Table 1

Summary of key points from the consensus statement

Neurobiological and environmental background

• Anomalies in brain functioning identified in case control studies of cognitive, electrophysiological and neuroimaging studies, and the effectiveness of pharmacological treatments with dopamine agonists support the neurobiological underpinnings of ADHD.

• High heritability and associated environmental risk factors suggest a primary role for genetic influences that are moderated by environmental factors in the majority of cases.


Diagnosis

• The gender differences in child and adult ADHD may be due to different expression of symptoms and co-morbidities, perception of impairments, and referral bias; and deserve further study.

• Age, gender, and IQ matched reference values are still lacking for diagnostic assessment of ADHD in adults.

• The age-of-onset criteria required for the retrospective diagnosis of ADHD in adults is less reliable and less important than the persistence of symptoms and impairment of ADHD during the lifespan.

• A cut off of 4/9 current DSM-IV criteria may be sufficient in adults with a childhood onset of symptoms, when accompanied by significant impairments.

• Age-appropriate presentations of ADHD symptoms should be taken into account when scoring the symptoms of ADHD in adults.

• The diagnosis of ADHD in adulthood should be based on self-report and in-depth evaluation, but collateral information is desirable.

• Various instruments are available for screening and assessment of ADHD, but validation studies are urgently needed.

• Neurobiological and neuropsychological tests are neither imperative nor sufficient for the diagnosis of ADHD but may document specific functional impairments.


Treatment

• Non- treatment may deprive the patient of the chance to resolve functional and psychosocial impairments at personal, relationship and professional levels.

• The severity of ADHD and associated co-morbid disorders should be the first guide to select which disorder to treat first. Treatments can often be combined.

• Albeit local regulatory rules may dictate differently, in patients with ADHD and substance use disorder, ADHD treatment with stimulants should not be withheld, but rather postponed until problematic substance use is stopped and there is a commitment to the treatment process.

• Stimulants are the treatment of choice for adults with ADHD. Long-lasting, extended release formulations are preferred for reasons of adherence to treatment, for the protection against abuse, to avoid rebound symptoms, for safer driving, and to provide cover throughout the day without the need for multiple dosing.

• The non-stimulant atomoxetine can be a second line treatment. Others like modafinil, bupropion, guanfacine, and tricyclic antidepressants have shown efficacy in controlled studies.

• Psychotherapy targets the relief of co-morbidities and behavioural, social, cognitive or other functional impairments.

• The poor long-term prognosis in a substantial part of patients and the absence of a cure upon stopping medication underline the role of long-term management of the adult with ADHD.

• With appropriate diagnosis and treatment, morbidity may be low, health care use efficient, outcomes better and associated with lower economic burden.

• More research on ADHD throughout the lifespan until old age is needed.


Kooij et al. BMC Psychiatry 2010 10:67   doi:10.1186/1471-244X-10-67

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