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

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Abstract

Background

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.

Methods

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.

Results

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?

Conclusions

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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Most cited references 283

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The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

Stephen V Faraone, Joseph Biederman, Eric Mick (2006)

This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood. We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD. When we define only those meeting full criteria for ADHD as having 'persistent ADHD', the rate of persistence is low, approximately 15% at age 25 years. But when we include cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence is much higher, approximately 65%. Our results show that estimates of ADHD's persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.

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Molecular genetics of attention-deficit/hyperactivity disorder.

Stephen V. Faraone, Roy H Perlis, Alysa E Doyle … (2005)

Results of behavioral genetic and molecular genetic studies have converged to suggest that both genetic and nongenetic factors contribute to the development of attention-deficit/hyperactivity disorder (ADHD). We review this literature, with a particular emphasis on molecular genetic studies. Family, twin, and adoption studies provide compelling evidence that genes play a strong role in mediating susceptibility to ADHD. This fact is most clearly seen in the 20 extant twin studies, which estimate the heritability of ADHD to be .76. Molecular genetic studies suggest that the genetic architecture of ADHD is complex. The few genome-wide scans conducted thus far are not conclusive. In contrast, the many candidate gene studies of ADHD have produced substantial evidence implicating several genes in the etiology of the disorder. For the eight genes for which the same variant has been studied in three or more case-control or family-based studies, seven show statistically significant evidence of association with ADHD on the basis of the pooled odds ratio across studies: DRD4, DRD5, DAT, DBH, 5-HTT, HTR1B, and SNAP-25.

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Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis.

Viktória Simon, Pál Czobor, Sára Bálint … (2009)

In spite of the growing literature about adult attention-deficit hyperactivity disorder (ADHD), relatively little is known about the prevalence and correlates of this disorder. To estimate the prevalence of adult ADHD and to identify its demographic correlates using meta-regression analysis. We used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications. The pooled prevalence of adult ADHD was 2.5% (95% CI 2.1-3.1). Gender and mean age, interacting with each other, were significantly related to prevalence of ADHD. Meta-regression analysis indicated that the proportion of participants with ADHD decreased with age when men and women were equally represented in the sample. Prevalence of ADHD in adults declines with age in the general population. We think, however, that the unclear validity of DSM-IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central

ISSN (Electronic): 1471-244X

Publication date Collection: 2010

Publication date (Electronic): 3 September 2010

Volume: 10

Page: 67

Affiliations

[1 ]PsyQ, psycho medische programma's, Department Adult ADHD, Carel Reinierszkade 197, Den Haag, The Netherlands

[2 ]Department of Clinical Neuroscience, Karolinksa Institutet, Section Psychiatry, St. Goran, Stockholm, Sweden

[3 ]University Department of Psychiatry, Addenbrookes Hospital, Cambridge, UK

[4 ]Pediatric Department, Hôpitaux Pédiatriques CHU-Lenval, 06200 Nice, France

[5 ]Servicio de Psiquiatria, Hospital Universitari Vall d' Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain

[6 ]Reinier van Arkel Groep, Postbus 70058, 5201 DZ 's-Hertogenbosch, The Netherlands

[7 ]Department of Neuroscience/Psychiatri Ulleråker, MK 75, S-750 17 Uppsala, Sweden

[8 ]Institute of Development, Research, Advocacy and Applied Care (IDRAAC), Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, Balamand University, Beirut, Lebanon

[9 ]Centre des Consultations, Institut A Tzanck, Mougins, France

[10 ]Department of Psychiatry, Trinity College Dublin (TCD), Dublin 2, Ireland

[11 ]Clinique des Maladies Mentales et de l'Encéphale (CMME), Sainte Anne Hospital Paris, France

[12 ]Affektiva mottagningen, M 59, Psykiatri Sydväst, 141 86 Stockholm, Sweden

[13 ]Département de Psychiatrie Adulte, Unité Lescure, CH Charles Perrens, Bordeaux, France

[14 ]Private clinic for psychiatry and psychotherapy, 11a Schillerstrasse, Ottobrunn, Germany

[15 ]Department of Child Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway

[16 ]Geha Mental Health Center, Petach-Tiqva, Sackler Faculty of Medicine, Tel-Aviv University, Israel

[17 ]Department of Child Psychiatry, Regional Hospital of Bolzano, Via Guncina, Bolzano, Italy

[18 ]Faculty of Medical Sciences, New University of Lisbon, Campo dos Mártires da Pátria, 1169-056 Lisboa, Portugal

[19 ]Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany

[20 ]Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium

[21 ]Department of Neurosciences, Florence University, Florence, Italy

[22 ]Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece

[23 ]Programa Integral del Déficit de Atención en el Adulto (P.I.D.A.A), Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, Barcelona, Spain

[24 ]Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Lund University, Sweden

[25 ]Johanniterstraße 1, CH-3047 Bremgarten, Bern, Switzerland

[26 ]ADHD Program, University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium

[27 ]MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Kings College London, London, UK

Article

Publisher ID: 1471-244X-10-67

DOI: 10.1186/1471-244X-10-67

PMC ID: 2942810

PubMed ID: 20815868

SO-VID: 6b4feed6-0d91-4d1f-ae54-202d3333fb7b

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 4 May 2010

Date accepted : 3 September 2010

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

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Most cited references 283

The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

Molecular genetics of attention-deficit/hyperactivity disorder.

Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis.

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