II. Epidemiology
- Attention Deficit Disorder of childhood continues into adulthood in up to 30% of cases
III. Differential Diagnosis: Decreased attentiveness
- See ADHD Differential Diagnosis
- Hearing Impairment
- Thyroid disorders
- Liver disease
- Sleep Apnea
- Drug Interactions
- Mental health conditions
- Medication adverse effects
- Corticosteroids
- Antihistamines
- Anticonvulsants
- Caffeine
- Nicotine
IV. Contraindications: Stimulants
- Hypertension
- Tachycardia
- Arrhythmia
- Psychosis
- Bipolar Disorder
- Severe Anorexia
- Tourette Syndrome
V. Precautions: Stimulant safety in adults
-
Stimulant Use in adults with comorbid heart disease
- Sudden death events are reported at standard stimulant doses in adults and children
- Large trials have demonstrated overall safety in adults without increased cardiovascular events or sudden death
- Stimulant Diversion and Abuse
- Stimulant Abuse
- Overall Stimulant Abuse rate in adults: 2%
- Stimulant Abuse by adults aged 18 to 25 years: 4-6%
- Novak (2007) Subst Abuse Treat Prev Policy 2:32 [PubMed]
- Diversion (giving or selling medications to others)
- College student rate of use of non-prescribed stimulants: 8%
- Stimulant Abuse
VI. Evaluation
- See Attention Deficit Disorder regarding history questions
- Evaluate for contraindications to Stimulant Medications
- Vital Signs
- Blood Pressure (evaluate for Hypertension)
- Heart Rate (evaluate for Tachycardia)
- Electrocardiogram
- Evaluate for Arrhythmia
- Variable recommendations as to whether to obtain Electrocardiogram prior to starting Stimulant Medication
- Vital Signs
VII. Diagnosis
- See ADHD Diagnosis
- Proposed changes to upcoming DSM-V for diagnosis of ADHD in Adults
- Onset of observed ADHD symptoms by age 12 years (instead of current cirteria of age 7 years)
- Four diagnostic criteria positive in either Inattention or Hyperactive categories (instead of current 6 criteria required)
- Diagnostic tools
- Adult ADHD Self-Report Scale SymptomChecklist v1.1 (ASRS)
VIII. Associated Conditions
IX. Management
- Same management and medications apply to adults as they do in children
- See ADHD Management
- See ADHD Medication
- Consider Cognitive Behavioral Therapy for adults with ADHD
X. Prevention: Stimulant Diversion and Abuse
- Initiate Controlled Substance Agreement (contract)
- Implement random drug screening
- Regular follow-up visits (e.g. every 6 months)