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
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)
Risk factors
- family history of ADHD
- male sex
- low birth weight
- psychosocial adversity
- obstetric complications in pregnancy or labor
- lead exposure
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
Tests to consider
- urine drug screen
- electroencephalogram
- brain imaging (CT or MRI)
- polysomnography
- computer-based program
Treatment algorithm
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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.Full text Abstract
National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Sep 2019 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Depression in adults
- Bipolar disorder in adults
- Borderline personality disorder
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 information
ADHD: what is it?
ADHD: what are the treatment options?
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer