Issues in the Diagnosis and Treatment of the Adult Patient with Adhd*

Once believed to be a childhood syndrome, attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized as a disorder that continues into adulthood. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, definitions for ADHD suggest that it may persist into adulthood, but they fail to differentiate between childhood and adult manifestations of the disorder. This article reports on the findings of several longitudinal studies of children with ADHD into adulthood. The findings suggest that while many symptoms and impairments are similar, they manifest differently in adults, primarily as a result of maturity and changes in lifestyle. In this article, adult ADHD symptoms are described, and clinical trial results of the efficacy of off-label use of drugs for adult ADHD are reviewed. Preliminary efficacy results of atomoxetine (an investigational drug currently under Food and Drug Administration review) to treat adult ADHD are also reported. (Advanced Studies in Medicine. 2002;2(25):902-905) U ntil recently, attention-deficit/hyperactivity disorder (ADHD) was seldom diagnosed in adults, despite medical evidence supporting its existence. The persistence into adulthood of ADHD symptoms such as impulsivity, inattention, and difficulty regulating physical activity has been reported in a number of studies dating back to the mid 1970s. Nonetheless, the early emphasis on hyperactivity as a core component of ADHD, a trait that we now know typically diminishes with age, overshadowed the continuation of the cognitive symptoms into adulthood. Even though awareness of adult ADHD historically has been limited, growing medical evidence in this area and revised Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) diagnostic criteria for childhood ADHD have spawned more widespread recognition of this syndrome. The third edition (DSMIII) designated an attention deficit disorder classification, describing it as residual for adults, but remained somewhat vague about adult symptoms. The revised third edition of DSM (DSM-III-R) stated that approximately one third of children with ADHD showed continuing signs into adulthood, but did not code this as a separate category. The fourth edition of DSM (DSM-IV) states that “symptoms attenuate during late adolescence and adulthood, although a minority experience the full complement of symptoms of ADHD into midadulthood,” thereby acknowledging the persistence of ADHD diagnosis within the adult population.