Attention deficit hyperactivity disorder in adults
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, 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 criminality
- distracted easily by surroundings and external stimuli
Risk factors
- family history of ADHD
- male sex
- psychosocial adversity
- other environmental factors
Diagnostic investigations
1st investigations to order
- Conners Adult ADHD Rating Scale
- Brown Attention Deficit Disorder Scale
- World Health Organization Adult ADHD Self-Report Scale
- Wender Utah Rating Scale
- neuropsychological testing
Investigations to consider
- urine drug screen
- electroencephalogram
- brain imaging (CT or MRI)
- polysomnography
- computer-based program
Treatment algorithm
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
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
MA is a member of the UK Adult ADHD Network (UKAAN) executive committee, Adult ADHD and Autism Service at South West Yorkshire Partnership NHS Foundation Trust, and a board member of the Wigan and Northumberland Clinical Commissioning Groups. MA has received a National Institute for Health Research (NIHR) grant for use of AI in diagnosis of attention deficit hyperactivity disorder. MA has provided consultancy to Takeda.
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
- Generalized anxiety and other anxiety disorders
More DifferentialsGuidelines
- Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)
- World Federation of ADHD International consensus statement
More GuidelinesPatient leaflets
ADHD: what is it?
Coping strategies for teenagers and adults with ADHD
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer