Objective: To examine the prevalence of comorbid Axis I (current and lifetime) and II disorders in adult men and women with attention-deficit hyperactivity disorder (ADHD). Method:Adult patients (n = 447; 266 men, 181 women) received comprehensive assessments for ADHD and Axis I and II disorders. Adults were aged between 17 and 74 years. Among the patients diagnosed with ADHD (n = 335), there were those with ADHD inattentive subtype (ADHD-I) (n = 199), hyperactive-impulsive subtype (ADHD-H) (n = 24), or combined ADHD subtype (ADHD-C) (n = 112). Chi-square and logistic regression analyses were performed to examine associations between adults with and without ADHD on Axis I and II disorders.Results: Adults with ADHD, compared with those without ADHD, had higher rates of Axis I (46.9% and 27.31%) and Axis II (50.7% and 38.2%) disorders. Adults with ADHD-C were more likely to have mood disorder, anxiety, conduct disorder, and substance use disorder as well as obsessive-compulsive personality disorder, passive-aggressive personality disorder, depressive personality disorder, narcissistic personality disorder, and borderline personality disorder (BPD).Men with ADHD were more likely to have antisocial personality disorder and had higher rates of current drug abuse than women with ADHD. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia. Women with ADHD were more likely to have BPD than men with ADHD. Conclusions:Adults with ADHD have very high rates of comorbid Axis I and II disorders, with differences found between men and women on certain comorbid disorders.Can J Psychiatry. 2009;54(10):673-683. Clinical Implications· In diagnosing and treating adults with ADHD, the assessment and treatment of other conditions that may be comorbid with ADHD is crucial to adequately treat patients and promote optimal outcome. · One-third of patients referred for ADHD diagnosis do not have ADHD but may have other conditions. · Comprehensive, systematic evaluations are crucial for accurate diagnosis and comprehensive treatment. Limitations· Exclusion criteria, which included current substance abuse and psychiatric conditions, and which required urgent treatment, might have resulted in a decrease in the level of comorbidity found. · Sources of referral (for example, self-and physician-referral) might also have selected for a less comorbid patient population.

This review focuses on the treatment of attention defi cit hyperactivity disorder (ADHD) in adults. It briefl y addresses prevalence, diagnostic and differential diagnostic issues specifi c to adults. Stimulant medication, non-stimulant medication, and psychosocial treatments are thoroughly reviewed. For each class of medication possible mechanism of action, effi cacy and side effects are summarized. Special attention is given to the pharmacological treatment for patients with adult ADHD and various comorbidities. In summary, stimulant medications are most effective and combined medication and psychosocial treatment is the most benefi cial treatment option for most adult patients with ADHD.

Attention-deficit/hyperactivity disorder (ADHD) has been commonly thought of as a childhood disorder that diminished over time. It is one of the most common developmental disorders and it is estimated that ADHD affects 5-10% of children. Two-thirds of children with ADHD will continue to have symptoms of ADHD that persist throughout adolescence. Longitudinal studies have demonstrated that symptoms of ADHD can also remain in adulthood, affecting 4.4% of the adult population. However, diagnosing adults with ADHD can prove difficult because they often find that their symptoms are egosyntonic. In addition, the development of comorbid conditions, such as anxiety, depression, personality disorders or substance abuse, can often overshadow underlying ADHD symptoms. Nonetheless, treatments such as stimulant and nonstimulant medication (e.g., atomoxetine), and cognitive-behavior therapy have been effective in treating adults with ADHD. This article reviews the prevalence of adults with ADHD, followed by a discussion of the neurobiological and genetic underpinnings of the disorder. Issues regarding the diagnosis and treatment of ADHD are also addressed.

Attention-defi cit/hyperactivity disorder (ADHD) is prevalent, chronic, and often comorbid with other disorders. This article reviews the literature on ADHD and comorbid major depressive disorder from childhood through adolescence and adulthood. We also report fi ndings from a study we conducted that examined the prevalence of ADHD and comorbid major depression in adults. Diagnostic history data were analyzed in 524 adults (308 men; 216 women), 383 of whom had a diagnosis of ADHD. Adults with ADHD were more likely to have current major depression than adults without ADHD. Adults with the combined subtype of ADHD were more likely to have past and current major depression than those with the inattentive and hyperactive impulsive subtypes. Men and women with ADHD were more likely to have current major depression than men and women without ADHD, but women in the inattentive and combined subtype groups were more likely to have had past major depression than women in the hyperactive impulsive subtype group. Implications for diagnosis and treatment are discussed.