Attention Deficit/Hyperactivity Disorder in Adults: Position of Portuguese Experts on Diagnosis and Treatment

Authors

  • Nuno Madeira Coimbra Institute for Biomedical Imaging and Translational Research/ Instituto de Ciências Nucleares Aplicadas à Saúde (CIBIT/ICNAS). Universidade de Coimbra. Coimbra. Portugal;Instituto de Psicologia Médica. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal; Centro de Responsabilidade Integrado de Psiquiatria. Unidade Local de Saúde de Coimbra. Coimbra. Portugal.
  • Gustavo França Serviço Local de Saúde Mental do Porto Ocidental. Hospital de Magalhães Lemos. Unidade Local de Saúde de Santo António. Porto. Portugal; Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal.
  • Gustavo Jesus Serviço de Psiquiatria. Hospital de Vila Franca de Xira. Unidade Local de Saúde do Estuário do Tejo. Lisboa. Portugal; Católica Medical School. Universidade Católica Portuguesa. Rio de Mouro. Portugal; Partners in Neuroscience (PIN). Paço de Arcos. Portugal.
  • João M. Fernandes Centro de Apoio ao Desenvolvimento Infantil (CADIn). Instituição Particular de Solidariedade Social. Cascais. Portugal.
  • Susana S. Almeida Serviço de Psiquiatria. Instituto Português de Oncologia. Porto. Portugal; Faculdade de Medicina. Universidade do Porto. Porto. Portugal; Hospital CUF Porto. Porto. Portugal.
  • Carlos N. Filipe NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal.

DOI:

https://doi.org/10.20344/amp.22149

Keywords:

Adulto, Perturbação de Hiperatividade com Défice de Atenção/diagnóstico, Perturbação de Hiperatividade com Défice de Atenção/tratamento, Portugal

Abstract

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood, affecting approximately 1.5% - 3% of the adult population in Portugal. Untreated ADHD in adults is associated with increased risks of substance abuse, criminality, poor academic and professional performance. Less than 20% of adults with ADHD are properly diagnosed and treated due to overlapping symptoms with other psychopathological comorbidities, lack of awareness, and prejudice surrounding this disorder. This position paper results from expert meetings involving six Portuguese experts in managing adult ADHD. It aims to guide diagnostic and treatment strategies, as well as address the main barriers and limitations in managing these patients within the Portuguese context, specifically regarding diagnosis and treatment. Furthermore, it seeks to clarify and demystify associated misconceptions, increase medical awareness, and promote discussion for the development of guidelines to improve the diagnosis, treatment, and quality of life of adults with ADHD in Portugal.

Downloads

Download data is not yet available.

References

REFERÊNCIAS

Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17:302.

Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, et al. The descriptive epidemiology of dsm-iv adult adhd in the world health organization world mental health surveys. Atten Defic Hyperact Disord. 2017;9:47-65.

Almeida J, Xavier M, Cardoso G, Gonçalves Pereira M, Gusmão R, Barahona Correa B, et al. Estudo epidemiológico nacional de saúde mental. 1.º Relatório. Lisboa: Faculdade de Ciências Médicas da Universidade Nova de Lisboa; 2013.

Kranz TM, Grimm O. Update on genetics of attention deficit/hyperactivity disorder: current status 2023. Curr Opin Psychiatry. 2023;36:257-62.

Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med. 2006;36:159-65.

Caye A, Rocha TB, Anselmi L, Murray J, Menezes AM, Barros FC, et al. Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiatry. 2016;73:705-12.

Moffitt TE, Houts R, Asherson P, Belsky DW, Corcoran DL, Hammerle M, et al. Is adult adhd a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. Am J Psychiatry. 2015;172:967-77.

Agnew-Blais JC, Polanczyk GV, Danese A, Wertz J, Moffitt TE, Arseneault L. Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiatry. 2016;73:713-20.

Sibley MH, Arnold LE, Swanson JM, Hechtman LT, Kennedy TM, Owens E, et al. Variable patterns of remission from adhd in the multimodal treatment study of adhd. Am J Psychiatry. 2022;179:142-51.

Bohmwald K, Andrade CA, Galvez NM, Mora VP, Munoz JT, Kalergis AM. The causes and long-term consequences of viral encephalitis. Review. Front Cell Neurosci. 2021;15:755875.

Adeyemo BO, Biederman J, Zafonte R, Kagan E, Spencer TJ, Uchida M, et al. Mild traumatic brain injury and adhd: a systematic review of the literature and meta-analysis. J Atten Disord. 2014;18:576-84.

Dobrosavljevic M, Larsson H, Cortese S. The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults. Expert Rev Neurother. 2023;23:883-93.

Beauchaine TP, Ben-David I, Bos M. ADHD, financial distress, and suicide in adulthood: a population study. Sci Adv. 2020;6:eaba1551.

Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers. 2015;1:15020.

Chang Z, Lichtenstein P, D’Onofrio BM, Sjolander A, Larsson H. Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study. JAMA Psychiatry.

