Attention deficit hyperactivity disorder in adulthood: diagnosis, etiology and therapy

Until the late nineties, attention deficit and hyperactivity disorder (ADHD) was often regarded in Germany as a disorder that fades away in late adolescence. However, it has recently become clear from numerous studies that core symptoms of ADHD persist into adulthood in a substantial subgroup of patients.

Selective review of relevant literature in Medline, up to September 2007.

The prevalence of ADHD in adulthood is estimated at about 2%. Core symptoms include attention deficit in the presence of understimulation, chronic restlessness, impulsivity, disorganized behaviour, and disorders of affect regulation. The extent of psychosocial impairment depends on symptom severity, psychiatric comorbidity (such as addiction or depression), and psychosocial support. As in childhood, ADHD in adulthood is a clinical diagnosis. Genetic factors probably play a key role in primary ADHD. Treatment should include psychotherapy and medical treatment.

ADHD in adulthood is commoner than for example bipolar disorder or schizophrenia. It may be regarded as a risk factor for the development of other psychiatric conditions. Highly effective treatment is possible not only in childhood but also in adulthood. The problem of off-label use of psychotropic medication in adults limits treatment in adult ADHD.