Trouble du déficit d'attention/hyperactivité de l'adulte
(Atttention Deficit/Hyperactivity Disorder)

2: Arch Clin Neuropsychol. 2005 Mar;20(2):249-69.

Attention Deficit Hyperactivity Disorder: manifestation in adulthood.
Riccio CA, Wolfe M, Davis B, Romine C, George C, Lee D.

Department of Educational Psychology, Texas A & M University, TAMU MS4225, College Station, TX 77843-4225, USA. criccio@tamu.edu

The purpose of the current study was to investigate the manifestation of ADHD in adults using a combination of structured clinical interview, behavioral self-report, and a range of neuropsychological measures. Symptom criteria that are endorsed by adults with ADHD as compared to non-diagnosed adults and an adult sample with other clinical disorders tend to reflect problems with follow-through, forgetting, organization, and losing things. Notably, adults in the No Diagnosis group endorsed a higher frequency of symptoms than base rates reported elsewhere. Related to sense of time, adults with ADHD endorsed problems with meeting deadlines, not completing tasks, not planning ahead, and having a poorer sense of time significantly more frequently than adults in either the No-Diagnosis or Other Clinical Disorder group. Results highlighted the need for further research specific to the manifestation of ADHD in adulthood and the development of diagnostic criteria that take into account the differences in development as well as age-related differences in contextual demands.

PMID: 15708734 [PubMed - indexed for MEDLINE]

3 : Can Fam Physician. 2005 Jan;51:53-9.

Attention deficit disorder in adults. Management in primary care.
Kates N.
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ont.

OBJECTIVE: To review the ways attention deficit disorder (ADD) presents in adults in primary care and to suggest treatment approaches. SOURCES OF INFORMATION: PsycINFO, PubMed, and Academic Search Elite databases were searched. Level I evidence supports the effectiveness of stimulants for treating ADD in adults, and mixed evidence (levels I and II) supports the effectiveness of antidepressants. MAIN MESSAGE: Attention deficit disorder is a prevalent but often unrecognized disorder in adults. The diagnosis, which must include onset of symptoms before age 7, is often missed. This could be because family physicians are not always familiar with the presentation in adults, because it frequently presents with comorbid problems, or because specific questions are not asked to elicit the diagnosis. Diagnosis is based on clinical assessment often assisted by self-rating scales. Management includes support and education, helping patients develop additional structure in their lives and make necessary behavioural changes, enhancing self-esteem, supporting and educating families, and prescribing medication. Medication choices include stimulants and antidepressants; medication can benefit up to 60% of people with ADD. CONCLUSION: It is crucial for primary care physicians to identify ADD in adults and to initiate treatment or referral. Several simple interventions can be employed.

PMID: 15732222 [PubMed - indexed for MEDLINE]
Comment in: Can Fam Physician. 2005 Jan;51:16, 20-1.

4- Entrevue Medscape, mai 2004
Treatment for Adult ADHD: A Newsmaker Interview With Timothy Wilens, M. par Martin Korn, MD

5: J Clin Psychiatry 2004; 65 (suppl 3:27-37)

A Guide to The Treatment of Adults With ADHD
Margaret D. Weiss, M.D., Ph.d., and Jacqueline R. Weiss, M. D.

While child and adolescent physicians are familiar with the treatment of attention-deficit/hyperactivity disorder (ADHD), many adult physicians have little experience with the disorder. It is difficult to develop clinical skills in the management of residual adult manifestations of developmental disorders without clinical experience with their presentation in childhood. Adult patients are increasingly seeking treatment for the symptoms of ADHD, and physicians need practice guidelines. Adult ADHD often presents differently from childhood ADHD. Because adult ADHD can be comorbid with other disorders and has symptoms similar to those of other disorders, it is important to understand differential diagnoses. Physicians should work with patients to provide feedback about their symptoms, to educate them about ADHD, anb to set treatment goals.
Treatment for ADHD in adults should include a medication trial, restructuring of patient's environment to make it more compatible with the sypmtoms of ADHD, and ongoing supportive management to address any residual impairment and to facilitate functional and developmental improvements.
Commentaires: les auteurs conservent toujours une perspective clinique, faisant un lien constant entre enfance et âge adulte, comme leur expérience le permet. Ils ajoutent même de nouveaux critères d'observation non-inclus au DSM IV, comme la procrastination, la surréaction à la frustration, la sous-motivation, l'insomnie et la mauvaise organisation temporelle.
La psychiatrie de l'adulte se doit d'être prudente et vigilante avant de poser des diagnostics lourds, comme la maladie bipolaire ou la dépression unipolaire, le trouble de personnalité limite (borderline), sans prendre en compte toutes les variantes du TDA/H qui, chez l'adulte, n'ont pas eu tous les égards à ce jour.
CJ

