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Adult attention deficit hyperactivity disorder

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) was originally believed to be primarily a pediatric condition. However, the available data suggest that between 30 and 70 percent of children with ADHD continue to manifest symptoms in adulthood [1-4]. It is estimated that between 1 and 7 percent of the adult population experiences ADHD symptoms [1,2]. An international survey of adult ADHD in ten countries in Europe, the Americas, and the Middle East found cross national prevalence rates ranging from 1.2 to 7.3 percent, with less prevalence in lower income countries [5]. A report from the US National Comorbidity Survey Replication found an adult prevalence of 4.4 percent using conservative diagnostic criteria [6].

Adults with suspected ADHD frequently present to primary care physicians, who are often uncomfortable evaluating these patients for several reasons:

  • Criteria are not objectively verifiable and there is a reliance upon patients' subjective reports of symptoms.
  • The available DSM-IV criteria do not describe the more subtle cognitive behavioral symptoms that primarily affect adults.
  • A commonly used treatment is long-term prescription of a Schedule-II drug with potential for abuse [7].

The primary care clinician's role is further complicated by the high number of adults who self diagnose ADHD, often influenced by the popular press. The number of adults who self-refer for ADHD evaluation and therapy greatly exceeds the number who are actually determined to have the condition [8]. However, epidemiologic data suggest that the majority of adults with clinically significant ADHD symptoms in the US are never formally diagnosed or treated [6]

PATHOGENESIS

Animal studies and clinical response to drugs with noradrenergic activity suggest that the pathophysiologic basis of ADHD centers on an imbalance in catecholamine metabolism in the cerebral cortex.
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