Updated European Consensus Statement on diagnosis and treatment of adult ADHD

Abstract

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Being Different but Striving to Seem Normal: The Lived Experiences of People Aged 50+ with ADHD

“…A number of studies confirm the findings of both psychiatric and physical comorbidity, i.e. Caci et al (2015), Kooij et al (2019), Fayyad et al (2007), and Kessler et al (2006).…”

“…The National Comorbidity Survey Replication in USA estimated the prevalence to 4.4% (Kessler et al, 2006). Populations diagnosed with ADHD are known to often report other mental co-morbidities (Brod, Schmitt, Goodwin, Hodgkins, & Niebler, 2012a;Kooij et al, 2019;Silva et al, 2013) and heritability is estimated to 70-80% for adult and childhood ADHD (Kooij et al, 2019).…”

An update on the pharmacokinetic considerations in the treatment of ADHD with long-acting methylphenidate and amphetamine formulations

“…While stimulants have long been recommended as first-line pharmacotherapy for ADHD, there are inconsistencies in the treatment recommendations in current guidelines [133]. Most guidelines and consensus statements recommend stimulants without identifying an agent of first choice nor offer any distinctions between MPH and AMP [2,11,13,14], whereas some recommend MPH over AMP for children [15,133]. Because AMP is thought to work through a different mechanism of action than MPH, a lack of response to one class of psychostimulant does not preclude response to another class [122,123].…”

“…Stimulants, methylphenidate (MPH) and amphetamine (AMP), have been used to treat ADHD for more than 60 years, with longacting stimulant formulations currently recommended as first-line pharmacotherapy in children, adolescents, and adults with ADHD because of their greater efficacy compared to non-stimulant medications [2,[9][10][11][12][13][14][15]. Both MPH and AMP have been shown to have very high effect sizes (>0.8) relative to non-stimulant medications (~0.6), with AMP having moderately greater effects than MPH [16][17][18].…”

Development of the Korean Practice Parameter for Adult Attention-Deficit/Hyperactivity Disorder

“…As with childhood/adolescent ADHD, pharmacotherapy for adult ADHD can highly effective [83], and is often recommended as the first-line of treatment for adult ADHD by the National Institute for Health and Clinical Excellence (NICE) [187]. Of the several options available for ADHD, stimulants were the first choice for treatment of adult ADHD [83, [187][188][189][190]. The non-stimulant ATX is recommended as a second-line of treatment, followed by other non-stimulants such as bupropion and tricyclic antidepressants [83,187,191].…”