The prevalence of ADHD in the childhood and adolescent population is between 8-15% and the prevalence of adult ADHD is approximately 4%.
ADHD has a classic triad cluster of symptoms including inattention, restlessness, and impulsivity. There are two subtypes of ADHD including hyperactive type and inattentive type. Most often, adults present with the inattentive type even if they had symptoms of hyperactivity as children.
The diagnosis of adult ADHD can be challenging since many other psychiatric and medical illnesses can mimic many of the same symptoms such as anxiety, depression, bipolar, dementia, seizures, post chemotherapy, traumatic brain injury, substance abuse and side effects of medications.
Many experts believe that in order to officially have a diagnosis of ADHD, one must have symptoms starting prior to 7 years old; however, many research studies have demonstrated that adults with ADHD are often poor historians and underreport their symptoms from childhood. Thus, it is helpful to get a report from someone who knew the patient during childhood.
The diagnosis of ADHD is determined based upon a cluster of symptoms from the DSM-IVR.
Here is a useful link for screening your patient for ADHD:
The patient must have 6 out of 9 of the following:
- Organization Difficulty
- Losses things frequently
- Leaves tasks unfinished
- Poor focus
- Easily distracted
- Difficulty listening
- Easily forgetful
- Careless Mistakes
- Avoids tasks that require concentration
and 6 out of 9 of the following:
- Talks excessively
- Blurts out answers
- Interrupts frequently
- Can play or work quietly
- Leaves one’s seat
- Always on the go
- Can’t wait his/her turn
The mainstay of treatment for adult ADHD is stimulants and Straterra, a non-stimulant. Only Straterra is FDA approved for adult ADHD.
The medicines that I most often use in my practice are Ritalin (methylphenidate) and the mixed amphetamine salt, Adderall. Ritalin is effective for 3-4 hours and often requires bid dosing. Thus, one of the longer acting agents such as Ritalin LA, Metatdate CD or Concerta or commonly prescribed. I often will start a patient at 5 mg once a day and titrate up to 20 mg bid as tolerated.
Adderall’s duration is also 3-4 hours; however, many clinicians have noticed that it’s effective activity is moderately longer and that some patients only require once a day dosing. I often start a patient at 5 mg of Adderall once and titrate up to 10 mg bid as tolerated.