Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: Recommendations from the British Association for Psychopharmacology

Psychopharmacology Unit, University of Bristol, Bristol, and Bethlem Royal Hospital, Kent, UK.
Journal of Psychopharmacology (Impact Factor: 3.59). 02/2007; 21(1):10-41. DOI: 10.1177/0269881106073219
Source: PubMed


Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children's services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

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    • "This drug was selected because it is freely available in the Brazilian public healthcare system. The treatment protocol was designed following Brazilian guidelines (Mattos et al. 2006) for ADHD treatment that are very similar to the worldwide practice (Nutt et al. 2007). A detailed description of this part of the study can be found in Victor et al. (2009, 2014). "
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    ABSTRACT: Course and predictors of persistence of attention deficit hyperactivity disorder (ADHD) in adults are still largely unknown. Neurobiological and clinical differences between child and adult ADHD raise the need for follow-up studies of patients diagnosed during adulthood. This study investigates predictors of ADHD persistence and the possibility of full remission 7 years after baseline assessment. A 7-year follow-up study of adults with ADHD (n = 344, mean age 34.1 years, 49.9% males) was conducted. Variables from different domains (social demographics, co-morbidities, temperament, medication status, ADHD measures) were explored with the aim of finding potential predictors of ADHD persistence. Retention rate was 66% (n = 227). Approximately a third of the sample (n = 70, 30.2%) did not maintain ADHD criteria and 28 (12.4%) presented full remission (<4 symptoms), independently of changes in co-morbidity or cognitive demand profiles. Baseline predictors of diagnostic persistence were higher number of inattention symptoms [odds ratio (OR) 8.05, 95% confidence interval (CI) 2.54-25.45, p < 0.001], number of hyperactivity/impulsivity symptoms (OR 1.18, 95% CI 1.04-1.34, p = 0.01), oppositional defiant disorder (OR 3.12, 95% CI 1.20-8.11, p = 0.02), and social phobia (OR 3.59, 95% CI 1.12-11.47, p = 0.03). Despite the stage of brain maturation in adults suggests stability, approximately one third of the sample did not keep full DSM-IV diagnosis at follow-up, regardless if at early, middle or older adulthood. Although full remission is less common than in childhood, it should be considered as a possible outcome among adults.
    Full-text · Article · Jan 2015 · Psychological Medicine
    • "Because stimulant medications used for ADHD have abuse potential, clinicians face the challenge of indentifying a drug-seeking patient who deliberately performs badly on a diagnostic test or presents a false history intended to match a checklist of diagnostic criteria (Green & Rabiner, 2012; Harrison, Edwards, & Parker, 2007; Rabiner et al., 2009a). Individuals treated for ADHD as children often discontinue treatment during adolescence; therefore, college students with ADHD may have experienced treatment gaps (Nutt et al., 2007). They may also be geographically separated from previous providers, further reducing their access to care. "
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    ABSTRACT: Objective: To assess perceptions concerning ADHD among U.S. college healthcare providers. Method: A 37-question survey was conducted from October 4 to December 2, 2010. Participants were contacted via mail or telephone and compensated for participation. Results: Thirty-eight percent of the respondents (physicians, n = 59; nurses, n = 138; directors, n = 101) viewed ADHD as a "problem"/"very much a problem" at their institution. Referrals for evaluation came from students (84%), psychologists/counselors (68%), or the institution (68%). Although 48% of respondents felt "comfortable"/"very comfortable" in their ability to recognize ADHD, 92% referred students for evaluation. Most respondents (>90%) agreed medication use may be warranted; 52% of respondents who treat ADHD or consult with a specialist (from 95% of physicians to 31% of directors) prescribed pharmacotherapy. Conclusion: Although college healthcare providers recognize the importance of treating ADHD, their discomfort in diagnosing and treating ADHD represents a barrier to care for college students.
    No preview · Article · Apr 2014 · Journal of Attention Disorders
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    • "When pharmacologic treatment is indicated, the European guidelines unanimously recommend the use of stimulants in children, adolescents, and adults as a first-line pharmacologic therapy [12]. Atomoxetine, or other nonstimulant therapies, such as clonidine and guanfacine, are recognized as alternatives in most European guidelines [2, 6, 12, 14] and are listed as first-line pharmacologic treatment options for: (1) adults with ADHD who began treatment in childhood; (2) when parent or patient preference is to not use a stimulant; (3) among patients who fail to respond or have a sub-optimal response to stimulants; or (4) when a patient has co-morbid substance abuse, tics, or anxiety [2, 12–14, 16]. Among school-age children, adolescents, and adults with severe ADHD [12, 15], several European guidelines recommend adopting a multimodal treatment plan [13, 15, 17, 18] that may include methylphenidate, atomoxetine, or dexamfetamine, depending on country-specific availability [6]. "
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    ABSTRACT: With preliminary data suggesting an increasing trend in attention-deficit/hyperactivity disorder (ADHD) prevalence in Europe, the use of psychotropic medications in this population needs to be better understood, particularly among patients with ADHD and no co-morbid psychiatric disorder. Medical charts of patients aged 6-17 years with one or more ADHD diagnosis between January 1, 2004 and June 30, 2007, and use of ADHD medication were abstracted by physicians from six European countries. Patients with a history of epilepsy or diagnosis of Tourette syndrome were excluded. Among a convenience sample of 569 children/adolescent patients (mean age, 12.1 years), 80 (14.1 %) patients used psychotropic concomitant medication (PCM) along with their current on-label ADHD medication. The number of pre-existing co-morbidities, high impairment due to the symptom of anger, and country (France; Italy; the Netherlands; and Spain vs. the reference country, Germany) were significantly associated with PCM use (UK was not significantly different vs. Germany). In particular, in France, Italy, the Netherlands, and Spain, PCM use was highest. These findings suggest that greater attention to the use of PCM, which are not indicated for the treatment of ADHD, may be warranted in children and adolescents receiving PCM. This highlights the need for further research to assess the impact of PCM use in ADHD patients and to consider alternative, individualized, indicated treatment strategies for patients with ADHD.
    Full-text · Article · Nov 2013
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