Aiming for remission in adults with attention-deficit/hyperactivity disorder: The primary care goal

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is often undiagnosed and undertreated in adults, resulting in wide-ranging problems and functional deficits in patients' lives. In addition, psychiatric comorbidities unrelated to symptom severity may be present. However, effective treatment that can alleviate symptoms and bring about meaningful improvements in functionality is available. Primary care providers can play a crucial role in recognizing and diagnosing ADHD, initiating and monitoring treatment, and obtaining consultations or arranging referrals when necessary, all with the goal of achieving and maintaining remission. Fulfillment of this role requires a practical understanding of the diverse clinical manifestations of ADHD in patients stratified by age and sex, and familiarity with current treatment guidelines. Although there is no absolute consensus on the criteria by which remission is defined, treatment response may be guided by objective ratings of global symptom severity and patients' self-reports of changes in their ability to cope with routine daily tasks, academic and vocational responsibilities, and social relationships. Although there has been much research into the genetic and neurophysiologic basis of ADHD, it is more important for primary care providers to appreciate that ADHD is a chronic condition requiring lifelong follow-up and that clinical presentation and response to treatment can vary widely among patients and over time in the same patients. Such variability makes the management of ADHD challenging, but the opportunity to bring about dramatic improvement in patients' lives makes it imperative for primary care providers to be competent in this area. This review provides primary care clinicians with a practical definition of remission in adults with ADHD, to emphasize that symptom reduction does not necessarily mean intact functionality, and to suggest a multidisciplinary approach aimed at achieving the greatest possible reduction of symptoms and normalization of functionality.

Childhood Factors Affecting Persistence and Desistence of Attention-Deficit/Hyperactivity Disorder Symptoms in Adulthood: Results From the MTA

“…2 Studies suggest that of all children with ADHD, 45%–85% are symptomatic in adolescence while 50%–60% continue to show symptoms in adulthood. 3–6 The large heterogeneity in persistence rates is partly determined by the age at which symptoms are assessed; symptoms of ADHD, particularly hyperactivity/impulsivity, decrease with age leading to lower persistence rates at adulthood than adolescence. 3,5,7 Further, heterogeneity in persistence rates also result from the varying definitions of persistence employed by studies.…”

Trend, characteristics, and pharmacotherapy of adults diagnosed with attention-deficit/hyperactivity disorder: a nationwide survey in Taiwan

“…ADHD is thought to be a life-long condition;5,50,51 however, adults with ADHD may develop adequate coping strategies and then be able to stop using medications 52. However, the reasons for discontinuing ADHD medication may also be related to other factors such as the severity of symptoms, adverse effects, treatment effectiveness, patients’/clinicians’ attitude toward the medication, and social stigma,8 all of which are difficult to analyze from claims data.…”

A clinician’s guide for navigating the world of attention deficit hyperactivity disorder medications

“…Interestingly, clinicians interpret 30% symptom improvement as "much" or even "very much improved" on global clinical measures. [29][30][31][32] Patients and clinicians may be tempted to be satisfied with 30% improvement, even though the evidence is clear that such minimal improvement almost inevitably means continued functional impairment. For most patients, further improvement is possible.…”