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Attention Deficit Disorder in Adults
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Attention Deficit Disorder in Adults
, Adult ADHD, ADHD in Adults, Adult Attention Deficit Disorder
See Also
Attention Deficit Disorder in Children
School Problem Evaluation
ADHD Diagnosis
ADHD Differential Diagnosis
ADHD Comorbid Conditions
ADHD Non-Pharmacologic Management
ADHD Medication
s
Dextroamphetamine
(
Dexedrine
,
Dextrostat
,
Adderall
) or
Lisdexamfetamine
(
Vyvanse
)
Methylphenidate
(
Ritalin
,
Methylin
,
Concerta
)
Atomoxetine
(
Strattera
)
Epidemiology
Attention Deficit Disorder
of childhood continues into adulthood in up to 30% of cases
Differential Diagnosis
Decreased attentiveness
See
ADHD Differential Diagnosis
Hearing Impairment
Thyroid
disorders
Liver
disease
Sleep Apnea
Drug Interaction
s
Mental health conditions
Anxiety Disorder
Major Depression
Bipolar Disorder
Obsessive Compulsive Disorder
Substance Abuse
Personality Disorder
(
Antisocial Personality
,
Borderline Personality
)
Learning Disorder
s
Intellectual Disability
Medication adverse effects
Corticosteroid
s
Antihistamine
s
Anticonvulsants
Caffeine
Nicotine
Contraindications
Stimulants
Hypertension
Tachycardia
Arrhythmia
Psychosis
Bipolar Disorder
Severe
Anorexia
Tourette Syndrome
Precautions
Stimulant safety in adults
Stimulant Use
in adults with comorbid heart disease
Sudden death events are reported at standard stimulant doses in adults and children
Wigal (2009) CNS Drugs 23(suppl 1): 21-31 [PubMed]
Large trials have demonstrated overall safety in adults without increased cardiovascular events or sudden death
Habel (2011) JAMA 306(24): 2673-8 [PubMed]
Stimulant Diversion and Abuse
Stimulant Abuse
Overall
Stimulant Abuse
rate in adults: 2%
Stimulant Abuse
by adults aged 18 to 25 years: 4-6%
Novak (2007) Subst Abuse Treat Prev Policy 2:32 [PubMed]
Diversion (giving or selling medications to others)
College student rate of use of non-prescribed stimulants: 8%
Evaluation
See
Attention Deficit Disorder
regarding history questions
Evaluate for contraindications to
Stimulant Medication
s
Vital Sign
s
Blood Pressure
(evaluate for
Hypertension
)
Heart Rate
(evaluate for
Tachycardia
)
Electrocardiogram
Evaluate for
Arrhythmia
Variable recommendations as to whether to obtain
Electrocardiogram
prior to starting
Stimulant Medication
Diagnosis
See
ADHD Diagnosis
Proposed changes to upcoming DSM-V for diagnosis of ADHD in Adults
Onset of observed
ADHD
symptoms by age 12 years (instead of current cirteria of age 7 years)
Four diagnostic criteria positive in either Inattention or Hyperactive categories (instead of current 6 criteria required)
Diagnostic tools
Adult ADHD Self-Report Scale SymptomChecklist v1.1 (ASRS)
https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf
Associated Conditions
See
ADHD Comorbid Conditions
Management
Same management and medications apply to adults as they do in children
See
ADHD Management
See
ADHD Medication
Consider
Cognitive Behavioral Therapy
for adults with
ADHD
Young (2020) J Atten Disord 24(6): 875-88 [PubMed]
Prevention
Stimulant Diversion and Abuse
Initiate
Controlled Substance Agreement
(contract)
Implement random drug screening
Regular follow-up visits (e.g. every 6 months)
References
Post (2012) Am Fam Physician 85(9):890-896 [PubMed]
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