Adult ADHD; Diagnosis; EPA; European Network Adult ADHD; Treatment; Updated European Consensus Statement; Central Nervous System Stimulants; Adult; Attention Deficit Disorder with Hyperactivity/diagnosis; Attention Deficit Disorder with Hyperactivity/therapy; Central Nervous System Stimulants/therapeutic use; Europe; Female; Health Services Accessibility/standards; Humans; Male; Practice Guidelines as Topic/standards; Prevalence; Psychotherapy/methods; Consensus; Attention Deficit Disorder with Hyperactivity; Health Services Accessibility; Practice Guidelines as Topic; Psychotherapy; Psychiatry and Mental Health
Abstract :
[en] Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
Disciplines :
Psychiatry
Author, co-author :
Kooij, J J S; PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands, Amsterdam UMC, LocationVUMc, Dept. of Psychiatry, Amsterdam, the Netherlands. Electronic address: s.kooij@psyq.nl
Bijlenga, D; PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands
Salerno, L; INS, Institute of Neuroscience, Florence, Italy
Jaeschke, R; Jagiellonian University Medical College, Section of Affective Disorders, Department of Psychiatry, Krakow, Poland
Bitter, I; Semmelweis University, Department of Psychiatry, Budapest, Hungary
Balázs, J; Institute of Psychology, Eotvos Lorand University, Vadaskert Child Psychiatric Hospial and Outpatient Clinic, Budapest, Hungary
Thome, J; Thome, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitatsmedizin Rostock, Rostock, Germany
Dom, G; Antwerp University (UA, CAPRI), Boechout, Belgium
Kasper, S; Medical University Vienna, Department of Psychiatry and Psychotherapy, Vienna, Austria
Nunes Filipe, C; Nova Medical School. Universidade NOVA Lisboa, Lisboa, Portugal
Stes, S; University Psychiatric Center, KU Leuven, Kortenberg, Belgium
Mohr, P; National Institute of Mental Health, Klecany, Czech Republic, Third Faculty of Medicine, Charles University Prague, Czech Republic
Leppämäki, S; Helsinki University Central Hospital, Department of Psychiatry, HUS, Finland
Casas, M; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain, Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
Bobes, J; Department of Psychiatry, School of Medicine, University of Oviedo - Centro de Investigación Biomédica and Red de Salud Mental, CIBERSAM, Oviedo, Spain
Mccarthy, J M; Visiting senior lecturer, King's College London, United Kingdom, Midland Regional Forensic Service, Hamilton, New Zealand
Richarte, V; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Kjems Philipsen, A; DPC Naestved, Ladby, Naestved, Region Sjaelland, Denmark
Pehlivanidis, A; National and Kapodistrian University of Athens Medical School, Eginition Hospital, Department of Psychiatry, Athens, Greece
Niemela, A; Wellmind Terveys Oy, Oulu, Finland
Styr, B; Mccabi Health Services (H.M.O), Tel Aviv, Israel
Semerci, B; Hasan Kalyoncu University, Poyracık Sokak. Istanbul, Turkey
Bolea-Alamanac, B; General Systems Division, Centre for Addiction and Mental Health/ Dept. Of Psychiatry, University of Toronto, Toronto, Canada
Edvinsson, D; Uppsala University, Uppsala University Hospital, Akademiska sjukhuset, Uppsala, Stockholm
Baeyens, D; Parenting and Special Education, KU Leuven, Leuven, Belgium
Wynchank, D; PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands
Sobanski, E; Central Institute of Mental Health, Mannheim, University Medical Center Mainz, Mainz, Germany
Philipsen, A; University of Bonn, Department of Psychiatry and Psychotherapy, Bonn, Germany
McNicholas, F; University College Dublin, Dublin, Republic of Ireland
Caci, H; Hopitaux Pediatriques de Nice CHU Lenval, Nice, France
Mihailescu, I; Alexandru Obregia Clinical Hospital of Psychiatry, Bucharest , Romania
Manor, I; Geha MHC, Petach-Tikva, Israel
Dobrescu, I; University of Medicine and Pharmacy "Carol Davila". Child and adolescent Psychiatry Department, Prof. Dr. Alex Obregia"Psychiatry Hospital, Bucharest, Romania
Saito, T; Department of Child and adolescent Psychiatry, Graduate School of Medicine, Hokkaido University, North 15,West 7, Kita-ku, Sapporo, 060-8638 Japan
Krause, J; Outpatient Clinic, Ottobrunn, Germany
Fayyad, J; St George Hospital University Medical Center, Balamand University Faculty of Medicine, Institute for Development, Research, Advocacy and Applied Care, Department of Psychiatry and Clinical Psychology, St George Hospital, Achrafieh, Beirut, Lebanon
Ramos-Quiroga, J A; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain, Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
Foeken, K; Vieux Chemin de Cagnes à La Gaude, la Gaude, France
