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10 May 2016

Asherson P et al. Lancet Psychiatry 2016; 3: 568-578.

Although commonly regarded as a childhood-onset disorder, ADHD can arise during adulthood with or without account of symptoms of the disorder during childhood. Despite the high prevalence of adult ADHD (2.5–3.4%), many cases remain undiagnosed (>10% of non-psychotic patients in clinical and forensic services). In the present review, the search strategy and selection of data for inclusion was two-fold. Firstly, the authors cited the most established findings that have been replicated or demonstrated in systematic reviews and meta-analyses, and secondly, they highlighted new, emerging findings that require further research to confirm or refute initial findings.

Confounding factors for the diagnosis of adult ADHD are numerous. In children, symptoms are reported by parents and teachers and these reports are more accurate than adult self-report, which can be biased, with adults likely to underplay symptoms. In addition, there is a paucity of clinically reliable cognitive and neuroimaging biomarkers of adult ADHD, and their development is hindered by the heterogeneity of the cognitive and neuronal impairments observed in adult ADHD.

The authors suggest that more accurate self-rating of ADHD in adults could be achieved by the use of subjective accounts of mental state phenomena. In addition, they emphasise the need for development of objective cognitive and neuroimaging tests correlated with clinical outcomes such as response to pharmacotherapy. Functional magnetic resonance is emerging as a promising tool to identify such neuronal biomarkers. The authors also suggest a focus on symptoms of ADHD beyond inattention/hyperactivity-impulsivity; these include insomnia, emotional instability, excessive mind-wandering and difficulties in executive function.

Pharmacotherapy has proved efficacious in the clinical management of adult ADHD. Although both stimulants and non-stimulants show clinical efficacy, stimulants are more effective for the short duration of treatment that is characteristic of placebo-controlled trials. Despite limitations in study design, psychosocial support based on cognitive and behavioural therapies appear to provide added benefits to pharmacological interventions.

The review highlights the importance of proper diagnosis and appropriate treatment of ADHD to secure the well-being of patients.

Read more about key conceptual issues in adult ADHD here

Asherson P, Buitelaar J, Faraone SV, et al. Adult attention-deficit hyperactivity disorder: key conceptual issues. Lancet Psychiatry 2016; 3: 568-578.

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