Elsevier

Disease-a-Month

Volume 53, Issue 2, February 2007, Pages 70-131
Disease-a-Month

Attention Deficit Hyperactivity Disorder Across the Lifespan: The Child, Adolescent, and Adult

https://doi.org/10.1016/j.disamonth.2007.01.001Get rights and content

Management of a child, adolescent, college student, or adult with ADD/ADHD (ADHD) is reviewed with emphasis on pharmacologic approaches in the adult. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants (psychostimulants), antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Psychopharmacology approved and/or used in pediatric patients are also used in adults with ADHD, though most are not officially FDA-approved. It is emphasized that ADHD management should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient of any age, and judicious use of medications. Such an approach is recommended to benefit those with ADHD achieve their maximum potential across the human life span.

Introduction

Features of attention deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD) were first identified in children in the 19th century. Heinrich Hoffman was a German physician and medical writer/illustrator who, in 1854, wrote about a young child, Fidgety Phillip, who had traits of what is now called ADHD.1 It was described over a century ago as a disorder of children in which there was unruly behavior and hyperactivity, mainly noted in boys.2 Attention dysfunction and conduct disorder-like behavior were noted in children diagnosed with encephalitis lethargica (Von Economo’s Disease) between 1916 and 1927.3 The pathophysiology was felt to be encephalitis with subsequent brain damage. A group of children were identified with these same symptoms, but without overt encephalitis; eventually they were diagnosed with minimum brain damage or dysfunction.4 Other terms for ADHD in the 20th century included the hyperkinetic syndrome and hyperactive reaction of childhood.5, 6 In this discussion, the term ADHD (attention-deficit/hyperactivity disorder) is used and refers to both ADD and AHDH.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) of 1980 classified this disorder as ADD and ADHD.1 The DSM-IIIR of 1987 noted that adults may have ADD/ADHD. The 1994 DSM-IV and the 2000 DSM-IV-TR continued with this terminology with the caveat that ADD/ADHD begins in childhood.7 The concept that ADHD can occur in adults who can benefit from ADHD medication was first noted in the literature in 1976.8

ADHD is noted in 3 to 9% of children and adolescents by American research, three times more commonly in males than females; it is noted in 3 to 5% of adults with equal male-to-female ratios if the diagnostic criteria are based on the American Psychiatric Association’s DSM.7, 9, 10, 11 Clinicians in European countries use criteria based on the International Classification of Diseases, use the term attention-deficit/hyperkinetic disorder, and estimate a much lower prevalence for ADHD vs AHDH.10 However, various studies from different countries using similar diagnostic criteria confirm the widespread prevalence of AHDH.12, 13 In 2006, 5 million individuals in the United States were prescribed psychostimulant medication, 3.5 million between ages 3 and 19 years, and 1.5 million between ages 20 and 64 years.14

Section snippets

ADHD: The Child and Adolescent

ADHD is a neurobehavioral disorder with abnormalities in various neurotransmitter systems, including noradrenergic, serotonergic, and dopaminergic.14, 15, 16, 17 There are various degrees of attention dysfunction, impulsivity, and hyperactivity that interfere with day-to-day functioning. Neuroimaging (ie, PET scans) and genetic studies suggest that ADHD is a neurobiological disorder involving neurotransmitter dysfunction in various parts of the central nervous system, especially dopamine

ADHD in the College Student

College students may present with major problems in concentration leading to reduced grades and considerable anxiety over an inability to deal with academic pressures.116 A careful evaluation may reveal ADHD with or without other disorders (TABLE 1, TABLE 2). One must decide whether to treat the co-morbid condition or the ADHD primarily, although each must be treated in some manner. Management includes helping the student understand the ADHD diagnosis, ensure the best academic milieu, arrange

Adult ADHD

Current estimates suggest about half of childhood ADHD continues into adulthood, and a prevalence of approximately 3 to 5% is found in adults over age 20.11, 153, 154, 155, 156 It is important to understand that ADD/ADHD can not only cause major disruption in the lives of children, but also that of adults as well.157, 158, 159 Indeed, ADD/ADHD is not only a pediatric disorder, but a neurobiological disorder across the lifespan. It is not a “pediatric” disease only, but a condition that impacts

Summary

ADHD is a complex and controversial neurobehavioral disorder that affects humans across a life span.3, 12, 154, 156, 209, 210Table 34 provides a summary of the authors’ guidelines for management in adults. Clinicians should work with other local colleagues who can help with a comprehensive neuropsychiatric and psychological evaluation as well as management options. Most adults with ADHD can achieve some benefit from medication (ie, psychostimulants, antidepressants, or atomoxotine).

