ADHD across the lifespan. (November 2020)

• Record Type: Journal Article
• Authors: Asherson, Philip
• Is Part Of: Medicine. Volume 48:Number 11(2020)
• Page Start: 737
• Page End: 741
• Publication Date: 2020-11
• Subjects: ADHD -- atomoxetine -- attention-deficit hyperactivity disorder -- child-onset disorder -- dexamfetamine -- hyperkinetic syndrome -- lisdexamfetamine -- methylphenidate -- MRCP -- neurodevelopmental disorder -- stimulants; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Médecine factuelle -- Périodiques; Medicine; Periodicals; Electronic journals; Electronic journals; 610
• DOI: 10.1016/j.mpmed.2020.08.013
• Languages: English
• ISSNs: 1357-3039

Abstract

Abstract: Attention-deficit hyperactivity disorder (ADHD) is a common condition with neurodevelopmental origins that typically starts in early childhood and follows a persistent trait-like course. It is characterized by inattention, impulsivity and hyperactivity that persist over time and lead to clinical and psychosocial impairments. Emotional instability is a common feature and is sometimes the main presenting complaint. Neurodevelopmental and psychiatric co-morbidities are common. ADHD can be diagnosed and treated at all ages and persists into adulthood in around two-thirds of individuals. Many adults with ADHD were not diagnosed as children. Psycho-education and environmental adaptations are recommended in all cases. If significant impairment remains in at least one domain after implementation and review of environmental modifications, pharmacological treatments are recommended. Drug treatments are similar at all ages. Methylphenidate is the recommended first-line drug in children and adolescents. If ineffective or not tolerated, lisdexamfetamine is recommended as second line, followed by atomoxetine and guanfacine. In adults, lisdexamfetamine or methylphenidate is recommended as first-line treatment, followed by atomoxetine. Atomoxetine can be used as first line when there are concerns with potential drug abuse or diversion, or high levels of co-morbid anxiety. ADHD-focused groups should be offered if significant impairment remains after drug treatment.