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ADHD was once regarded primarily as a childhood condition, but it has gained more recognition as a lifelong disorder affecting people of all ages in recent years. Despite evidence of its legitimacy in adults, physicians are often hesitant and ill-equipped to manage adults with ADHD symptoms, especially those without an established diagnosis. While the disorder is well recognized and treated in children, the training of healthcare providers to identify and treat adult ADHD is lacking. Further complicating the matter is the fact that most of the existing evidence for adult ADHD treatment is extrapolated from clinical data in children.

Comorbidities are more frequent in adults with ADHD than in children, and include disruptive and antisocial behaviors, anxiety, substance abuse, and mood disorders. These comorbidities may influence physicians’ ability to effectively diagnosis ADHD. However, clearly documenting patients’ history of ADHD symptoms using the DSM-IV and identifying functional impairments can greatly assist physicians diagnosing and managing ADHD in their adult patients. Physicians can ask patients suspected of having ADHD to complete a simple self-report questionnaire and proceed to assess DSM-IV criteria in those likely to have the disorder.

Consider Pharmacotherapy

Pharmacotherapy options for adult ADHD are similar to those for children, but physicians are often challenged by other issues in adults, most notably substance abuse, cardiovascular adverse effects, and comorbidities. Stimulant medications are first-line therapies for adult ADHD (eg, methylphenidate, dexmethylphenidate, mixed amphetamine salts, and dextroamphetamine), but these agents are psychoactive substances with the potential for abuse. It’s important to determine if substance abuse is present; if it is, the problem should be addressed before administering ADHD agents.

Adults with ADHD who partake in episodic binge drinking or occasional marijuana use put themselves at greater risk for failing ADHD therapies, but these adults are not as great a concern, for example, as those who abuse methamphetamine or opioids daily. Depending on the patient, a period of sobriety may be beneficial before initiating treatment to more clearly document symptoms and determine the most appropriate treatment strategy.

Address Residual Symptoms

Although pharmacotherapy is effective as first-line treatment for adult ADHD, some patients may continue to experience significant functional impairment even though their symptoms improve. Cognitive-behavioral interventions are a promising adjunct to medications because they can address residual ADHD symptoms. These interventions help patients develop coping skills and more structured environments. For example, patients can learn life management skills that may have been impaired for years because of untreated ADHD. Although our understanding of applying psychosocial treatment is still in its infancy for adult ADHD, recent pilot studies examining the benefits of cognitive-behavioral interventions have led to positive outcomes.

In order to overcome the potential reluctance towards treating adults with ADHD symptoms, more efforts are needed for better education on the condition in this specific patient group. Physicians need to learn more effective methods for differentiating comorbid conditions, diagnosing ADHD confidently, and managing the disorder appropriately. Efforts are still ongoing to develop consensus guidelines for adult ADHD. The hope is that such recommendations will assist physicians in the diagnosis and management for this underserved patient population.

James J. McGough, MD, has disclosed to Physician’s Weekly that he has received grant and research support from Eli Lilly and Company, McNeil Pharmaceuticals, Novartis Pharmaceuticals, and Shire PLC. He has also served as a consultant for Eli Lilly and Company, McNeil Pharmaceuticals, Novartis Pharmaceuticals, and Shire PLC. Furthermore, he has served on the speakers’ bureau for Eli Lilly and Company, McNeil Pharmaceuticals, Novartis Pharmaceuticals, and Shire PLC.