ABSTRACT
AIM: To update the existing knowledge about attention deficit hyperactivity disorder (ADHD) in adults, with special interest given to aspects concerning epidemiology, diagnosis, progression and treatment. DEVELOPMENT: Acknowledging the fact that ADHD can persist into adulthood is a relatively recent development. Nevertheless, over the last few years evidence has been put forward to support the validity of its diagnosis in adults. The prevalence of ADHD in the general adult population is estimated to be around 4%. Over 50% of the children with the disorder will continue to have it as adults. The symptoms of ADHD can be different in adults, with less hyperactivity and a slight decrease in impulsiveness, but with the same symptoms of inattention. ADHD in adulthood is linked to serious economic, occupational, academic and familial repercussions, as well as to road accidents and to the presence of other psychiatric pathologies (such as drug addiction, personality disorders and depression). CONCLUSIONS: A number of different psychometric instruments are available in Spanish for evaluating ADHD in adults. The use of structured interviews, together with a systemized evaluation of possible comorbid disorders, makes it easier to reach a correct differential diagnostic. Pharmacological treatment in adults is essentially the same as that used with children, but weight-adjusted. Clinical trials have been carried out with psychostimulants and results show methylphenidate to be the most effective and the safest. Atomoxetine is the non-stimulating pharmaceutical that has been most widely studied in adults. Cognitive behavioural psychological treatments have proved to be effective in adults with ADHD.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/physiopathology , Adrenergic Uptake Inhibitors/therapeutic use , Adult , Atomoxetine Hydrochloride , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/epidemiology , Central Nervous System Stimulants/therapeutic use , Child , Comorbidity , Humans , Methylphenidate/therapeutic use , Neuropsychological Tests , Propylamines/therapeutic useABSTRACT
Objetivo. Actualizar los conocimientos existentes sobreel trastorno por déficit de atención con hiperactividad (TDAH) enadultos, centrándose en aspectos relativos a la epidemiología, diagnóstico,evolución y tratamiento. Desarrollo. El reconocimiento dela persistencia del TDAH en la edad adulta es relativamente reciente.A pesar de ello, durante los últimos años se han aportadoevidencias que sustentan la validez del diagnóstico en adultos. Laprevalencia del TDAH en la población general adulta se estima entorno al 4%. Más del 50% de niños afectados continuarán presentandoel trastorno en la edad adulta. Los síntomas del TDAH puedenmanifestarse de diferente forma en los adultos, mostrandomenor hiperactividad y una leve disminución de la impulsividadpero manteniéndose los síntomas de inatención. El TDAH en laedad adulta se asocia a graves repercusiones económicas, laborales,académicas, familiares, así como a accidentes de tráfico y a lapresencia de otras patologías psiquiátricas (como drogodependencias,trastornos de personalidad y depresión). Conclusiones. Se disponede diferentes instrumentos psicométricos en español paraevaluar el TDAH en adultos. El empleo de entrevistas estructuradas,así como una evaluación sistematizada de los posibles trastornoscomórbidos, facilitarán el correcto diagnóstico diferencial. Eltratamiento farmacológico en adultos es esencialmente el mismoque en niños, pero adaptado al peso. Existen ensayos clínicos conpsicoestimulantes, destacando el metilfenidato por su eficacia y seguridad.Dentro del grupo de fármacos no estimulantes, la atomoxetinaes el mejor estudiado en adultos. Los tratamientos psicológicoscognitivoconductuales se han mostrado eficaces en adultoscon TDAH
Aim. To update the existing knowledge about attention deficit hyperactivity disorder (ADHD) in adults, withspecial interest given to aspects concerning epidemiology, diagnosis, progression and treatment. Development. Acknowledgingthe fact that ADHD can persist into adulthood is a relatively recent development. Nevertheless, over the last few yearsevidence has been put forward to support the validity of its diagnosis in adults. The prevalence of ADHD in the general adultpopulation is estimated to be around 4%. Over 50% of the children with the disorder will continue to have it as adults. Thesymptoms of ADHD can be different in adults, with less hyperactivity and a slight decrease in impulsiveness, but with thesame symptoms of inattention. ADHD in adulthood is linked to serious economic, occupational, academic and familialrepercussions, as well as to road accidents and to the presence of other psychiatric pathologies (such as drug addiction,personality disorders and depression). Conclusions. A number of different psychometric instruments are available in Spanishfor evaluating ADHD in adults. The use of structured interviews, together with a systemised evaluation of possible comorbiddisorders, makes it easier to reach a correct differential diagnostic. Pharmacological treatment in adults is essentially thesame as that used with children, but weight-adjusted. Clinical trials have been carried out with psychostimulants and resultsshow methylphenidate to be the most effective and the safest. Atomoxetine is the non-stimulating pharmaceutical that has beenmost widely studied in adults. Cognitive behavioural psychological treatments have proved to be effective in adults with ADHD