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3 May 2015

Mattingly G et al. Postgrad Med 2015; 127: 323-329.

The goal of treatment in adult ADHD for primary care clinicians should include both symptom reduction and restoration of near normal functionality, a recent review reports.

Please note that this study was sponsored by Shire.

This review summarised information related to the definition of adult ADHD remission, and how this may be achieved, using published literature (April 2003 to April 2013) and guidance from the authors’ practical experience.

A lack of consensus on the criteria by which remission is defined was identified; for example, rating scales may define remission based on a fixed percentage reduction in symptom level from baseline, but this does not necessarily mean restoration of normal academic, vocational or social functionality. Monitoring for the presence of remission using rating scales may also fail to accurately reflect a patient’s condition; if for example they had high baseline levels of impairment or met clinical criteria for remission during the day at work, but not in the evening when medication effects may have worn off. Therefore it is important that the treating physician schedules regular discussions with the patient to understand their daily routine and functioning. Regular re-evaluation to assess undiagnosed psychiatric comorbidity and the adequacy of current treatment is also vital given that patients may also go in and out of remission throughout their lives, particularly at times of crises (e.g. work/relationship problems).

Although stimulants are considered the first-line treatment option for adults with ADHD, the review also emphasised the importance of a multimodal approach to the long-term management of ADHD, including components of medical education, behavioural therapy, family therapy and lifestyle coaching, coordinated by members of a multidisciplinary team of healthcare professionals. Researchers concluded that the responsibility of the primary care clinician is to monitor for and manage ADHD symptoms and functional impairments both before and after remission, if achieved, in order to optimise the potential for patients to lead more stable and productive lives.

Read more about a practical definition of remission in adults with ADHD here

Mattingly G, Culpepper L, Babcock T, et al. Aiming for remission in adults with attention-deficit/hyperactivity disorder: The primary care goal. Postgrad Med 2015; 127: 323-329.

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