Attention-deficit/hyperactivity disorder (
ADHD) is associated with impairments in educational, occupational, neuropsychological, and social functioning in adults. Successful diagnosis and treatment of the disorder in adults can be a challenge because recent and integrative clinical guidelines are lacking and diagnostic criteria are based on making a retrospective diagnosis of childhood-onset
ADHD. To develop evidence-based recommendations for the treatment of
ADHD in adults, the scientific literature was reviewed, including primary clinical studies, meta-analyses, and available clinical guidelines. Studies show that stimulant
therapy is highly effective and safe in the management of
ADHD in adults, with similar response rates to those reported in children at doses that are equivalent on a mg/kg basis. Long-acting stimulants, such as OROS
methylphenidate (OROS MPH,
Concerta),
dexmethylphenidate (d-MPH,
Focalin), and mixed
amphetamine salts extended release (MAS XR,
Adderall XR), have durations of action of up to 10 to 12 hours, which permit once-daily dosing. For adults with
ADHD who do not respond to stimulant
therapy or who have a comorbid condition in which a stimulant is contraindicated, the nonstimulant
atomoxetine (
Strattera) may be an appropriate alternative. For many adults, cognitive-behavioral therapy in addition to
pharmacotherapy may improve treatment response.
Attention-deficit/hyperactivity disorder medications may increase blood pressure and heart rate in adults, so patients should be monitored.