Devenir à l'âge adulte du trouble déficit de l'attention/hyperactivité (ADHD): Aspects épidémiologiques et cliniques

Translated title of the contribution: Outcome of ADHD syndrome in adulthood: Epidemiological and clinical aspects

C. Schlösser, A. Kovács, François Ferrero

Research output: Contribution to journalArticle

Abstract

This paper highlights the existence of ADHD syndrome in adults and presents its different epidemiological and clinical aspects. Many recent works, mainly from North-American Research centres, have put forward the possibility of the persistence of this syndrome until adulthood. In prospective studies and in family surveys they evaluated the importance of genetic factors and certain comorbidities as well as the increased risk for these patients to develop antisocial personality disorder or drug abuse later on in their life. Researchers estimate that 30 to 50% of adults diagnosed with ADHD during childhood will continue to have problems as adults and will report symptoms acute enough to cause impairment in daily functioning. In families with children suffering from ADHD there is a 5 to 10 times higher probability to find parents with ADHD than in controls. These children with family risk factors are more prone to develop antisocial personality, possibly reflecting an ADHD subtype with a poorer prognosis. The diagnostic interview in the adult ADHD patient should not only look for the typical symptoms as described in the DSM-IV criteria for ADHD, as these tend to be moderated by adult coping strategies, hiding the underlying persistent syndrome. Furthermore, low self-esteem and underdeveloped social skills due to life-long ADHD can lead to use of drugs or alcohol to overcome these difficulties. As the risk for psychiatric disorders increases with age, most of the patients with persisting ADHD present with a co-morbidity such as coexisting depression, anxiety and other psychiatric disorders. Ratey et al. found that all of the adult ADHD patients studied had primarily been diagnosed with another psychiatric disorder: 47% with different forms of depression, 15% with anxiety, 15% with eating disorder, insomnia or somatisation disorder and 15% with substance abuse. This makes differential diagnosis more difficult and requires careful evaluation. Asking the adult patient about the presence of ADHD during childhood is an essential part of the diagnostic interview, but patients often cannot recall their own turbulent behaviour as kids. The parents (if available) can give more accurate answers, whether the child was moving around all the time, interrupting conversations, having difficulties in school or making friends. In the adult ADHD patient the clinician should look for behaviours or thinking patterns in daily functioning which reflect inattention or impulsivity such as: inability to complete tasks; difficulties sustaining attention and making decisions; frequent changing of jobs; intolerance to anger, stress or frustration; feelings of restlessness and/or irritability; frequent marital problems. The UTAH criteria for ADHD in adults are a valuable instrument to help diagnosing the syndrome. Although there are only few well-controlled treatment trials in adults with ADHD, stimulants seem to be the drug of choice. Newer antidepressants can act favourably on coexisting depression and anxiety. Methylphenidate acts on dopamine and norepinephrin circuits in the frontal cortex, enhancing control of impulsivity: ADHD patients, in contrast to current beliefs, calm down with stimulants when gaining capacity to focus their attention and inhibit unwanted stimuli or responses. Optimal response has been shown with multimodal treatments, e.g. combining stimulants, specific cognitive behavioural therapy and social skills training.

Original languageFrench
Pages (from-to)29-36
Number of pages8
JournalSchweizer Archiv fur Neurologie und Psychiatrie
Volume153
Issue number1
Publication statusPublished - 2002

Fingerprint

Psychiatry
Antisocial Personality Disorder
Anxiety
Impulsive Behavior
Depression
Substance-Related Disorders
Parents
Interviews
Combined Modality Therapy
Psychomotor Agitation
Methylphenidate
Somatoform Disorders
Frustration
Anger
Sleep Initiation and Maintenance Disorders
Cognitive Therapy
Frontal Lobe
Self Concept
Diagnostic and Statistical Manual of Mental Disorders
Pharmaceutical Preparations

Keywords

  • Adults
  • Attention deficit
  • Epidemiology
  • Evolution
  • Hyperactivity disorder (ADHD)

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Neuropsychology and Physiological Psychology

Cite this

Devenir à l'âge adulte du trouble déficit de l'attention/hyperactivité (ADHD) : Aspects épidémiologiques et cliniques. / Schlösser, C.; Kovács, A.; Ferrero, François.

In: Schweizer Archiv fur Neurologie und Psychiatrie, Vol. 153, No. 1, 2002, p. 29-36.

Research output: Contribution to journalArticle

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