Attention-Deficit/Hyperactivity Disorder in Adults: Evidence-Based Recommendations for Management
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in educational, occupational, neuropsychological, and social functioning in adults. Successful diagnosis and treatment of the disorder in adults can be a challenge because recent and integrative clinical guidelines are lacking and diagnostic criteria are based on making a retrospective diagnosis of childhood-onset ADHD. To develop evidence-based recommendations for the treatment of ADHD in adults, the scientific literature was reviewed, including primary clinical studies, meta-analyses, and available clinical guidelines. Studies show that stimulant therapy is highly effective and safe in the management of ADHD in adults, with similar response rates to those reported in children at doses that are equivalent on a mg/kg basis. Long-acting stimulants, such as OROS methylphenidate (OROS MPH, Concerta), dexmethylphenidate (d-MPH, Focalin), and mixed amphetamine salts extended release (MAS XR, Adderall XR), have durations of action of up to 10 to 12 hours, which permit once-daily dosing. For adults with ADHD who do not respond to stimulant therapy or who have a comorbid condition in which a stimulant is contraindicated, the nonstimulant atomoxetine (Strattera) may be an appropriate alternative. For many adults, cognitive-behavioral therapy in addition to pharmacotherapy may improve treatment response. Attention-deficit/hyperactivity disorder medications may increase blood pressure and heart rate in adults, so patients should be monitored.
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Psychostimulants are first-line pharmacotherapy for ADHD in children, adolescents, and adults because they have greater efficacy than nonstimulants.
“Psychostimulants, including amphetamines and methylphenidate, are first-line pharmacotherapies for individuals with attention-deficit/hyperactivity disorder (ADHD).”
Treatment of adult ADHD can influence psychosocial impairment that results as a consequence of core ADHD symptoms and may lead to improvements in associated features and comorbid disorders.
“Treatment of adult ADHD can influence psychosocial impairment that results as a consequence of 'core' ADHD symptoms, and may lead to improvements in associated features and comorbid disorders [245-247].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [247]
Rostain and Ramsey reported similar findings to Safren et al.
“Similar findings were reported by Rostain and Ramsey [247], while a further study reported added benefits from CBT and psychoeducation delivered in a brief intensive group format [311].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [247]
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- Authors
- Rostain, A. L.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- Rostain, Anthony L.
- Venue
- Postgraduate Medicine
- Publisher
- Informa UK Limited
- Published
- 2008-01
- Volume
- 120
- Issue
- 3
- Pages
- 27-38
- ISSN
- 0032-5481 (ISSN-L)
- 1941-9260
- OpenAlex
- W2282858369
- Cited by
- 50
- References
- 72
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 1 · 2021: 3 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 1 · 2015: 4 · 2014: 6 · 2013: 5 · 2012: 9
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Postgraduate Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Janssen Scientific Affairs
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- adult ADHD, attention deficit hyperactivity disorder, stimulant medication, long-acting stimulants, OROS methylphenidate, dexmethylphenidate, atomoxetine, non-stimulant medication, cognitive behavioral therapy, comorbidities, treatment guidelines
- MeSH terms
- Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Humans, Cognitive Behavioral Therapy, Practice Guidelines as Topic
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