Adult Attention Deficit-Hyperactivity Disorder

Short-term trials involving adults with ADHD have shown significant improvements in symptoms with stimulants and atomoxetine; however, data on long-term benefits and risks of these medications, particularly among older persons, have been insufficient. ForewordThis Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.StageA 31-year-old middle-school teacher sought medical help because she was having trouble keeping up with her job assignments and responsibilities. Her primary symptoms were an inability to stay focused and being easily distracted. She reported daydreaming with multiple thoughts at the same time, an inability to complete tasks on time, frequently forgetting to do things at work, and being unable to remain still during solitary activities (e.g., watching a movie and reading a book). Her friends described her as excessively talkative, disorganized, impatient, and careless. From childhood, her teachers noted that she was inattentive and messy and often did ... Attention Deficit-Hyperactivity Disorder in Adults The recognition that attention deficit-hyperactivity disorder (ADHD) persists after adolescence has led to an increase in its diagnosis and treatment in adults. Randomized trials show clinically significant improvements in ADHD symptoms and in daily functioning with the use of approved medications (stimulants and atomoxetine) for ADHD in adults. Clinical trials of medications for ADHD have been largely short-term and have predominantly involved young and middle-aged adults. Data are lacking on long-term benefits and risks and on risks among elderly patients. The absolute risk of serious cardiovascular adverse events associated with ADHD medications appears to be very low. However, the observed increases in pulse rate and blood pressure with stimulant use underscore the need for caution in prescribing these agents for patients with cardiovascular disease. The risk of addiction to stimulant medications prescribed for the treatment of ADHD in adults is low, but the clinician should be aware of their potential for abuse and dependence.