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 persistent trait-like course. It is characterized by inattention, impulsivity and hyperactivity that are persistent over time and lead to clinical and psychosocial impairments. Emotional instability is a common feature of ADHD that is sometimes the main presenting complaint. Neurodevelopmental and psychiatric co-morbidities are common. ADHD can be diagnosed and treated at all ages and persists into adulthood in around two-thirds of individuals. Many adults with ADHD were not diagnosed as children. In children with moderate impairment, psychological approaches, including parent training and cognitive behavioural therapy, are recommended as first-line treatment. Drug treatment should, however, be offered as a first line to children with ADHD with severe impairment, if psychological interventions have not been effective or if patients prefer medication. In adults, drug treatments are the recommended first-line treatments, with psycho-education and cognitive behavioural therapy as complementary approaches. Drug treatments are similar at all ages. Methylphenidate is the recommended first-line drug, followed by atomoxetine or dexamfetamine/lisdexamfetamine. Atomoxetine may be used as first line when there are concerns with potential drug abuse or diversion, or high levels of co-morbid anxiety.