Adult ADHD

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.