Adult ADHD undertreated despite effective interventions

ADHD, a chronic neurodevelopmental disorder that begins in childhood, continues into adulthood in the majority of children. Prevalence figures show that 3-4% of adults are affected by ADHD and it is associated with a broad range of psychosocial impairments.

Dr Esther Sobanski investigates the pharmacological management of adult ADHD at the Department of Psychiatry and Psychology, Central Institute of Mental Health, Mannheim, Germany. “In contrast [to the 3-4% prevalence rate], diagnostic prevalence is below 0.5%, indicating that a majority of cases go undiagnosed and untreated,” she said.

Reviewing the impact of ADHD in adults, Dr Sobanski noted that peer-group, relationship and parenting difficulties, poor work and academic performance, as well as a tendency towards dangerous driving habits like speeding and accident proneness in daily living were all associated with the disorder.

“In addition to ADHD core symptoms, patients often experience associated symptoms like emotional dysregulation, sleep disturbances or low self-esteem, as well as suffering from comorbid disorders, particularly depressive episodes, substance use and anxiety disorders,” she explained.

Dr Sobanki’s research suggests that medication can have an impact beyond ADHD core symptoms, improving psychosocial functioning like managing on-road driving or parenting while treating symptoms such as emotional dysregulation or sleep problems.

Current guidelines recommend a multimodal approach for treatment of adult ADHD, including psycho-education, pharmacotherapy, disorder-oriented psychotherapy and occupational rehabilitation.

However, although pharmacotherapy has been shown to be highly effective, and a growing body of evidence supports disorder-oriented psychotherapy in residual symptoms, many adults remain untreated.

“New pharmacological treatment approaches not only target ADHD core symptoms but also co-morbid psychiatric disorders like alcohol use disorders or social phobia,” Dr Sobanksi noted. “However, in the European Union only two medications are approved for de novo use in adult ADHD.”

“Available data from a cross national suggest that most adults with ADHD in Europe are untreated,” she added.