Adult ADHD: clinical aspects and therapeutic implications

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) has been originally described as a disorder of childhood and adolescence. In the last years, a huge amount of evidence supports a syndromal continuity form childhood to adulthood. the identification of ADHD in adults raises several problems of differential diagnosis and the disorder is frequently associated with other mental disorders, at least in patients referred to psychiatric settings. It is not clear if adult ADHD is characterized by a specific pattern of symptoms that include attentive deficits and consequent behavioral manifestations, instead of hyperactivity. Comorbidity with other mental disorders influences clinical picture, severity, course and treatment outcome. In particular comorbid ADHD, bipolar disorder and alcohol/substance abuse disorders coexist in a relevant proportion of cases and it might represent a specific phenoptype, associated with treatment resistance. Substances use, often poly-drug abuse, such as alcohol, cocaine, stimulants and heroin, inevitably complicates course and therapeutic choice. The recognition of ADHD in adults has important implications at therapeutic level, even when present as incomplete and residual forms. Psychostimulants and other compounds with specific efficacy on ADHD symptomatology has been shown to be useful also in adults both in monotherapy and in association with other drugs, such as mood stabilizers. However their use should be cautious when a mood disorder coexists, for the possible induction of manic-switches or rapid cycling. Further research is necessary in order to better characterize the clinical picture of ADHD in adults and to elaborate widely shared treatment guidelines.