Last reviewed: June 2018
Last updated: November  2017

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 misuse
  • thrill-seeking behavior
  • 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 behavior)
  • has organizational 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
Full details

Risk factors

  • FHx of ADHD
  • male gender
  • psychosocial adversity
  • other environmental factors
Full details

Diagnostic investigations

1st investigations to order

  • Conners Adult ADHD Rating Scale
  • Brown Attention Deficit Disorder Scale
  • WHO Adult ADHD Self-Report Scale
  • Wender Utah Rating Scale
  • neuropsychological testing
Full details

Investigations to consider

  • urine drug screen
  • EEG
  • brain imaging (CT or MRI)
  • polysomnography
Full details

Treatment algorithm

ONGOING

ADHD without concomitant mood disorder or anxiety

ADHD with depression (with or without prominent anxiety)

ADHD with bipolar disorder (with or without prominent anxiety)

ADHD with anxiety disorder alone

Contributors

Authors VIEW ALL

Consultant Psychiatrist

South West Yorkshire NHS Partnership Foundation Trust

University of Huddersfield

Huddersfield

UK

Disclosures

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.

Peer reviewers VIEW ALL

Lucio Bini Mood Disorders Center

New York

NY

Disclosures

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

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.

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