Disponible librairie McGill, dans le Journal of Clinical Psychiatry

6: CMAJ • March 18, 2003; 168 (6)

Assessment and management of attention-deficit hyperactivity disorder in adults
Margaret Weiss and Candice Murray
(Dr. Weiss is with the Division of Child Psychiatry and Ms. Murray is with the Department of Psychology, University of British Columbia, Vancouver, BC.)
Correspondence to: Dr. Margaret Weiss, Rm. B430, Children's and Women's Health Centre of British Columbia, 4500 Oak St., Vancouver BC V6H 3N1; fax 604 875-2468; mweiss@cw.bc.ca

Attention-deficit hyperactivity disorder (ADHD) is estimated to affect 2%–6% of adults. The symptoms in adults with ADHD mirror those in children with the disorder and are associated with significant educational, occupational and interpersonal difficulties. Double-blind, placebo-controlled trials have established that adult ADHD is responsive to stimulant medication treatment. New medications and psychotherapeutic approaches are being developed in an effort to achieve optimal treatment effects in this population. We review the available literature and provide an approach to the assessment and management of ADHD in adults.
© 2003 Canadian Medical Association or its licensors
Texte disponible librairie McGill, dans le Canadian Association Medical Journal

7: Biol Psychiatry. 2004 Apr 1;55(7):692-700.

Gender effects on Attention-Deficit/Hyperactivity disorder in adults, revisited
Biederman J, Faraone SV, Monuteaux MC, Bober M, Cadogen E.
Pediatric Psychopharmacology Unit of the Psychiatry Department (JB, SVF, MCM, MB, EC), Massachusetts General Hospital, Boston, Massachusetts, USA.

BACKGROUND: This study reexamined gender differences in a large sample of adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: We assessed the effects of ADHD, gender, and their interaction on rates of psychiatric comorbidity and cognitive functioning in 219 adults with ADHD who were referred to an outpatient psychiatric clinic over the last 7 years compared with 215 control subjects group-matched to control subjects on age and gender, and ascertained from ongoing family genetic case control adults with ADHD. RESULTS: There was no evidence that gender moderated the association between ADHD and other psychiatric disorders. Attention-deficit/hyperactivity disorder was associated with cognitive deficits and higher rates of major depression, anxiety, substance use disorders, and antisocial personality disorder.
CONCLUSIONS: Attention-deficit/hyperactivity disorder in adults is associated with psychiatric and cognitive impairment in both genders. These results bear striking similarities to findings reported in pediatric samples, supporting the validity of ADHD and stressing the importance of identifying and treating the disorder in adulthood.
PMID: 15038997 [PubMed - in process]
Texte disponible librairie McGill, dans Biological psychiatry

8: JAMA. 2004 Aug 4;292(5):619-23.

Attention-deficit/hyperactivity disorder in adults.
Wilens TE, Faraone SV, Biederman J.

Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114-3139, USA. twilens@partners.org
PMID: 15292088 [PubMed - in process
commentaire: article excellent et disponible sur JAMA.

9: J Clin Psychiatry. 2004 Oct;65(10):1301-13.
A clinical perspective of attention-deficit/hyperactivity disorder into adulthood.
Wilens TE, Dodson W.

From the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Dr. Wilens), and the Attention Disorders Treatment Center, Denver, Colorado (Dr. Dodson).

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder that affects all age groups. Recent data on the clinical presentation, comorbidity, neurobiology, and treatment are reviewed. METHOD: Using the search term ADHD, a selective PubMed review of the clinical literature was undertaken to evaluate recent data relevant to ADHD with attention to a life span perspective of the disorder. RESULTS: A growing literature indicates that ADHD is more persistent than previously thought and has a developmental variability in its presentation. The disorder impairs academic, social, and occupational functioning and is often associated with comorbidity, including cigarette smoking and substance abuse. Considerable evidence suggests that the disorder has a strong genetic component and a biological underpinning; the pathophysiology includes dysfunction in both noradrenergic and dopaminergic systems. Both psychosocial therapy and pharmacotherapy have been shown effective in the treatment of the disorder throughout the life span. The therapeutic effectiveness of pharmacologic agents in the treatment of ADHD has been attributed to noradrenergic and/or dopaminergic effects.
CONCLUSION: ADHD is associated with impairment and comorbidity throughout the life span. Growing evidence suggests the importance of short- and long-term management of the disorder. While the long-term treatment of ADHD is expected to lessen the individual's impairment, the outcome for adults who have received treatment since childhood requires further study.

