Managing ADHD in Adolescence and Young Adulthood: Emerging Comorbidities and Tailored Treatment

Abstract

The prevalence of ADHD in adolescence ranges from 4 to 6%. In this age range, the disorder may manifest in difficulty fulfilling academic, personal and social responsibilities. Adolescents with ADHD often struggle to maintain routines, organize their time, be effective interpersonally, inhibit stimulus-seeking behaviors, and control their emotional reactions. Around 75% of adolescents with ADHD have at least one comorbid disorder. The most frequent are Conduct Disorder (15–30%), Substance Abuse Disorder (30–70% depending on the drug), and Mood or Anxiety Disorders (20–40%). The presence and severity of these disorders leads to under-diagnosis of ADHD, and management of ADHD may prevent or reduce morbidity associated with comorbid conditions. Collection of data by interview is sufficient to identify a diagnosis of ADHD across the lifespan. Neuropsychological evaluation may be critical to confirm learning disabilities and need for possible learning accommodation in this age group. Academic supports and accommodations may be helpful both in straightforward ADHD and in the presence of other learning disabilities. Severe outcomes associated with ADHD can occur in this age range, including illegal behavior, risky sexual activities or motor accidents. Psychopharmacology improves ADHD in adolescents and is clinically observed to reduce many but not all of these poor outcomes. It is useful to look for risk factors of worse prognosis and to anticipate persistence into adult life to design a specific support and treatment plan.