Clinical assessment and treatment of attention deficit hyperactivity disorder in adults
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that frequently persists into adulthood, with significant levels of inattentive, hyperactive and impulsive behavior. Impairments associated with adult ADHD include distress from the symptoms, impaired ability to function in work and academic settings, and problems sustaining stable relationships. The disorder is commonly associated with volatile moods, antisocial behavior, and drug and alcohol misuse. There is an increased risk of developing comorbid anxiety, depression, personality disorders, and drug and alcohol dependence. Despite the proven effectiveness of drugs such as methylphenidate, dexamphetamine and atomoxetine, few cases of ADHD are recognized and treated in the UK. The reasons for this are unclear, since most psychiatrists working with children and adolescents are aware that ADHD commonly persists into adult life and they also see the disorder affecting parents of children with ADHD. Issues of transition from the care of child to adult psychiatry and the need to refer adult relatives of children with ADHD to suitable psychiatric services are a major concern. Furthermore, many cases of adult ADHD go unrecognized or are seen by mental health teams that are not familiar with the subtleties of the adult presentation. As a result, misdiagnosis and treatment for conditions such as atypical depression, mixed affective disorder, cyclothymia, and borderline and unstable emotional personality disorders is not uncommon. There is therefore a requirement for further training in this area. This review will describe the common clinical presentation and provide guidelines for the diagnosis and treatment of ADHD in adults. Any psychiatrically trained physician using standard psychiatric assessment procedures can perform clinical evaluations for adult ADHD. As with other psychiatric disorders in adulthood, ADHD has its own characteristic onset, course and psychopathology. Symptoms of ADHD are trait-like, being stable characteristics from early childhood, and commonly co-occur with affective instability. Stimulants are the mainstay of treatment and are effective in around 70% of cases. Psychotherapeutic interventions also have an important role. These guidelines will assist psychiatrists and other adult mental health workers in identifying and treating individuals with adult ADHD.
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A range of characteristics closely associated with the core ADHD syndrome often lead to some of the impairments typically seen in adults with ADHD, including disorganization, short-fuse, temper, mood lability, and sensitivity to stress.
“These include symptoms such as disorganization, short-fuse, temper, mood lability and sensitivity to stress [35,116].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [116]
Many adults with ADHD experience lifetime mood lability with frequent highs and lows, and short-fuse temper outburst.
“In addition, many adults with ADHD experience lifetime mood lability with frequent highs and lows, and short-fuse temper outburst [35,37,116-118].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [116]
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- Authors
- Asherson, P.
- Affiliations
- King's College London (GB)
- Corresponding author
- Asherson, Philip
- ORCID
- Asherson, Philip
- Venue
- Expert Review of Neurotherapeutics
- Publisher
- Informa UK Limited
- Published
- 2005-07
- Volume
- 5
- Issue
- 4
- Pages
- 525-539
- ISSN
- 1473-7175 (ISSN-L)
- 1744-8360
- OpenAlex
- W2014193692
- Cited by
- 195
- References
- 45
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 6 · 2023: 10 · 2022: 9 · 2021: 6 · 2020: 6 · 2019: 10 · 2018: 8 · 2017: 9 · 2016: 14 · 2015: 6 · 2014: 9 · 2013: 19 · 2012: 20
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Review of Neurotherapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, persistent ADHD, clinical features, diagnosis, stimulant medication, methylphenidate, d-amphetamine, atomoxetine, misdiagnosis, comorbidities, psychotherapy, neuroticism
- MeSH terms
- Adult, Age Factors, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Humans, Psychotherapy, Substance-Related Disorders
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