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ADHD in adults: diagnosing & treating this common problem

I only recently came across the important article "European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD" published in the open access journal BMC Psychiatry last autumn.  I suspect that most mental health professionals working with adults are poor at recognising and treating Attention Deficit Hyperactivity Disorder (ADHD) - and I certainly include myself in this company! 

The abstract of the free full text article reads: "BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group".

The article points out that although sufferers may no longer have full criterion disorder as they age - "around two-thirds of children with ADHD continue to have impairing levels of ADHD symptoms as adults".  And goes on to state "The prevalence of ADHD in adults estimated from epidemiological studies is in the range of 2-5%. Persistent forms of ADHD are thought to have a higher familial loading than ADHD that does not persist, with increased rates of ADHD among the parents and siblings of those with persistent ADHD and high rates of ADHD among the offspring of parents with ADHD ... ADHD occurs in around 10-20% of people with common mental health problems according to epidemiological and clinical research. Further studies show that this rate may be higher in some clinical populations such as those attending forensic, addiction and personality disorder clinics, highlighting the importance of screening within such high risk populations.  There is growing recognition of the importance of diagnosing and treating the disorder in parents of children with ADHD since around 20% of parents of children with ADHD will have ADHD themselves".

There are a whole series of screening instruments available.  I find the WHO Adult ADHD Self-Report Scale (ASRS) particularly helpful.  It's freely available in several different languages at http://www.hcp.med.harvard.edu/ncs/asrs.php.  The ASRS has questions for each of the 18 DSM-IV items, re-phrased to better describe ADHD presentation in adults.  There is also a briefer 6-item version.  Here in the UK, the 2008 NICE guideline states "Diagnosis should only be made by a specialist psychiatrist, paediatrician or other healthcare professional with training and expertise in the diagnosis of ADHD." and "Do not diagnose ADHD based on rating scales or observational data alone. However, rating scales are valuable adjuncts ... ADHD should be considered in all age groups. Adjust symptom criteria for age-appropriate changes in behaviour".

More to follow ... 

For further information about ADHD, see my 2008 blog post "NICE guidelines: attention deficit hyperactivity disorder (ADHD) in children, young people, and adults", the very helpful general advice and specific treatment pathways recommended in the 24-page NICE quick refererence guide and the suggestion for potentially useful websites.  


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