Psychiatric Annals

Guest Editorial Free

Adult ADHD

Lenard A. Adler, MD

This issue of Psychiatric Annals is an update on attention-deficit/hyperactivity disorder (ADHD), with a specific focus on adults. Adult ADHD is a common neuropsychiatric disorder, affecting between 8 and 9 million adults in the United States.1 Most adults with ADHD are not diagnosed and, therefore, left untreated.

This issue highlights important topics in the diagnosis and treatment of adult ADHD. The current pharmacologic treatments, stimulant and nonstimulant medications, although highly effective, have limitations in that many patients do not adhere to treatment. Additionally, psychiatric comorbidities are quite common in people with adult ADHD, complicating the diagnostic and treatment landscape.

The articles here review four pertinent issues that are particularly important to the mental health clinician regarding adult ADHD: (1) emotional dysregulation, (2) the cardiovascular effects of medications, (3) substance use disorders, and (4) cognitive-behavioral therapy (CBT). Emotional dysregulation symptoms are a set of commonly co-occurring symptoms that are not included in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition,2 but can be quite impairing and easy for clinicians to misidentify. It is important for clinicians to understand the potential cardiovascular effects of adult ADHD pharmacotherapies as all US Food and Drug Administration-approved medicines for adult ADHD can potentially effect blood pressure and pulse.3 Stimulant medications, which are Schedule II compounds, are most commonly prescribed for ADHD; therefore, a review of substance use disorders and ADHD is particularly important. Not all adults with ADHD respond to pharmacotherapy, but there is burgeoning research in CBT to treat patients with residual symptoms or those who do not respond to medications.

Thank you to everyone who contributed to this important issue.


  1. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716–723. doi:. doi:10.1176/ajp.2006.163.4.716 [CrossRef]
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
  3. Wilens TE, Hammerness PG, Biederman J, et al. Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2005;66(2):253–259. doi:10.4088/JCP.v66n0215 [CrossRef]

Lenard A. Adler, MD

Lenard A. Adler, MD, is the Director, Adult ADHD Program, and a Professor of Psychiatry and Child and Adolescent Psychiatry, New York University (NYU) School of Medicine.

Address correspondence to Lenard A. Adler, MD, Department of Psychiatry and Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 8th Floor, New York, NY 10016; email:

Disclosure: Lenard A. Adler, MD, has disclosed the following relevant financial relationships: research grants paid to NYU on Dr. Adler's behalf from Sunovion Pharmaceuticals, Shire Pharmaceuticals, Lundbeck, Enzymotec, Purdue Pharma; personal fees for consulting or advisory boards from Sunovion Pharmaceuticals, Enzymotec, Shire Pharmaceuticals, the National Football League, Major League Baseball, Shire Pharmaceuticals, Otsuka Pharmaceuticals, Alcobra Pharmaceuticals; and royalty fees from NYU School of Medicine for license of Adult ADHD rating scales and training materials.


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