;71:319-25.4

Pozzi M, Bertella S, Gatti E, Peeters G, Carnovale C, Zambrano S, et al. Emerging drugs for the treatment of attention-deficit hyperactivity disorder (ADHD). Expert Opin Emerg Drugs. 2020;25:395-407.

Barkley RA, Brown TE. Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS Spectr. 2008;13:977-84.

Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014;16:PCC.13r01600.

McCarthy S, Wilton L, Murray ML, Hodgkins P, Asherson P, Wong IC. The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care. BMC Pediatr. 2012;12:78.

Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157:816-8.

Costa Alves J, Morais S, Ferreira de Macedo A. Consulta de psiquiatria do neurodesenvolvimento: uma analise a nivel nacional. Acta Med Port. 2023;36:802-10.

National Institute for Health and Care Excellence. Guidelines. Attention deficit hyperactivity disorder: diagnosis and management. 2019. [consultado 2024 jul 09]. Disponível em: https://www.nice.org.uk/guidance/ng87/resources/attention-deficit-hyperactivity-disorderdiagnosis-and-management-pdf-1837699732933.

Royal College of Psychiatrists. College Report CR235 - ADHD in adults: Good practice guidance. 2023. [consultado 2024 jul 09]. Disponível em: https://www.rcpsych.ac.uk/docs/default-source/improving-care/

better-mh-policy/college-reports/cr235-adhd-in-adults---good-practiceguidance.pdf?sfvrsn=7c8cc8e4_12.

Australasian ADHD Professionals Association (AADPA). Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). Australia: AADPA; 2022.

Kooij JJ, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balazs J, et al. Updated european consensus statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14-34.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5™). Washington, DC: American Psychiatric Publishing; 2013.

Ramos-Quiroga JA, Nasillo V, Richarte V, Corrales M, Palma F, Ibanez P, et al. Criteria and concurrent validity of diva 2.0: a semi-structured diagnostic interview for adult adhd. J Atten Disord. 2019;23:1126-35.

National Comorbidity Survey (NCS). Adult ADHD Self-Report Scales: ASRS. [consultado 2024 out 28]. Disponível em: https://www.hcp.med.harvard.edu/ncs/asrs.php.

Bolea-Alamanac B, Nutt DJ, Adamou M, Asherson P, Bazire S, Coghill D, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28:179-203.

Sadek J. Malingering and stimulant medications abuse, misuse and diversion. Brain Sci. 2022;12:1004.

Patel GR. Feigning adhd: a necessary exploration of an uncomfortable topic. Journal of the New Zealand College of Clinical Psychologists. 2023;33:61-71.

Fuermaier AB, Fricke JA, de Vries SM, Tucha L, Tucha O. Neuropsychological assessment of adults with ADHD: a delphi consensus study. Appl Neuropsychol Adult. 2019;26:340-54.

Sobanski E, Bruggemann D, Alm B, Kern S, Deschner M, Schubert T, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (adhd). Eur Arch Psychiatry Clin Neurosci. 2007;257:371-7.

Torgersen T, Gjervan B, Rasmussen K. ADHD in adults: a study of clinical characteristics, impairment and comorbidity. Nord J Psychiatry. 2006;60:38-43.

Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, et al. The descriptive epidemiology of dsm-iv adult adhd in the world health organization world mental health surveys. Atten Defic Hyperact Disord. 2017;9:47-65.

Young S, Adamo N, Asgeirsdottir BB, Branney P, Beckett M, Colley W, et al. Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. 2020;20:404.

Landau Z, Pinhas-Hamiel O. Attention deficit/hyperactivity, the metabolic syndrome, and type 2 diabetes. Curr Diab Rep. 2019;19:46.

Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5:727-38.

Stuhec M, Lukic P, Locatelli I. Efficacy, acceptability, and tolerability of lisdexamfetamine, mixed amphetamine salts, methylphenidate, and modafinil in the treatment of attention-deficit hyperactivity disorder in adults: a systematic review and meta-analysis. Ann Pharmacother. 2019;53:121-33.

Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, et al. The world federation of adhd international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789-818.

Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018;28:1059-88.

Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, et al. ADHD pharmacotherapy and mortality in individuals with adhd. JAMA. 2024;331:850-60.

Direção-Geral da Saúde. Norma n.º 002/2019: abordagem diagnóstica e intervenção na perturbação do espectro do autismo em idade pediátrica e no adulto. Lisboa: DGS; 2019.

Taylor DM, Barnes TR, Young AH. The Maudsley prescribing guidelines in psychiatry. 14th ed. London: John Wiley & Sons; 2021.

Published

2025-03-03

How to Cite

1.
Madeira N, França G, Jesus G, Fernandes JM, Almeida SS, Filipe CN. Attention Deficit/Hyperactivity Disorder in Adults: Position of Portuguese Experts on Diagnosis and Treatment. Acta Med Port [Internet]. 2025 Mar. 3 [cited 2025 Mar. 10];38(3):187-96. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/22149

Issue

Section

Guidelines