Rad, F; University of Medicine and Pharmacy "Carol Davila", Child and adolescent Psychiatry Department, Prof. Dr. Alex Obregia"Psychiatry Hospital, Bucharest, Romania
Adamou, M; University of Huddersfield and South West Yorkshire Partnership NHS, Manygates Clinic, Wakefield, England
Ohlmeier, M; Klinikum Kassel, Department of Psychiatry and Psychotherapy, Kassel, Germany
Fitzgerald, M; Trinity College, Blanchardstown Village, Dublin, Republic of Ireland
Gill, M; Department of Psychiatry, Trinity College Dublin, School of Medicine, Dublin, Republic of Ireland
Lensing, M; Oslo University Hospital, Department of Rare Disorders, NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo, Norway
Motavalli Mukaddes, N; Istanbul Institute of Child and Adolescent Psychiatry, Istanbul, Turkey
Brudkiewicz, P; Centrum Dobrej Terapii, Cracow, Poland
Gustafsson, P; Lund University, Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden
Tani, P; Department of Psychiatry, Clinic for Neuropsychiatry, Helsinki University Central Hospital, HUS, Finland
Oswald, Pierre ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Educatio > Service de Psychopathologie légale ; High Security Hospital, CRP Les Marronniers, Tournai, Belgium
Carpentier, P J; Reinier van Arkel Mental Health Institute,'s-Hertogenbosch, Netherlands
De Rossi, P; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Department NSMOS, Faculty of Medicine and Psychology, University "Sapienza"of Rome, Rome, Italy
Delorme, R; Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
Markovska Simoska, S; Macedonian Academy of Sciences and Arts, Skopje, Republic of Macedonia
Pallanti, S; Stanford University Medical Center, University of Florence, INS Institute of Neuroscience, Florence, Italy
Young, S; Psychology Services Limited, Croydon, England
Bejerot, S; Örebro Univerity, School of Medical Sciences, Campus USÖ, Örebro, Sweden
Lehtonen, T; Neuropsykologkonsult Taina Lehtonen, Hjärup, Sweden
Kustow, J; Barnet Adult ADHD Service, Barnet, Enfield and Haringey NHS Mental Health Trust, London, Barnet Adult ADHD Service, Springwell Centre, Barnet Hospital, Barnet, England
Müller-Sedgwick, U; Adult ADHD Service, Barnet, Enfield & Haringey NHS Mental Health Trust, North London & Department of Psychiatry, University of Cambridge, Adult ADHD Service, Springwell Centre / Barnet Hospital, Barnet, London, England
Hirvikoski, T; Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), CAP Research Center, Stockholm, Sweden
Pironti, V; Cambridge Adult ADHD & ASD Clinic, Cambridge, England
Ginsberg, Y; Stockholm Center for Eating Disorder R&D Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Félegyházy, Z; ADHD Központ(center) Budapest, Budapest, Hungary
Garcia-Portilla, M P; Dept. of Psychiatry, University of Oviedo, School of Medicine, Psychiatry, Oviedo, Spain
Asherson, P; SGDP Building, Institute of Psychiatry Psychology and Neuroscience, Kings' College London, London, England
R550 - Institut des Sciences et Technologies de la Santé
Funding text :
Kooij, J.J.S.: No conflict of interest. Bijlenga, D.: No conflict of interest. Salerno, L.: No conflict of interest. Jaeschke, R.: No conflict of interest. Bitter I.: Honoraria or consultation fees from EGIS, EGRIS, Eli Lilly, Gedeon Richter, Janssen/Janssen-Cilag, Lundbeck, MedAvante, Pierre Fabre, PSI (CRO) and Servier. Balázs, J.: No conflict of interest. Thome, J.: No conflict of interest. Dom, G.: No conflict of interest. Kasper, S.: Grants/research support, consulting fees and/or honoraria within the last three years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Eli Lilly, Janssen, KRKAPharma, Lundbeck, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe and Servier. Nunes Filipe, C.: No conflict of interest. Stes, S.: Principal Investigator before 2016 in studies funded by Janssen-Cilag, Lilly and Novartis; speaker fees and advisory board for Lilly, Novartis, Janssen-Cilag, and Shire. Since 2016 no conflicts of interest. Mohr. P.: consultant and speaker for Eli Lilly, Janssen-Cilag, and Lundbeck. Leppämäki, S.: No conflict of interest. Casas, M.: speaker fees from Janssen- Cilag, Bristol-Mayers Squibb, Ferrer-Brainfarma, Pfizer, Lundbeck, Otsuka, Servier, Lilly, Shire, GSK, Rovi and Adamed. Advisory board for Janssen-Cilag, Lilly, and Shire. Bobes, J.: research grants and/or consultant, advisor or speaker within de last 3 years for: AB-Biotics, Acadia Pharmaceuticals, Casen Recordati, D&A Pharma, Gilead, Ferrer, Hoffman La Roche, Indivior, Janssen-Cilag, Indivior, Lundbeck, Mundipharma, Otsuka, Pfizer, Reckitt-Benckiser, Servier and Shire, research funding from the Spanish Ministry of Economy and Competiveness – Centro de