivity often presents as a subjective feeling of inner restlessness and agitation, rather than overt hyperactivity.[3] Impulsivity may remain problematic in adults even when hyperactivity has diminished.[1] Closely related to impulsivity are "sensation seeking" behaviors when patients may seek out excitement from novel or thrilling stimuli - this may result in reckless driving, sexual risks, and provocative behavior leading to fights.[3]

This topic covers the management of ADHD in adults only. See also Attention deficit hyperactivity disorder in children.

Anamnesis y examen

Principales factores de diagnóstico

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

Todos los datos

Otros factores de diagnóstico

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)

Todos los datos

Factores de riesgo

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

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

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

Todos los datos

Pruebas diagnósticas que deben considerarse

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

Todos los datos

Algoritmo de tratamiento

En curso

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

Colaboradores

Autores

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

Consultant Psychiatrist

South West Yorkshire NHS Partnership Foundation Trust

University of Huddersfield

Huddersfield

Divulgaciones

None to declare.

Agradecimientos

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.

Divulgaciones

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.

Revisores por pares

Gianni Faedda, MD

Lucio Bini Mood Disorders Center

New York

Divulgaciones

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

Divulgaciones

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.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

Kooij JJS, Bijlenga D, Salerno L, et al. Updated European consensus statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019 Feb;56:14-34.Texto completo Resumen

Faraone SV, Banaschewski T, Coghill D, et al. The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021 Sep;128:789-818.Texto completo Resumen

National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Sep 2019 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Depression in adults
- Bipolar disorder in adults
- Borderline personality disorder
Más Diferenciales
Guías de práctica clínica
- Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)
- World Federation of ADHD International consensus statement
Más Guías de práctica clínica
Folletos para el paciente
ADHD: what is it?
ADHD: what are the treatment options?
Más Folletos para el paciente
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad

Attention deficit hyperactivity disorder in adults

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

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

Colaboradores

Autores

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

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Gianni Faedda, MD

Divulgaciones

David W. Goodman, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice