An editorial in the January 2007 issue of the British Journal of
Psychiatry strongly recommends that general adult psychiatrists
should diagnose and treat attention-deficit hyperactivity disorder
(ADHD) in adults appropriately with stimulant drugs.
ADHD is a common disorder affecting children and adults, and is
a predictor of adult mental health problems.
Symptoms include high levels of inattentiveness, impulsiveness
and restless overactivity, and are regarded as a source of
disability in children and adolescents, as well as a risk to adult
psychological adjustment.
Although ADHD can be effectively treated with stimulant
medication, and such treatment is widespread in the young, general
adult psychiatry has not yet followed suit in identifying and
treating substantial numbers of affected people.
Young people are entering adult life whilst still receiving
medication for ADHD, and adult psychiatrists are needed to take
over treatment when symptoms persist. Moreover, some adult patients
with ADHD may be misdiagnosed and ineffectively treated for other
disorders, such as depression and personality disorder.
Research suggests that between 15% and 65% of children diagnosed
with ADHD still have symptoms of the disorder in adulthood.
However, many children with ADHD go unrecognised, and may be
diagnosed in adulthood for the first time.
A survey of schoolchildren with ADHD in the London Borough of
Newham found that although levels of restless activity diminished
between the ages of 7 and 17, the 17-year-olds showed a level of
hyperactivity similar to that found in a group of normal
7-year-olds.
When the same people were followed up at the age of 26, they
were found to have disabilities associated with high levels of
psychiatric disorder, which were all the more significant because
of increasing demands in adult life for self-organisation and the
ability to plan ahead.
Adult behaviours linked to ADHD are associated with the
childhood symptoms of motor hyperactivity, attention deficit,
unfocused thinking, mood changes, disorganisation and
impulsiveness.
They include – at the severe end of the spectrum - feelings of
restlessness, difficulty in relaxing, feeling depressed when
inactive, lack of concentration on detail, depression or
excitability, poor time management, difficulties sustaining
relationships and a tendency to make rapid and facile decisions
without full analysis of the situation.
Psychiatrists diagnosing ADHD in adults need to be aware of the
fact that people with this disorder often show decreased symptoms
in a novel situation like a psychiatric evaluation. It is therefore
important to base mental state evaluations on a typical week and a
variety of normal situations.
Mood instability is very common in adult ADHD, and can lead to
diagnoses of depression or personality disorder. Many adults with
ADHD also have other problems, such as antisocial personality,
alcohol and drug misuse, anxiety disorders and learning
difficulties. ADHD in childhood may also lead to the development of
antisocial behaviour.
Some symptoms of adult ADHD are similar to those of bipolar
disorder, but ADHD tends to show a persisting trait of irritability
and volatility, very different from the grandiose and euphoric
symptoms of mania and the depression found in bipolar disorder.
Adults with untreated ADHD use more healthcare resources because
of smoking-related disorders, increased rates of serious accidents,
and alcohol and drug misuse. Further research is needed to quantify
the contribution of ADHD to psychiatric disorders in adulthood.