ADHD across the lifespan

Attention deficit hyperactivity disorder (ADHD) is a common mental disorder with neurodevelopmental origins that typically starts in early childhood and follows a trait-like course. The disorder is characterized by inattention, impulsivity and hyperactivity that are persistent over time and lead to clinical and psychosocial impairments. Emotional instability is a common associated feature and may be the main presenting complaint. Neurodevelopmental and psychiatric co-morbidities are common. ADHD can be diagnosed and treated at all ages and is found to persist into adulthood in around two-thirds of cases. Many adults with ADHD went undiagnosed as children. In children with moderate impairment, psychological approaches are the first-line treatment, including parent training and cognitive behavioural therapy. Drug treatment should be offered to children with ADHD with severe impairment, or where psychological interventions have not been effective. In adults, drug treatments are the first-line treatment, with psycho-education and cognitive behavioural therapy as complementary approaches. Drug treatments are similar at all ages. Methylphenidate is the first-line drug, followed by atomoxetine or dexamfetamine. Atomoxetine may be first line when there are concerns with potential drug abuse or diversion, or high levels of co-morbid anxiety.