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The Treatment of Adult ADHD: Complexity at Hand

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The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders

Abstract

ADHD is a highly heterogeneous disorder, characterized by multifactorial etiological risk factors, a different severity of symptoms, and a different impact of the neuropsychological impairments on the functioning of the individual. Moreover, comorbidity with other psychiatric conditions is frequent, so all these aspects can lead to a variety of cognitive and behavioral profiles. The phenotypic heterogeneity in ADHD is also coupled with the heterogeneity of response to treatment, and in order to provide specific and targeted interventions, it should be mandatory to address all dimensions (i.e., inattention, impulsivity, hyperactivity, emotional dysregulation) that appeared most affected when the patient asked for help.

Although pharmacological treatment is effective in most cases, there is a proportion of patients who may present an insufficient or even a lack of response to treatment, or may have to interrupt due to the side effects of medication. Moreover, drug responders can still experience impairment in several life domains, despite a reduction in the severity of ADHD core symptoms. In fact, after years of chronic underachievement and multiple experiences of failure, people with ADHD are generally afflicted by cognitive distortions and maladaptive negative beliefs that negatively impact motivation and can reinforce avoidance behavior, leading to mood instability. Furthermore, people with ADHD generally have a low treatment adherence and poor compliance, also due to deficits in their executive functioning, which lead to planning and organization problems. For all these aspects, a multimodal treatment is always recommended for adults with ADHD.

In this chapter, we have provided a description of the pharmacological treatment of ADHD in adults, differentiating between stimulant and non-stimulant drugs. For completeness of information, we have reported the most common brand name and the dosage generally used to start the treatment and the indication for the titration. In this context, we have not overlooked the new evidence of efficacy that comes from scientific literature and that requires more in-depth studies. We also provided a description of the most used psychosocial interventions for adult ADHD, and reported evidence indicating why combined treatment should be preferred.

Finally, we have included some excerpts from the previous chapters that concern the treatment of ADHD when it is in comorbidity with other disorders. To find out more, the reader can refer to the specific chapter.

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Pallanti, S., Salerno, L. (2020). The Treatment of Adult ADHD: Complexity at Hand. In: The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-39051-8_19

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