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16 Jun 2016

Zalsman G, Shilton T. Int J Psychiatry Clin Pract 2016; 20: 70-76.

Until recently, it was believed that the symptoms of ADHD are outgrown by the end of adolescence and the beginning of adulthood. This literature review describes the characteristics of the disease in adults with respect to prevalence, symptom presentation and methods of diagnosis and treatment.

The review reports that ADHD affects 2.5–5.2% of adults, and these numbers are likely to increase given the changes made to the diagnostic criteria, such as those outlined below, which now better reflect the persistent nature of the disorder into adulthood.

  • Diagnosis using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in adults (aged ≥17 years) is now based on the presence of at least five out of nine symptoms, in each of two domains: inattention and hyperactivity/impulsivity, whereas in DSM-IV it was six or more
  • The age-of-onset criterion has changed from 7 to 12, and for establishing a diagnosis the only requirement is the presence of symptoms prior to the age of onset, rather than impairment.

Of the three ADHD subtypes, the inattentive subtype is reported to be the most prevalent, accounting for 47% of cases.

Symptoms of hyperactivity, impulsivity and inattention may present in adults as follows:

  • Hyperactivity – inner restlessness and increased fidgeting in situations that require stillness, for example in meetings, lectures or at the movies
  • Impulsivity – impetuous actions, inability to retain jobs or sustain relationships
  • Inattention – may be expressed as boredom, indecisiveness, procrastination and distraction.

These symptom impairments may compromise academic and professional performance in addition to deterioration in inter-personal relationships and engagement in criminal behaviours.

The literature review also emphasises that optimal management of ADHD may be achieved by a multimodal treatment approach involving a person’s close relationships, including psychoeducation, cognitive behavioural therapy and pharmacotherapy (stimulants or non-stimulants).

The article sheds lights on the persistent nature of ADHD, which calls for an increased awareness in physicians of the diverse manifestations and burden of the illness.

Read more about presentation, consequences and management of adult ADHD here

Zalsman G & Shilton T. Adult ADHD: a new disease? Int J Psychiatry Clin Pract 2016; 20: 70-76.

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