1. ADHD in adults
Flavio Guzmán, MD

2. Overview Summary of DSM V criteria for ADHD
Brief comparison with DSM IV
Clinical features of adult ADHD

3. Introduction Children: 5.2 % Adults: 2.5 % Worldwide prevalence:
Adult ADHD: 1:1
Children 4:1
Male / Female ratio
Recognition that ADHD persists after adolescence
Increase of diagnosis and treatment in adults
Volkow, N. D., & Swanson, J. M. (2013). Clinical practice: Adult attention deficit-hyperactivity disorder. The New England journal of medicine, 369(20), 1935.
Polanczyk, Guilherme, et al. "The worldwide prevalence of ADHD: a systematic review and metaregression analysis." American journal of psychiatry 164.6 (2007):

4. DSM V Criteria

5. Diagnostic features Persistent pattern of
Inattention: not due to defiance or lack of comprehension
Hyperactivity / impulsivity
Interferes with functioning or development
More than one setting:
Home
School
Work
Informant confirmation
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

6. Diagnostic features Symptoms were present prior to age 12 years
Presentation
Combined
Predominantly inattentive
Predominantlty hyperactive/impulsive
Symptoms were present prior to age 12 years
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

7. Inattention Diagnostic criteria Children: at least 6 of 9 symptoms
Older adolescents (age 17 and older)and adults: at least 5 of 9 symptoms
Inattention
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

8. Inattention
Often fails to give close attention to details or makes careless mistakes
Details
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

9. Inattention Difficulty sustaining attention in:
Tasks
Play activities
Difficulty remaining focused during:
Lectures
Conversations
Lengthy reading
Attention / Focus

10. Inattention Does not seem to listen Mind seems elsewhere
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

11. Inattention Unable to finish: schoolwork chores
duties in the workplace
Loses focus
Easily sidetracked
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.
Start tasks

12. Inattention Difficulty organizing: Tasks Activities
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

13. Inattention Avoids tasks that require mental effort
Older adolescents and adults:
Paperwork
Reviewing papers
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

14. Inattention Often looses things necessary for tasks or activities
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

15. Inattention Is often easily distracted by minor stimuli
Adults: unrelated thoughts
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

16. Inattention Often forgetful in daily activities Adults:
returning calls
paying bills
keeping appointments
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

17. Hyperactivity / Impulsivity
Diagnostic criteria
Children: at least 6 of 9 symptoms
Older adolescents (age 17 and older)and adults: at least 5 of 9 symptoms
Hyperactivity / Impulsivity
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

18. Hyperactivity and impulsivity
Often fidgets with or taps hands or feet or squirms in seat
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

19. Hyperactivity and impulsivity
Leaves his/her place in:
Classroom
Office
Other workplace
Other situations
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

20. Hyperactivity and impulsivity
Children:
Run about or climb in situations where it is inappropriate
Adults:
May be limited to feeling restless
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

21. Hyperactivity and impulsivity
Often unable to play or engage in leisure activities quietly
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

22. Hyperactivity and impulsivity
Often “on the go”
Unable to or uncomfortable being still for extended time
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

23. Hyperactivity and impulsivity
Gives an answer before a question has been completed
Cannot wait for turn in conversation
Often talks excessively
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

24. Hyperactivity and impulsivity
Often has difficulty waiting his or her turn (while waiting in line)
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

25. Hyperactivity and impulsivity
Often interrupts others
Adolescents and adults: take over what others are doing
Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

26. Summary of DSM V changes
DSM IV
DSM V
Age of onset
<7 yr
<12 yr
Number of symptoms
Inattention
Six of nine
Children: six of nine
Adolescents (≥17 yr) and adults: five of nine
Hyperactivity - Impulsivity
Other
ADHD types
ADHD presentations
Feldman, H. M., & Reiff, M. I. (2014). Attention Deficit–Hyperactivity Disorder in Children and Adolescents. New England Journal of Medicine, 370(9),

27. Diagnostic assessment for adult ADHD
Patient interview: determine if ADHD symptoms
Started in childhood
Are severe enough
Have been present throughout the patient’s life
Have led to dysfunctioning throughout the patient’s life
Interview an informant: partner, parent or other relative
Kooij, JJ Sandra. Adult ADHD: Diagnostic assessment and treatment. Springer, 2013

28. Adult ADHD: Summary of symptoms
Hyperactivity
Excessive fidgeting
Inability to sit still
Impulsivity
Spending impulsively
Starting new jobs and relationships on impulse
Sensation seeking behaviors
Inattention
Distractibility
Disorganization
Being bored
Need for variation
Difficulty making decisions
Lack of overview
Kooij, S. J., Bejerot, S, et al (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC psychiatry, 10(1), 67.

29. Adult ADHD: Summary of symptoms
Mood lability
Frequents highs and lows
Short-fuse temper outbursts
Kooij, S. J., Bejerot, S, et al (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC psychiatry, 10(1), 67.

30. Comorbidity in adult ADHD
Comorbidity is the rule
75% of patients have at least one disorder
Mood, anxiety, sleep, personality and substance use disorders
Learning and other neurodevelopmental disorders
Kooij, S. J., Bejerot, S, et al (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC psychiatry, 10(1), 67.

31. End of presentation