References (210)

  • F.X. Castellanos et al.

    Controlled stimulant treatment of ADHD and comorbid Tourette’s syndrome: Effects of stimulant and dose

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • S.F. Law et al.

    Do typical doses of methylphenidate cause tics in children treated for attention-deficit hyperactivity disorder?

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • P.B. Chappell et al.

    Guanfacine treatment of comorbid attention-deficit/hyperactivity disorder and Tourette’s syndrome: preliminary clinical experience

    J Am Acad Child Adolesc Psychiatry

    (1995)
  • R. Steingard et al.

    Comparison of clonidine response in the treatment of attention-deficit hyperactivity disorder with and without comorbid tic disorders

    J Amer Acad Child Adolesc Psychiatry

    (1993)
  • T. Spencer et al.

    Attention-deficit/hyperactivity disorder and comorbidity

    Pediatr Clin North Am

    (1999)
  • D.C. Lin-Dyken et al.

    Attention deficit hyperactivity disorder

  • G. Still

    The Coulstonian lectures on some abnormal physical conditions in childrenLecture 1

    Lancet

    (1902)
  • L.A. Adler et al.

    Management of ADHD in adults

    J Clin Psychiatry

    (2002)
  • S.D. Clements

    Minimal Brain Dysfunction in Children: Terminology and Identification

    (1966)
  • C. Ounsted

    The hyperkinetic syndrome in epileptic children

    Lancet

    (1955)
  • W.W. Dodson

    Pharmacotherapy of adult ADHD

    JCLP/In Session

    (2005)
  • D.R. Wood et al.

    Diagnosis and treatment of minimum brain dysfunction in adults

    Arch Gen Psychiatry

    (1976)
  • T.E. Wilens et al.

    A review of pharmacotherapy of adults with attention-deficit/hyperactivity disorder

    J Atten Dis

    (2002)
  • S.V. Faraone et al.

    The worldwide prevalence of ADHD: is it an American condition?

    World Psychiatry

    (2003)
  • R.C. Kessler et al.

    The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication

    Am J Psychiatry

    (2006)
  • S. Katragadda et al.

    ADHD in children, adolescents, and adults

    Prim Care Clin Office Pract

    (2007)
  • D.E. Greydanus et al.

    Attention deficit hyperactivity disorder

  • R. Pary et al.

    Attention deficit disorder in adults

    Ann Clin Psychiatry

    (2002)
  • D.E. Greydanus et al.

    Attention deficit/hyperactivity disorder in adolescents

  • S.V. Faraone et al.

    Candidate gene studies of attention-deficit/hyperactivity disorder

    J Clin Psychiatry

    (2006)
  • M.L. Wolraich et al.
  • E. MacDonald et al.

    Behavioral assessment

  • M.A. Larsen et al.

    Psychometric testing

  • Attention Deficit Hyperactivity Disorder

    (2001)
  • NIMH Research on Treatment for Attention Deficit Hyperactivity Disorder (ADHD): The Multimodal Treatment Study: Questions and Answers

    (2000)
  • National Institute of Health (NIH). Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. NIH Consensus...
  • C.K. Whalen et al.

    Therapies for hyperactive children: Comparisons, combinations, and compromises

    J Consult Clin Psychol

    (1991)
  • W.E. Pelham et al.

    Effects of methyphenidate and expectancy on children with ADHD: behavior, academic performance, and attributions in a summer treatment program and regular classroom settings

    J Consult Clin Psychol

    (2002)
  • Reuters Health. ADHD: Kids with Attention Problems More Likely to Wet Bed

    (2002)
  • Attention Deficit Hyperactivity Disorder

    (1999)
  • S.P. Hinshaw

    Academic underachievement, attention deficits, and aggression: comorbidity and implications for intervention

    J Consult Clin Psychol

    (1992)
  • K.C. Wells et al.

    Parenting and family stress treatment outcomes in attention deficit hyperactivity disorder (ADHD): an empirical analysis in the MTA study

    J Abnorm Child Psychol

    (2000)
  • K.C. Wells et al.

    Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation

    J Abnorm Child Psychol

    (2000)
  • D.E. Greydanus et al.

    Psychopharmacology of ADHD in adolescents

    Adolesc Med

    (2002)
  • D.E. Greydanus

    Psychopharmacology of ADHD in adolescents: Quo vadis?

    Psychiatr Times

    (2003)
  • D.E. Greydanus et al.

    Attention deficit hyperactivity disorder

  • L.L. Greenhill

    The science of stimulant abuse

    Pediatr Ann

    (2006)
  • C. Bradley

    The behavior of children receiving benzedrine

    Am J Psychiatry

    (1937)
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