Twists and turns of adult ADHD treatment

Twists and turns of adult ADHD treatment

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that does not end when adolescence gives way to adulthood. Robust scientific evidence supports the recognition of ADHD in adults, as well as in children and adolescents. Accordingly, the latest diagnostic and classification manuals – DSM-5-TR and ICD-11 – describe ADHD across the lifespan, acknowledging its chronological continuity. I am pleased to see this logical diagnostic framework formally validated.

But what can a clinician do for a 22-year-old former student with excellent academic results who reports impatience, difficulty concentrating, impulsivity, frequent conflicts over minor issues, and a tendency to offend others without clear reason? He has dropped out of university to earn money, believes he has ADHD, and asks for a prescription for methylphenidate, the first-line treatment for his condition. A positive ADHD diagnosis requires evidence that the symptoms have been present since childhood. His mother confirms this history, but she cannot provide documentation from child psychiatry or psychology, being shocked by the suggestion that she should have sought a consultation: “He was not crazy; he had excellent academic results”.

If the differential diagnosis rules out other mental and behavioral disorders, what comes next? An integrated treatment approach is needed. Should it include stimulants such as methylphenidate, or non-stimulants such as atomoxetine? Should psychotherapy be added? If so, should it be paid for privately or accessed through referral to a psychologist contracted by the national health insurance system?

It is the time to establish a national protocol for easy access for this category of patients to individualized and adequate treatment of this mental health issue.