Attention deficit disorder in adults. Management in primary care.

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.