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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlthough once considered a childhood disorder that would remit in adolescence, we now know that there is a 70% persistence of attention deficit hyperactivity disorder (ADHD) into adulthood [Barkley RA et al. \u003Cem\u003EJ Abnormal Psychiatry\u003C\/em\u003E 2002]. This article provides guidance on how to identify and treat adult ADHD.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurodevelopmental Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EChild \u0026amp; Adolescent Psychiatry\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAdult ADHD: Prevalence, Identification, Treatment\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EAlthough once considered a childhood disorder that would remit in adolescence, we now know that there is a 70% persistence of attention deficit hyperactivity disorder (ADHD) into adulthood [Barkley RA et al. \u003Cem\u003EJ Abnormal Psychiatry\u003C\/em\u003E 2002]. Gabriel Kaplan, MD, Hoboken University Medical Center, Hoboken, NJ, provided guidance on how to identify and treat adult ADHD.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ESome of the most comprehensive data on adult ADHD came from the results of the National Comorbidity Survey Replication (NCS-R) [Kessler RC et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2006], a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. The NCS-R included a screen for adult ADHD in a probability subsample of 3199 subjects aged 18 to 44 years. A subset of 154 subjects also completed structured interviews (ie, the Adult DHD Clinical Diagnostic Scale v1.2, based on ADHD-DSM-IV strict criteria and the WHO-Composite International Diagnostic Interview). The results of this study showed an estimated prevalence of current adult ADHD of 4.4%. There was a high level of comorbidity (mood disorder 38.3%, anxiety disorder 47.1%, substance abuse 15.2%) and significantly elevated odds of disability in all dimensions of basic and instrumental functioning, as assessed by the WHO Disability Assessment. Only 10.9% of the respondents had received ADHD treatment in the previous 12 months. Other studies have shown a similar pattern of impairment [Murphy K \u0026amp; Barkley RA. \u003Cem\u003ECompr Psychiatry\u003C\/em\u003E 1996; Biederman J et al. \u003Cem\u003EJ Clin Psychiatry\u003C\/em\u003E 2006; Barkley RA et al. ADHD in Adults: What the Science Says. New York, NY: Guilford Press. 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EA diagnosis of ADHD can be complicated by the presence of psychiatric and medical conditions that are known to mimic ADHD [Searight HR et al. \u003Cem\u003EAm Fam Physician\u003C\/em\u003E 2000; Stern MA. \u003Cem\u003ECNS Spectr\u003C\/em\u003E 2008 13(Suppl 15)]. It is also important to note that the pattern of ADHD symptoms changes over time. While hyperactivity, impulsivity, and inattention are the cardinal symptoms of ADHD, over time adult patients present with less overt hyperactivity and impulsivity, although inattention remains the most persistent aspect of the ADHD triad [Biederman et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2000; Adler L, Cohen J. \u003Cem\u003EPsychiatr Clin North Am\u003C\/em\u003E 2004] (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11338\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11338\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11338\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EDevelopmental Evolution of ADHD Symptoms in Adults.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EWhen conducting a diagnostic workup for ADHD, Dr. Kaplan recommends a comprehensive psychiatric interview with expanded focus on:\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-8\u0022\u003EPresent illness\u2013academic and work status, areas of impairment, and the presence of significant symptoms of substance abuse, or affective or anxiety disorder\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003EPast History\u2013the presence of ADHD childhood symptoms (corroborated with relatives when possible)\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-10\u0022\u003EMedical History\u2013current medications, history of head trauma or other neurological conditions, presence of endocrinology problems\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EAppropriate rating scales include the Conners\u0027 Adult ADHD Rating Scale (CAARS), the Brown ADD Rating Scale (BAADS), and the Adult ADHD Self Report Scale v1.1 (ASRS-v1.1) for current symptoms and the Wender Utah Rating Scale (WURS) for retrospective childhood symptoms [Brown T ed. Comorbidities Handbook for ADHD Complications in Children and Adults. Washington DC, American Psychiatric Press. 2009]. It is expected that the criteria for ADHD will be revised to be more appropriate for the adult population in DSM-V.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EThe mainstay of treatment for ADHD is either long- or short-acting stimulants. There are currently 6 medications that are approved (5 stimulants; 1 nonstimulant). Adjunctive psychotherapy can also be associated with improved outcomes.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/3\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmk01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmk01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}