PMID: 15491232 [PubMed - in process]
Texte disponible librairie McGill

10: Am J Psychiatry. 2004 Nov;161(11):1948-56.
Diagnostic controversies in adult attention deficit hyperactivity disorder.
McGough JJ, Barkley RA.
Suite 1414, 300 UCLA Medical Plaza, Los Angeles, CA 90095. jmcgough@mednet.ucla.edu.

OBJECTIVE: While it is increasingly recognized that attention deficit hyperactivity disorder (ADHD) persists into adulthood, there is no consensus on diagnostic criteria for adult ADHD. In this article the authors describe and contrast competing approaches for diagnosis of adult ADHD used in clinical and research practice. METHOD: The authors review the Wender Utah criteria, DSM criteria, and laboratory assessment strategies for adult ADHD. Advantages and disadvantages of each approach are described, and recommendations are made as a basis for clinical assessment and future research. RESULTS: Both the Wender Utah criteria and DSM-based approaches identify significantly impaired ADHD adults with neurocognitive, biological, and treatment response patterns similar to pediatric ADHD patients. The Wender Utah criteria established the need for retrospective childhood diagnosis and recognize developmental differences in adult symptom expression. The Wender Utah criteria fail to identify patients with predominately inattentive symptoms, exclude some patients with significant comorbid psychopathology, and diverge significantly from the DSM conception of ADHD. The DSM criteria have never been validated in adults, do not include developmentally appropriate symptoms and thresholds for adults, and fail to identify some significantly impaired adults who are likely to benefit from treatment. There are insufficient scientific data to justify use of laboratory assessment measures, including neuropsychological tests and brain imaging, in diagnosing adult ADHD.
CONCLUSIONS: Adult ADHD remains a clinical diagnosis. Clinicians should be flexible in application of the current ADHD criteria to adults. Additional research is required to validate adult diagnostic criteria.
PMID: 15514392 [PubMed - in process]
Disponible
http://ajp.psychiatryonline.org/cgi/content/full/161/11/1948

10: MMW Fortschr Med. 2004 Aug 19;146(33-34):31-4.

[Adult attention deficit/hyperactivity disorder][Article in German]

Laufkotter R, Eichhammer P, Hajak G.
Klinik und Poliklinik fur Psychiatrie und Psychotherapie der Universitat Regensburg. rainer.laufkoetter@medbo.de
ADHD (attention deficit/hyperactivity disorder) in adults is a more complex pathological condition than ADHD seen in children and adolescents. The number of reports of impaired self-regulation are on the increase. Psychiatric comorbities are being found ever more frequently, and negative life experiences are coloring the clinical presentation to an ever greater extent. Therapeutic strategies involving the use of stimulants and antidepressants are often needed to pave the way for individual and group psychotherapy.
Despite the fact that it is currently considered to be "fashionable", the diagnosis of ADHD is a clinically relevant and persisting psychological disorder.

PMID: 15526623 [PubMed - in process]

11: Psychol Med. 2005 Jun;35(6):807-16.

Stopping and changing in adults with ADHD.

Bekker EM, Overtoom CC, Kenemans JL, Kooij JJ, De Noord I, Buitelaar JK, Verbaten MN.
Department of Psychopharmacology, Utrecht University, The Netherlands. E.M.Bekker@pharm.uu.nl

BACKGROUND: A lack of inhibitory control has been suggested to be the core deficit in children with attention deficit hyperactivity disorder (ADHD). This means that a primary deficit in behavioral inhibition mediates a cascade of secondary deficits in other executive functions, such as arousal regulation. Clinical observations have revealed that with increasing age symptoms of hyperactivity and impulsivity decline at a higher rate than those of inattention. This might imply that a deficit in attention rather than a lack of inhibitory control is the major feature in adult ADHD. METHOD: To study whether an attentional or inhibitory deficit predominates, the stop-signal task and the stop-change task were presented to 24 adults with ADHD combined subtype and 24 controls. RESULTS: Relative to controls, the stop-signal reaction time (SSRT) was significantly more prolonged than the go-stimulus reaction time (RT) in patients with ADHD. This disproportionate elongation of the SSRT was comparable across tasks, even though the stop-change task exerted more complex (or at least different) demands on the inhibitory system than the stop-signal task. ADHD patients had a higher proportion of choice errors, possibly reflecting more premature responses. Specifically in the stop-change task, patients had more variable choice responses and made more inappropriate change responses, which may also reflect enhanced impulsivity. CONCLUSIONS: The results support a core deficit in behavioral inhibition in adults with ADHD. We further suggest that there is more evidence for a critical role of deficient inhibitory control in adults than in children with ADHD.

PMID: 15997601 [PubMed - in process]