Manifestation of Adult Attention-Deficit/ Hyperactivity Disorder and Available Treatment Options

self-reported symptoms suggestive of ADHD. The diagnosis of adult ADHD can be challenging because these self-reported symptoms are not objectively verifiable. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), emphasizes both inattention and impulsivity/hyperactivity, but these symptoms may be subtle and difficult to elicit in adults. Symptoms are usually longstanding, and the growing consensus is that disinhibition may be a cardinal feature.4 Disinhibition may be manifested as poor self-regulation and difficulty with focused attention and goal-directed thought and action. Although children with symptoms of ADHD are characterized as being constantly “on the go,” adults with these symptoms are considered to be “on edge.” Patients may have difficulty completing tasks or relaxing, and they are generally disorganized. Impulsivity may take the form of socially inappropriate behavior, such as interrupting or intruding on conversations. ADHD can coexist with many psychiatric conditions such as depression, Generalized Anxiety Disorder (GAD), and bipolar disorder. The symptomatology of many of these conditions mirrors those of ADHD, making it difficult to “tease out” which condition is causing the range of symptoms described by family members or the patient. In a study of 56 adults who met the DSM-IV criteria for ADHD, the majority had additional psychiatric diagnoses; only seven subjects had a diagnosis of ADHD alone.5 Additional diagnoses included GAD (53%), dysthymic disorder (25%), and cyclothymic disorder (25%). Antisocial personality features were found in one fifth of adults with ADHD.4 Adults with ADHD are more likely to be unemployed or underemployed, to be smokers, and to have substance abuse and marital problems.6 These factors underscore the importance of proper diagnosis and treatment. In the attempt to extend the DSM-IV criteria to adult patients, problems may arise,7