Adult ADHD – An Increasingly Recognised And Diagnosed Condition

This blog is written by our clinicians and aims to keep patients informed with up to date information on medical conditions. The editor of the blog is Dr Cristina Romete.

What is ADHD? 

ADHD is an abbreviation for Attention Deficit Hyperactivity Disorder. ADHD is a  is one of the most-common psychiatric syndrome characterised by the extreme end of a spectrum in terms of inattention, impulsivity and hyperactivity.

Adults with ADHD are significantly more likely than the general population to experience other mental health conditions: in particular, mood and anxiety disorders. A risk of developing substance misuse difficulties, occupational, interpersonal and social problems is also substantially increased (Kessler et al., 2006). The presence of other comorbid disorders is not a barrier to conducting an assessment for ADHD.

People in the following groups may have increased prevalence of ADHD compared with the general population: people born preterm,  children and young people diagnosed with oppositional defiant disorder or conduct disorder, children and young people with mood disorders (for example, anxiety and depression), people with a close family member diagnosed with ADHD, people with neurodevelopmental disorders (for example, autism spectrum disorder) (NICE, 2018).

How common ADHD in adults? 

Attention deficit and hyperactivity disorder is not restricted to children. The estimated prevalence of ADHD in adult ADHD is 4.4% (Kessler et al., 2006).

ADHD is thought to be under-recognised, particularly in  in girls and women  (NICE, 2018, Magon, 2016). They are less likely to be referred for assessment for ADHD and they may be more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental condition (NICE, 2018).

Not detecting or treating ADHD results in psychiatric comorbidity, relationship and parenting problems, educational and occupational underachievement, frequent job losses, and opportunistic lawbreaking (Magon, 2016, Kessler et al., 2006).

How ADHD is diagnosed?

The general approach to assessing ADHD is similar to that for other mental disorders. This involves conducting detailed clinical assessment and also gathering information from third parties, such as previous school reports, developmental assessments, opinions from parents and partners. It is always helpful to speak directly with a parent or relative who has known the individual since childhood. Important diagnostic requirement is to demonstrate functional impairment in different aspects of life. Examples can include  educational and occupational problems, difficulties in social life and relationship. In assessment special attention is paid to the age of symptoms onset. In case of ADHD symptoms are developing from early childhood and will be usually evident before age 7.

Structured questionnaires are usually used to aid diagnostic process. The most widely used questionnaire in the UK for adults include The Diagnostic Interview for ADHD in Adults (DIVA) (Kooij and Francken, 2010). This is a structured interview, which addresses current and childhood behaviours, and also different aspects of  impairment.

How is ADHD treated ? 

Management involves a combination of pharmacological, psychological, and skills-based interventions.

The National Institute for Health and Clinical Excellence (NICE)  recommends medication a first-line treatment for adults with moderate to severe impairment (NICE, 2018). There is strong evidence that adults with ADHD respond well to pharmacological treatments  (Bolea et al., 2012, Bolea-Alamanac et al., 2014).

Medication treatments can be classified into stimulants (methylphenidate, dexamphetamine) and non-stimulants (atomoxetine). Stimulants have an immediate action and can therefore be titrated more quickly. Non-stimulants have a delayed onset of action similar to that of antidepressants. The mechanism of action of ADHD treatments involves creating and increased availability of dopamine and/or noradrenaline in the brain.

Although some medication treatments are not licensed in the adult population, this should not prevent medications being prescribed according to best clinical practice (NICE, 2018).

What is required before starting medication?

A relevant medical history in terms of cardiovascular, neurological and hepatic disorders should be gathered.  Blood pressure and pulse should be measured and a record of the most recent blood tests should be taken.

An electrocardiogram (ECG) is required in case of family history or medical history of serious cardiac disease or family history of early cardiac death.

If you would like to make an appointment and discuss your concerns, or be assessed for possible adult ADHD do get in touch!

 

References: 

BOLEA-ALAMANAC, B., NUTT, D. J., ADAMOU, M., ASHERSON, P., BAZIRE, S., COGHILL, D., HEAL, D., MULLER, U., NASH, J., SANTOSH, P., SAYAL, K., SONUGA-BARKE, E. & YOUNG, S. J. 2014. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol, 28, 179-203.

BOLEA, B., ADAMOU, M., ARIF, M., ASHERSON, P., GUDJONSSON, G., MULLER, U., NUTT, D. J., PITTS, M., THOME, J. & YOUNG, S. 2012. ADHD matures: time for practitioners to do the same? J Psychopharmacol, 26, 766-70.

KESSLER, R. C., ADLER, L., BARKLEY, R., BIEDERMAN, J., CONNERS, C. K., DEMLER, O., FARAONE, S. V., GREENHILL, L. L., HOWES, M. J., SECNIK, K., SPENCER, T., USTUN, T. B., WALTERS, E. E. & ZASLAVSKY, A. M. 2006. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry, 163, 716-23.

KOOIJ, S. H. & FRANCKEN, M. H. 2010. DIVA 2.0. Diagnostic Interview for ADHD in Adults (DIVA). DIVA Foundation.

MAGON, R. 2016. Attention-deficit hyperactivity disorder in adults. InnovAiT, 10, 165-172.

NICE. Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. 2018. NICE guideline [NG87].

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