Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 25-13: Attention-Deficit/Hyperactivity Disorder + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ +++ Medication ++ Methylphenidate and amphetamine are the most effective treatments Atomoxetine, a nonstimulant Second-line agent FDA-approved for ADHD Affects norepinephrine and dopamine transport and makes more of these neurotransmitters available in the brain Bupropion 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