Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD) is thought to affect between 8 – 12% of children worldwide, making it the most commonly diagnosed neurodevelopmental disorder1. Though a highly heterogenous condition, impulsivity, hyperactivity and inattention traditionally characterise the core symptoms of ADHD2,3. Interestingly, although most patients with ADHD do not exhibit neurological symptoms, the condition is more frequently observed among individuals with other brain pathologies including epilepsy and autism spectrum disorder (ASD) compared with the background population. It is also more common in males than females4.
A common misconception associated with ADHD is that symptoms do not persist beyond childhood. In fact, although onset usually occurs before the age of seven, ADHD can affect patients throughout their life, increasing the risk of academic under-attainment, unemployment, relationship and legal problems, substance abuse, and psychiatric illness3,4. Adults with ADHD also show higher mortality than the general population5. To date, no curative treatment has been identified, however, the condition can be well managed through psychological and in some cases pharmacological interventions1.
Meet the experts
Professor Philip Asherson is Professor of Neurodevelopmental Psychiatry at King’s College London. Professor Jan Buitelaar leads the research group on neuropsychiatric and developmental disorders at the Radboud University Medical Centre and is head of the Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands. Professor David Coghill is Honorary Clinical Professor of Child and Adolescent Psychiatry at the University of Dundee. Professor Michael Huss is head of the department of Child and Adolescent Psychiatry at Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Germany.
In this discussion, Professors Coghill discusses the evidence that ADHD patients who are not diagnosed and treated during childhood or adolescence typically experience more extensive impairments in adulthood than those identified and managed earlier.
Pointers for treatment adherence in adult patients
How do you check if patients are abusing medication?
Long-term management of ADHD in adults: Evidence from the pivotal trial on MPHLA
Recent evidence in the long-term management of adults with ADHD
Professor Huss summarises the clinical data previously available which was sparse and not of high quality.
He goes on to describe the results of the long-term study of methylphenidate modified-release long-acting formulation (MPHLA) in adults with ADHD which is the longest-term and largest randomised controlled trial to date with a total duration of 66 weeks and a sample size of 725 patients.
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- Lambez B, Harwood-Gross A, Golumbic EZ, Rassovsky Y. Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis. Journal of Psychiatric Research. 2020;120:40–55.
- Ougrin D, Chatterton S, Banarsee R. Attention deficit hyperactivity disorder (ADHD): Review for primary care clinicians. London J Prim Care (Abingdon). 2010;(1):45–51.
- Dalsgaard S, Ostergaard SD, Leckman JF, Mortensen PB, Pedersen MG. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: A nationwide cohort study. Lancet. 2015;385(9983):2190–2196.
- Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim care companion CNS Disord. 2014;16(3). doi:10.4088/PCC.13r01600.
- McCarthy S, Asherson P, Coghill D, Hollis C, Murray M, Potts L, et al. Attention-deficit hyperactivity disorder: Treatment discontinuation in adolescents and young adults. Br J Psychiatry. 2009;194(3):273–277.
- Kooij SJJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry. 2010;10:67.
- Turgay A, Goodman DW, Asherson P, Lasser RA, Babcock TF, Pucci ML, et al. Lifespan persistence of ADHD. J Clin Psychiatry. 2012;73(02):192–201.
- Young S, González RA, Mutch L, Mallet-Lambert I, O’Rourke L, Hickey N, et al. Diagnostic accuracy of a brief screening tool for attention deficit hyperactivity disorder in UK prison inmates. Psychol Med. 2016;46(7):1449–1458.
- Goodman DW. Sustained treatment effect in attention-deficit/ hyperactivity disorder: Focus on long-term placebo-controlled randomized maintenance withdrawal and open-label studies. Ther Clin Risk Manag. 2013;9(1):121–130.
- Bijlenga D, Kulcu S, Van Gellecum T, Eryigit Z, Kooij JJS. Persistence and adherence to psychostimulants, and psychological well-being up to 3 years after specialized treatment of adult Attention-Deficit/Hyperactivity Disorder: A naturalistic follow-up study. J Clin Psychopharmacol. 2017;37(6):689–696.
- Garner AA, O’Connor BC, Narad ME, Tamm L, Simon J, Epstein JN. The relationship between adhd symptom dimensions, clinical correlates, and functional impairments. J Dev Behav Pediatr. 2013;34(7):469–477.
- Philipsen A, Jans T, Graf E, Matthies S, Borel P, Colla M, et al. Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder a randomized clinical trial. JAMA Psychiatry. 2015;72(12):1199–1210.
- Fredriksen M, Halmøy A, Faraone S V, Haavik J. Long-term efficacy and safety of treatment with stimulants and atomoxetine in adult ADHD: a review of controlled and naturalistic studies. Eur Neuropsychopharmacol. 2013;23(6):508–27.
- Huss M, Ginsberg Y, Tvedten T, Arngrim T, Philipsen A, Carter K, et al. Methylphenidate hydrochloride modified-release in adults with attention deficit hyperactivity disorder: A randomized double-blind placebo-controlled trial. Adv Ther. 2014;31(1):44–65.