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Key Features

  • Persistent patterns of inability to sustain attention, excessive motor activity/restlessness/impulsivity, or both

  • Symptoms interfere with daily functioning

  • Symptoms began prior to age 12 and in at least two settings (ie, school/work, home, with friends/family)

  • Prevalence in adults is estimated to be 4–5%

Clinical Findings

  • Although begins in childhood, symptoms persist into adulthood in approximately two-thirds of patients

  • Presenting symptoms in adulthood tend to be inattention, restlessness, and impulsivity, whereas hyperactivity has often improved

  • Other findings include

    • Careless mistakes

    • Being easily sidetracked

    • Having trouble keeping deadlines or with organization

    • Losing belongings

    • Forgetfulness in daily chores/tasks

    • Feeling restless (eg, may leave a seat though expected to remain)

    • Feeling "driven by a motor"

    • Interrupting others

    • Cannot wait his or her turn

Diagnosis

  • At least 5 inattention symptoms or 5 hyperactivity/impulsivity symptoms are required to meet criteria for ADHD

  • It is often useful in making this diagnosis to have patients provide questionnaires to other adult observers, including those who knew them during childhood, such as parents

Treatment

Medication

  • Methylphenidate and amphetamine are the most effective treatments

  • Atomoxetine, a nonstimulant

    • Second-line agent

    • FDA-approved for ADHD

    • Affects norepinephreine and dopamine transport and makes more of these neurotransmitters available in the brain

  • Buproprion could be considered in patients in whom a stimulant is contraindicated or who also suffer from major depression

  • Desipramine, a tricyclic antidepressant, could be considered in patients who have concomitant depression or neuropathic pain

  • Guanfacine and clonidine, used primarily to treat hypertension, have some efficacy in ADHD

Behavioral and Other Treatments

  • Psychoeducation regarding ADHD should be given to all patients

  • There is some evidence that cognitive behavioral therapy can help residual symptoms after medication management has been optimized

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