Clinical recognition and management of adult attention deficit hyperactivity disorder

Adults with attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are a new phenomenon to many health care providers. While increasing evidence indicates children with ADD/ADHD can have persistent problems into adulthood, the significance and management of these disorders for adults are poorly understood. Studies of adults are confounded by frequent comorbidity with other conditions and by retrospective diagnosis of childhood ADD/ADHD. Research studies of pharmacologic interventions do not indicate a clear pattern of efficacy and safety for any drug class. Pharmacologic treatment of adults with ADD/ADHD is often guided by clinical experience. Efficacy of treatment with medications may be related to specific subpopulations among adults with ADD/ADHD. No controlled studies of the clinical efficacy of nonpharmacologic treatment have been done, but clinical experience suggests that counseling to assist with organizational skills and interpersonal relationships may be helpful. Adults who present with problems that include impulsivity, distractibility, impaired interpersonal relationships and significant discrepancies between intellectual ability and work performance should have adult ADD/ADHD as part of their differential diagnosis. A cautious approach to pharmacological management and referral to counselors who have experience with adult ADD/ADHD is advised.