In This Article Attention-Deficit/Hyperactivity Disorder (ADHD) In Adults

  • Introduction
  • General Overviews
  • Historical Roots and Seminal Studies
  • Prevalence
  • Persistence from Childhood
  • Sex Differences
  • Ethnicity and Culture
  • Clinical Resources and Materials
  • Psychoeducation for Patients

Psychology Attention-Deficit/Hyperactivity Disorder (ADHD) In Adults
by
Will H. Canu, John T. Mitchell
  • LAST REVIEWED: 08 May 2015
  • LAST MODIFIED: 21 November 2012
  • DOI: 10.1093/obo/9780199828340-0070

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable, heterogeneous, and relatively common psychological disorder that originates in childhood and, for many affected individuals, continues to cause substantial functional impairment into adulthood. The prevalence of this disorder in childhood was estimated by the Centers for Disease Control and Prevention in 2009 to be approximately 8 percent in the United States, with evidence showing more consistency than divergence from this rate in other regions worldwide. Three ADHD types are currently established by the American Psychiatric Association: Predominantly Hyperactive-Impulsive, Predominantly Inattentive, and Combined (i.e., prominent symptoms of both hyperactivity-impulsivity and inattention). Extensive research in child and adolescent populations has established that the hallmark symptoms that are broadly characterized by cognitive, behavioral, and emotional disinhibition tend to be associated with impairment in school, at home, in extracurricular activities, in relationships with peers and family members, and in other important endeavors (e.g., maintaining personal safety). Adding to the heterogeneity of the disorder, comorbidity with other psychological syndromes is common in clinical populations, with disruptive behavior (e.g., oppositional defiant disorder, conduct disorder), mood, anxiety, tic, and substance use disorders most frequently co-occurring. The term “adult ADHD” has been used somewhat loosely, seeming to refer in different contexts to one or more of the three following groups: (1) those who are diagnosed with ADHD in childhood whose related symptoms continue into adulthood to such an extent that functional impairment persists; (2) individuals who are not diagnosed in childhood yet exhibited signs of the disorder from an early age and present for assessment and intervention in adulthood due to increased task demands that result in impairment; and (3) persons who only begin to evince symptoms and impairment related to ADHD in adulthood. While research has demonstrated that presentation of bona fide ADHD symptoms may occur as late as early-to-middle adolescence, the current consensus among researchers in the field seems to argue against the existence of this latter group. In other words, it is virtually always the case that clear signs of ADHD at some point in childhood are at least retrospectively apparent in cases that merit a clinical diagnosis, and where such data is not present it is likely that a given individual is suffering from another condition that mimics ADHD symptoms or is malingering. For decades, ADHD was widely considered—by professionals and the public alike—to be confined to childhood and adolescence, and only after long-term, longitudinal studies concluded in the 1980s and 1990s that functional impairment commonly persisted in ADHD probands did substantial focus turn to affected adults. Despite this decades-long delay, research on the adult manifestation of ADHD is burgeoning, and broadly indicates that many of those affected in childhood continue to suffer deleterious outcomes in educational, professional, occupational, and relational domains of life. What follows is a brief primer on the related research; the reader seeking genuine expertise regarding ADHD in adulthood is encouraged to use these resources as a springboard to other, more extensive material.

General Overviews

Several resources that provide a broad overview of issues related to adult ADHD exist. These range from fairly high-level (e.g., Manos 2010; Spencer, et al. 2007) to in-depth (e.g., Barkley, et al. 2008). Of particular note is Barkley, et al. 2008, which comprehensively incorporates the existing adult ADHD literature into the reporting of results from two important longitudinal studies conducted by the authors in Milwaukee and Massachusetts. It is worth mentioning that Davidson 2008 focuses not only on the state of knowledge regarding the manifestation of ADHD in adults but also the efficacy of treatments and assessment for this population. The perspective of Kooij, et al. 2010 is particularly informative as it is representative of the growing worldwide agreement regarding the validity and characteristics of adult ADHD.

  • Barkley, R. A., K. R. Murphy, and M. Fischer. 2008. ADHD in adults: What the science says. New York: Guilford.

    E-mail Citation »

    An all-around excellent resource examining the broad issues related to adult ADHD, including the presentation of groundbreaking longitudinal research.

  • Davidson, M. A. 2008. ADHD in adults: A review of the literature. Journal of Attention Disorders 11:628–641.

    DOI: 10.1177/1087054707310878E-mail Citation »

    A brief review focusing on diagnostic issues, assessment methods, and treatment of ADHD in adults.

  • Kooij, S. J. J., S. Begerot, A. Blackwell, et al. 2010. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 10:1–24.

    DOI: 10.1186/1471-244X-10-67E-mail Citation »

    A thorough review of the clinical presentation, diagnostic issues, and treatment issues related to the adult ADHD population; this perspective from outside of the United States helps demonstrate the commonalities across Western countries.

  • Manos, M. J. 2010. Nuances of assessment and treatment of ADHD in adults: A guide for psychologists. Professional Psychology: Research and Practice 41:511–517.

    DOI: 10.1037/a0021476E-mail Citation »

    This resource aimed at mental health practitioners describes typical symptomatic differences in adults versus children, comorbidity considerations, and special approaches to treating affected adults.

  • Spencer, T. J., J. Biederman, and E. Mick. 2007. Attention-deficit/hyperactivity disorder: Diagnosis, lifespan, comorbidities, and neurobiology. Journal of Pediatric Psychology 32:631–642.

    DOI: 10.1093/jpepsy/jsm005E-mail Citation »

    Etiology, course, comorbidity, evidence for validity of the disorder in adulthood, and the need for better, developmentally appropriate diagnostic criteria for adults are among the topics that receive attention in this brief review.

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