Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

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European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

Context Prospective studies of childhood attention-deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. Objective To examine whether children diagnosed as having ADHD at a mean age of 8 years (probands) have worse educational, occupational, economic, social, and marital outcomes and higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance use disorders (SUDs), adult-onset psychiatric disorders, psychiatric hospitalizations, and incarcerations than non-ADHD comparison participants at a mean age of 41 years. Design Prospective, 33-year follow-up study, with masked clinical assessments. Setting Research clinic. Participants A total of 135 white men with ADHD in childhood, free of conduct disorder, and 136 men without childhood ADHD (65.2% and 76.4% of original cohort, respectively). Main Outcome Measures Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations; and incarcerations. Results Probands had significantly worse educational, occupational, economic, and social outcomes; more divorces; and higher rates of ongoing ADHD (22.2% vs 5.1%, P  Conclusions The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/1378851/yoa120020_1295_1303.pdf

Clinical and Functional Outcome of Childhood Attention-Deficit/Hyperactivity Disorder 33 Years Later

A meta-analysis evaluating the effects of school-based interventions for students with attention deficit hyperactivity disorder was conducted by examining 60 outcome studies between 1996 and 2010 t...

The Effects of School-Based Interventions for Attention Deficit Hyperactivity Disorder: A Meta-Analysis 1996-2010.

The adult form of attention deficit/hyperactivity disorder (aADHD) has a prevalence of up to 5% and is the most severe long-term outcome of this common neurodevelopmental disorder. Family studies in clinical samples suggest an increased familial liability for aADHD compared with childhood ADHD (cADHD), whereas twin studies based on self-rated symptoms in adult population samples show moderate heritability estimates of 30–40%. However, using multiple sources of information, the heritability of clinically diagnosed aADHD and cADHD is very similar. Results of candidate gene as well as genome-wide molecular genetic studies in aADHD samples implicate some of the same genes involved in ADHD in children, although in some cases different alleles and different genes may be responsible for adult versus childhood ADHD. Linkage studies have been successful in identifying loci for aADHD and led to the identification of LPHN3 and CDH13 as novel genes associated with ADHD across the lifespan. In addition, studies of rare genetic variants have identified probable causative mutations for aADHD. Use of endophenotypes based on neuropsychology and neuroimaging, as well as next-generation genome analysis and improved statistical and bioinformatic analysis methods hold the promise of identifying additional genetic variants involved in disease etiology. Large, international collaborations have paved the way for well-powered studies. Progress in identifying aADHD risk genes may provide us with tools for the prediction of disease progression in the clinic and better treatment, and ultimately may help to prevent persistence of ADHD into adulthood.

/pdf/the-genetics-of-attention-deficit-hyperactivity-disorder-in-32k8fhbczi.pdf

The genetics of attention deficit/hyperactivity disorder in adults, a review

Hyperactivity in children, or attention deficit hyperactivity disorder (ADHD), is associated with impairments in various major life activities by adulthood, particularly occupational functioning. ADHD appears to involve deficits in executive functioning (EF). Prior studies have not examined the contribution of these deficits to adult impairment generally and occupational adjustment specifically in longitudinal studies of hyperactive/ADHD children. We did so assessing EF by both self-report and tests and using self and other-rated impairment in 10 domains of major life activities and 12 measures of occupational impairment. We studied hyperactive (H; N = 135) and community control children (C; N = 75) followed to adulthood (mean age 27 years). The H cases were subdivided into those whose ADHD did (ADHD-P) and did not persist (ADHD-NP) using modified DSM-IV criteria. Self-reported EF deficits were more severe on all five EF scales in the ADHD-P than both the ADHD-NP and C groups and on three scales in the ADHD-NP compared to C groups. Most ADHD-P cases fell in the clinically impaired range on self-reported EF as did a substantial minority of ADHD-NP cases but few were so classified on the EF tests. Impairments in occupational functioning were predicted by the EF ratings to a greater degree than by the EF tests. Most EF tests were unrelated to work history with the exception of the Five-Points Test. We conclude that EF ratings are better predictors of impairment in major life activities generally and occupational functioning specifically at adult follow-up than are EF tests. We hypothesize that this paradox arises from each method assessing different levels of a hierarchically organized EF meta-construct briefly discussed herein.

Predicting impairment in major life activities and occupational functioning in hyperactive children as adults: self-reported executive function (EF) deficits versus EF tests.

Justin J. Trevino

Papers

ADHD in Adults: What the Science Says

Rationality and Compulsion: Applying Action Theory to Psychiatry

Psychiatric Interviewing and Assessment