ADHD across the lifespan

Abstract

Attention-deficit hyperactivity disorder (ADHD) is a common condition with neurodevelopmental origins that typically starts in early childhood and follows a persistent trait-like course. It is characterized by inattention, impulsivity and hyperactivity that persist over time and lead to clinical and psychosocial impairments. Emotional instability is a common feature and sometimes the main presenting complaint. Neurodevelopmental and psychiatric co-morbidities are common. ADHD can be diagnosed and treated at all ages, and persists into adulthood in around two-thirds of individuals. Many adults with ADHD were not diagnosed as children. Psycho-education and environmental adaptations are recommended in all cases. If significant impairment remains in at least one domain after implementation and a review of environmental modifications, pharmacological treatments are recommended. Drug treatments are similar at all ages. Methylphenidate is the recommended first-line drug in children and adolescents. If ineffective or not tolerated, lisdexamfetamine is recommended as second-line treatment, followed by atomoxetine and guanfacine. In adults, lisdexamfetamine or methylphenidate is recommended as first-line treatment, followed by atomoxetine. Atomoxetine can be used as first line when there are concerns with potential drug abuse or diversion, or high levels of co-morbid anxiety. ADHD-focused groups should be offered if significant impairment remains after drug treatment.