Investigación Biomedica en Red area de Salud Mental (CIBERSAM) and Instituto de Salud Carlos III, Spanish Ministry of Health, Social Services and Equality - Plan Nacional sobre Drogas- and the 7th Framework Program of the European Union. McCarthy, J.M.: No conflict of interest. Kjems Philipsen, A.: No conflict of interest. Pehlivanidis, A.: No conflict of interest. Niemela, A.: No conflict of interest. Bolea-Alamanac, B.: Honoraria on one occasion for an educational lecture for Janssen pharmaceuticals. Edvinsson, D.: No conflict of interest. Baeyens, D.: No conflict of interest. Wynchank, D.: Advisory boards of Janssen BV, Novartis and Eli Lilly for activities outside the scope of this paper (2009–2014). Sobanski, E.: lectures paid by Shire within the last two years. Philipsen, A.: Advisory boards, lectures, performed phase 5 studies, or travel grants within the last 5 years from Eli Lilly and Co, Janssen-Cilag, Lundbeck, MEDICE Arzneimittel, Pütter GmbH and Co KG, Novartis, Servier, and Shire; and has authored books and articles on ADHD published by Elsevier, Hogrefe, Oxford Press, Schattauer, Kohlhammer, Karger, and Springer. McNicholas, F.: Received an unrestricted educational grant from Shire Pharmaceuticals in 2016, and grant support for a UCD Newman Fellow 2014-2015. Caci, H.: No conflict of interest. Manor, I.: Honoraria, counseling and advisory boards for Jansen-Cilag, Israel, Teva Israel, Novartis Israel, Medison Israel. Asking for a research grant: Shire. Krause, J.: No conflict of interest. Fayyad, J.: No conflict of interest. Ramos-Quiroga, J.A.: speakers’ bureau and/or consultant for Eli-Lilly, Janssen-Cilag, Novartis, Shire, Lundbeck, Almirall, Braingaze, Sincrolab, and Rubió in the last 5 years. Travel awards (air tickets + hotel) for meetings from Janssen-Cilag, Rubió, Shire, and Eli- Lilly. The Department of Psychiatry chaired by him received unrestricted educational and research support in the last 5 years from: Eli-Lilly, Lundbeck, Janssen- Cilag, Actelion, Shire, Ferrer, and Rubió. Foeken, K.: No conflict of interest. Adamou, M.: No conflict of interest. Ohlmeier, M.: No conflict of interest. Fitzgerald, M.: No conflict of interest. Gill, M.: No conflict of interest. Lensing, M.: No conflict of interest. Motavalli Mukaddes, N.: advisor and speaker of Sanofi Drug Company. Brudkiewicz, P.: No conflict of interest. Gustafsson, P.: Former member of advisory board for Lilly, advisory board for Elvanse and Intunive (Shire). Tani, P.: No conflict of interest. Oswald, P.: No conflict of interest. Carpentier, P.J.: No conflict of interest. De Rossi, P.: No conflict of interest. Delorme, R.: No conflict of interest. Markovska Simoska, S.: No conflict of interest. Pallanti, S.: No conflict of interest. Young, S.: Honoraria for consultancy, travel, educational talks and/or research from Janssen, Eli Lilly, HB Pharma, and/or Shire. She is author of the Young-Bramham CBT Programme. Lehtonen, T. No conflict of interest. Hirvikoski, T.: no conflict of interest related to this article. Royalties for text books and manuals from Hogrefe. Pironti, V.: No conflict of interest. Ginsberg, Y.: Speaker fees, reimbursement for travel costs and/or consultant for Novartis, HB Pharma, Shire, Eli Lilly, Hogrefe, Broadman Clarke Partners, Medscape, Medibas and Natur & Kultur. Félegyházy, Z.: No conflict of interest. Richarte, V.: Speakers’ bureau for Eli-Lilly, Shire in the last 5 years. Travel awards (air tickets + hotel) for psychiatric meetings from Shire. The Department of Psychiatry received unrestricted educational and research support in the last 5 years from: Eli-Lilly, Lundbeck, Janssen- Cilag, Actelion, Shire, Ferrer, and Rubió. Kustow, J.: Consultancy services to Eli Lilly and Shire and speaker fees from Eli Lilly, Jansen Cilag and Shire. Müller, U.: Advisory board / consultancy fees or speaker honorarium from Eli Lilly, Heptares and Shire, Educational grants / travel expenses from Eli Lilly, Flynn Pharma / Medice, Janssen-Cilag, Lundbeck, Shire and Sunovion (all United Kingdom). Bejerot, S.: No conflict of interest. Semerci, B.: No conflict of interest. Dobrescu, I.: No conflict of interest. Styr, B.: No conflict of interest. Rad, F.: No conflict of interest. Mihailescu, I.: No conflict of interest. Garcia-Portilla, M.P.: No conflict of interest. Asherson, P.: Kings College London research support account for Asherson received honoraria for consultancy to Shire, Eli-Lilly and Novartis; educational/research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech; speaker at sponsored events for Shire, Lilly and Novartis.
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