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Attention-Deficit Hyperactivity Disorder (ADHD)

Brief Overview: Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and/or impulsivity that interfere with daily functioning.
Although commonly diagnosed in childhood, ADHD frequently persists into adulthood and may present differently over time. In adults, symptoms often include difficulty with organization, focus, time management, and emotional regulation rather than overt hyperactivity. With appropriate treatment, symptoms can be well managed.

Prevalence: According to UpToDate, “Epidemiologic studies of adult attention deficit hyperactivity disorder (ADHD) have estimated the current prevalence to be 2.6 (95% CI 1.5-4.6) percent globally.”

Etiology:

  • Neurobiologic differences in brain regions involved in attention, impulse control, and executive function.
  • Dysregulation of dopamine and norepinephrine neurotransmitter systems.
  • Genetics

Risk Factors:

  • Family history of ADHD
  • Premature birth or low birth weight
  • Prenatal exposure to lead, tobacco, alcohol, or substances

Commonly Associated Conditions:

  • Mood disorder
  • Anxiety
  • Substance use disorder
  • Sleep disorders

Common Medications:

  • First-line:
    • Stimulants – amphetamines (dextroamphetamine and lisdexamfetamine) or methylphenidate
      • Cardiovascular history review should be done prior to starting stimulants
  • Alternatives: atomoxetine, viloxazine, antidepressants (bupropion, nortriptyline)

Common Labs, Imaging, and Tests:

  • Conners Adult QADHD Rating Scale (CAARS)
  • Adult ADHD Self-Report Scale (ASRS)
  • Barkley Deficits in Executive Functioning Scale
  • Baseline vitals, cardiac history review (before starting stimulants)

Common Symptoms: Per UpToDate, common adult manifestations are:

  • Hyperactivity Symptoms:
    • Restlessness
    • Verbosity
    • Constant activity
    • A tendency to choose very active jobs
  • Impulsivity Symptoms:
    • Ending relationships
    • Quitting jobs
    • Overreacting to frustrations
    • More driving violations
  • Inattention Symptoms:
    • Procrastination
    • Difficulty making decisions
    • Poor time management
    • Difficulty in organizing activities

Common Treatments:

  • Medication (see above)
  • Cognitive-behavioral therapy (CBT) targeting executive dysfunction
  • Coaching or skills training (organization, time management).
  • Academic or workplace accommodations.
  • Treatment of comorbid conditions (anxiety, depression, sleep disorders).

Physical Findings:

  • Often normal physical exam.
  • Possible restlessness or fidgeting.
  • Can see changes in weight or appetite with stimulant use.

Potential Complications and Contraindications:

  • Potential complications if untreated:
    • Academic or occupational difficulties
    • Relationship stress
    • Increased risk of anxiety, depression, or substance use
    • Low self-esteem
  • Contraindications / cautions:
    • Uncontrolled hypertension or significant cardiac disease (stimulants)
    • History of substance misuse (requires careful selection/monitoring)
    • Monitor for appetite suppression, sleep disruption, or mood changes
    • Black box warning for atomoxetine regarding suicidal ideation (for youth under the age of 25 years)

General Health and Lifestyle Guidance:

  • Encourage structured routines and consistent schedules.
  • Promote sleep hygiene and regular physical activity.
  • Limit excessive caffeine or stimulant use.
  • Use planners, reminders, and digital tools.
  • Break tasks into smaller steps.
  • Reinforce medication adherence and follow-up appointments.
  • Normalize ADHD as a neurodevelopmental condition—not a personal failing.

Suggested Questions to Ask Patients:

  • What symptoms are most challenging for you right now?
  • How do attention or organization difficulties affect your daily life?
  • Were you diagnosed with ADHD in childhood or adulthood?
  • Are you currently taking medication? How is it working for you?
  • Any side effects such as appetite changes, sleep problems, or mood shifts?
  • Do you have anxiety, depression, or sleep concerns?
  • What strategies have helped you stay organized or focused?
  • Are you interested in behavioral therapy or coaching support?

Suggested Talking Points:

  • Symptoms often change over time, especially in adults.
  • Medication can improve focus, but skills and routines are also important.
  • It may take time to find the right medication and dose.
  • Managing ADHD can significantly improve quality of life and confidence.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.