IMpACTing on adult ADHD research.

In the last 20 years there has been an increasing awareness that attention deficit/hyperactivity disorder (ADHD) not only is the most frequent psychiatric disorder in childhood, but also persists into adulthood in at least 15% of cases (adult ADHD, aADHD) (Faraone et al., 2006). This chronic, substantial impairment as well as the co-morbid conditions being the rule rather than the exception in ADHD call for adequate diagnosis and treatment of this disorder. While the concept of childhood ADHD is still under debate in lay circles – the number of critical, populist and polemic articles not tinted by proper knowledge is legend – but not amongst clinicians and the scientific community, there are still psychiatrists who doubt the existence of persisting ADHD; this despite the overwhelming evidence of continuity from childhood to adulthood. As Thomas Kuhn has said, ‘[....] paradigms die when their promoters die’— times are changing and the paradigm that ADHD is a disorder limited to childhood and adolescence is finally dying. As stimulant medication has recently been licensed in many European countries for use in adult ADHD, and patients can be offered an effective remedy, awareness of the diagnosis has been further boosted. As a consequence, many psychiatric departments now run specialized outpatient services focusing on diagnosis and treatment of aADHD and its co-morbid conditions. From own experience it has to be said that these are highly beneficial in reducing patients' suffering, although more extensive, integrated programs that combine pharmacotherapy and psychotherapy with neuropsychological training and neurostimulatory techniques or neurofeedback are still scarce. In striking contrast to the advances in the clinical care of aADHD, research into the underlying pathophysiology falls far short. Despite the fact that persisting ADHD is the most severe, and potentially most genetically loaded and “biological” form of the disease, major questions have not yet been answered. What is the genetic basis of aADHD? Which factors predict persistence vs. remission in adolescence? Are there specific morphological changes in the brain of aADHD patients?, to name but a few (Franke et al., 2012). To address these issues, we founded the International Multicenter persistent ADHD CollaboraTion (IMpACT) in 2007,