Pharmacological Treatments for Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD), as defined by DSM-IV, is a heterogeneous syndrome affecting an estimated 7% of children. Many will continue to have clinically-significant features of ADHD as adults, although some patients referred to adult psychiatrists have previously-unrecognised ADHD. Studies involving neurocognitive assessments or brain imaging have indicated ADHD-associated brain dysfunctions. An important therapeutic role for drugs such as methylphenidate has been clearly established in children and the benefits of medication for ADHD in adults are being increasingly recognised.The present review is aimed at adult psychiatrists who are considering or managing drug treatments for ADHD in adult patients. The focus is on medication regimes, but relevant 'background' literature is also reviewed, as an awareness of a range of published evidence is necessary when assessing ADHD in adult patients and advising on possible drug treatments.

Impulsive aggression in adults with attention‐deficit/hyperactivity disorder

“…21) was insufficient for parallel analyses. The mean GSI rating was above the threshold for ‘caseness’, which is consistent with reports of a range of psychiatric comorbidity in adults with ADHD (1). The mean ADSA total score indicated ‘very considerable problems’ related to ADHD (33).…”

“…In view of the reported gender differences for the features, prevalence and comorbidity of ADHD (1), potential female subjects were excluded from the study, as the number of potential female subjects (i.e. 21) was insufficient for parallel analyses.…”

“…Several studies have found associations of these covariables with aggression and/or ADHD. A history of past ODD, and to a lesser extent past CD, both of which incorporate aspects of aggression, have been reported to be associated with features of adult ADHD (32), verbal IQ has been negatively correlated with aggression in various male samples (38, 39) and features of ADHD have been reported to diminish with increasing age (1). Also, as increased aggression has been associated with comorbidity in ADHD samples (23, 24), the range of comorbidity reflected by ‘PD features’ and GSI were also selected as covariates.…”

“…There is uncertainty about the status of impulsive aggression as a feature of the syndrome of attention‐deficit/hyperactivity disorder (ADHD), because aggression is found in the context of disorders which are commonly comorbid with ADHD, such as conduct disorder (CD) and, in adults, antisocial and borderline personality disorders (1). The syndromal context of impulsive aggression in subjects with ADHD may have important implications for the selection of research samples and the efficacy of drug treatments and other interventions which have a specific role for the treatment of ADHD.…”