The persistence of ADHD beyond adolescence has only been recently highlighted with prospective, longitudinal studies. Unfortunately, there was little, if any, training on this condition in residency programs. As a result, most physicians caring for adult patients are unaware of or don’t inquire about this condition. The core symptoms of inattention, hyperactivity and impulsivity seen in children still have relevance in the adult presentation, although hyperactivity and impulsivity may diminish with age. The cognitive symptoms of ADHD often appear to be normal variations, and therefore ignored by clinicians as psychiatrically relevant. The adult with ADHD may also contribute to this process by underreporting symptoms, impairments and chronicity. The elicitation of symptoms from the patient may be difficult for three reasons: child descriptors of symptoms are not relevant to adult tasks, symptoms and impairments are context- based, and finally, the patient may have developed ways to compensate for symptoms so as to mask impairments. Because of these factors, the evaluation process requires adequate time to gather this information for an accurate diagnosis.

Given the 35-40% of adults with ADHD have other active psychiatric comorbidities, the multiple symptom clusters may cause diagnostic confusion for the clinician. This further complicates the treatment algorithm for treating ADHD and the other disorders. Optimally, all active psychiatric conditions need to be assessed and then prioritized in order to develop a pharmacologic and therapeutic treatment algorithm. Pharmacologic options for the adult patient are also influenced by the presence of medical conditions, like untreated hypertension or cardiovascular disease and associated medications. Although challenging, the accurate diagnosis and effective treatment of ADHD in adults proves to be a very rewarding experience for patients and physicians.