Attention-Deficit/Hyperactivity Disorder in adults. A study of treatment and outcome in different age groups

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder that starts in childhood and, in a large number of cases, persists into adulthood. Pharmacotherapy, often with stimulant medication, is considered to be one of the cornerstones in treatment of ADHD. Although the efficacy of short-term pharmacological treatment in adults with ADHD is well documented, research on long-term treatment outcome is scarce. Little is known about the course of the disorder in middle-aged and older adults.

The thesis presents two questionnaire surveys in adults with ADHD in different age groups, carried out in 2008-2010. The aim of the SIBBE2 study (n=1080, mean age 36 years) was to investigate long-term outcome in a naturalistic sample of pharmacologically treated adults with ADHD. A survey of agreement between primary care physicians and patients on treatment of ADHD was part of the SIBBE study. The aim of the Fifty Plus study (n=251, mean age 56 years) was to investigate pharmacological treatment and quality of life in adults with ADHD who were fifty years and older.

In the SIBBE study the response rate of 35 % was lower than expected. ADHD symptoms and impairment at baseline did not differ substantially between participants and non-participants. In the Fifty Plus study more than 59 % of the eligible sample could be included for further analyses. The mean observation time in the SIBBE study was 4.5 years, whereas it was 5.7 years in the Fifty Plus study.

We found that among participants, 4-5 years after initiation, the majority reported current psychopharmacological treatment for ADHD, most often with stimulant medication. The primary care physicians and their patients agreed on the pharmacological, but not the nonpharmacological treatments that had been given. Physicians and ADHD patients reported low levels of misuse of stimulant medication. Adults treated pharmacologically for more than 24 months reported significantly more favorable outcome than those treated for 24 months or less. Only a minority of participants reported levels of ADHD symptomatology and current functioning that could be classified as remission. Middle-aged and older adults with ADHD reported significantly reduced quality of life compared with population norms. Comorbidity at baseline, ADHD symptom severity, and unemployment were associated with poorer outcome.

The findings indicate that for many subjects the negative impact of ADHD persisted into late adulthood. Psychopharmacological treatment for more than two years was associated with better outcome and should probably be recommended for those who report improvement with this treatment without significant side effects. Primary care physicians can safely take responsibility for the psychopharmacological treatment of adults with ADHD when the condition is stable. For a majority of adults with ADHD comprehensive treatment approaches beyond ADHD symptom reduction are needed to improve outcome. Future studies on long-term multidimensional treatment programs for adults with ADHD are warranted.