A Clinical Perspective of Attention-Deficit/Hyperactivity Disorder Into Adulthood

Timothy E. Wilens, M.D., and William Dodson, M.D.

Objective: Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder that affects all age groups. Recent data on the clinical presentation, comorbidity, neurobiology, and treatment are reviewed.

Method: Using the search term ADHD, a selective PubMed review of the clinical literature was undertaken to evaluate recent data relevant to ADHD with attention to a life span perspective of the disorder.

Results: A growing literature indicates that ADHD is more persistent than previously thought and has a developmental variability in its presentation. The disorder impairs academic, social, and occupational functioning and is often associated with comorbidity, including cigarette smoking and substance abuse. Considerable evidence suggests that the disorder has a strong genetic component and a biological underpinning; the pathophysiology includes dysfunction in both noradrenergic and dopaminergic systems. Both psychosocial therapy and pharmacotherapy have been shown effective in the treatment of the disorder throughout the life span. The therapeutic effectiveness of pharmacologic agents in the treatment of ADHD has been attributed to noradrenergic and/or dopaminergic effects.

Conclusion: ADHD is associated with impairment and comorbidity throughout the life span. Growing evidence suggests the importance of short- and long-term management of the disorder. While the long-term treatment of ADHD is expected to lessen the individual's impairment, the outcome for adults who have received treatment since childhood requires further study.

(J Clin Psychiatry 2004;65:1301-1313)

Received May 30, 2003; accepted Feb. 19, 2004. From the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Dr. Wilens), and the Attention Disorders Treatment Center, Denver, Colorado (Dr. Dodson).

Presented at the symposium "ADHD: From Neurobiology to a Plan for Life," which was held at the U.S. Psychiatric & Mental Health Congress, October 28-31, 2002, in Las Vegas, Nev., and supported by an unrestricted educational grant from Shire. Additional support for this research was provided by National Institutes of Health grant no. DA 14419 (Dr. Wilens).

Dr. Wilens has served as a consultant for, received grant support from, and participated in speakers boards for Abbott, Celltech Medieva, Lilly, McNeil, NIDA, NIMH, Novartis, Pfizer, Shire, and SKB/Glaxo. Dr. Dodson has served as a consultant for Shire and has received honoraria from and participated in speaker/advisory boards of Shire and Novartis.

Corresponding author and reprints: Timothy E. Wilens, M.D., Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital and Harvard Medical School, 15 Parkman Street, Boston, MA 02114 (e-mail: twilens@partners.org).