Handbook for attention deficit hyperactivity disorder in adults Handbook for attention deficit hyperactivity disorder in adults UK Adult ADHD Network (UKAAN) Philip Asherson (UKAAN President) Susan Young (UKAAN Vice President) Marios Adamou Blanca Bolea David Coghill Gisli Gudjonsson James Kustow Ulrich Müller Mark Pitts Johannes Thome www.ukaan.org Published by Springer Healthcare Ltd, 236 Gray’s Inn Road, London, WC1X 8HB, UK. www.springerhealthcare.com © 2013 Springer Healthcare, a part of Springer Science+Business Media. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the copyright holder. British Library Cataloguing-in-Publication Data. A catalogue record for this book is available from the British Library. 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Contents Author biographies ix Acknowledgments xv 1 Introduction to attention deficit hyperactivity disorder 1 References 3 2 Definition of attention deficit hyperactivity disorder in adults 5 Diagnostic criteria 5 Changes to Diagnostic and Stastical Manual of Mental Disorders 9 Age of onset 9 Subthreshold cases 13 Comorbid pervasive developmental disorder 14 Defining impairment in attention deficit hyperactivity disorder 14 References 16 3 The scientific basis of attention deficit hyperactivity disorder in adults 17 Prevalence of attention deficit hyperactivity disorder 17 Validity of the diagnostic construct 19 Main validating criteria 20 Etiology 24 Environmental risks 27 Cognitive processes 30 Neuroimaging and electrophysiology 30 Electrophysiological investigations 33 References 36 v vi • contents 4 Diagnostic assessment of attention deficit hyperactivity disorder in adults 41 Key principles 41 Diagnosing attention deficit hyperactivity disorder in adults 42 Diagnostic protocol 46 References 53 5 Neuropsychological assessment 55 Neuropsychological tests 56 Case studies 60 References 64 6 Comorbid symptoms, syndromes, and disorders 65 Clinical implications 65 Sources of comorbid symptoms, syndromes, and disorders 66 Core symptoms not listed within current operational criteria 66 Neurodevelopmental disorders and overlapping etiological influences 68 Attention deficit hyperactivity disorder as a risk factor for other mental health disorders and behavioral problems 69 Diagnosis and treatment of attention deficit hyperactivity disorder and comorbid disorders 71 References 82 7 Pharmacological treatments 87 Choice of drug therapy 87 Drug prescribing 89 Methylphenidate 93 Amphetamines 102 Atomoxetine 108 Bupropion 114 Other substances 116 Combination treatment 118 References 119 contents • vii 8 Psychological treatments 123 NICE clinical guidelines 124 Cognitive behavioral therapy 125 Dialectical behavioral therapy 132 Coaching 133 Summary 134 References 134 9 Attention deficit hyperactivity disorder during pregnancy 137 General considerations 138 Treatment 138 Maternal behavior during pregnancy 140 Attention deficit hyperactivity disorder treatment and breastfeeding 141 References 142 10 Attention deficit hyperactivity disorder and the criminal justice system 145 Attention deficit hyperactivity disorder and crime 145 Post-conviction 149 Treatment of offenders with attention deficit hyperactivity disorder 149 Summary 150 References 151 11 Service provision for adults with attention deficit hyperactivity disorder 153 Service populations 154 Costs of attention deficit hyperactivity disorder 155 Trends in service delivery 156 Pathways of care: a value-based approach 158 Service structure and determinants of service provision 160 Summary 165 References 165 Author biographies UKAAN The UK Adult ADHD Network (UKAAN) was established in March 2009 to provide support, education, research and training for mental health professionals working with adults with attention deficit hyperactiv- ity disorder (ADHD). UKAAN was founded by a group of experienced mental health specialists who run clinical services for adults with ADHD within the National Health Service. The network was established in response to UK guidelines from the National Institute of Health and Clinical Excellence (NICE, 2008) and the British Association for Psychopharmacology (Nutt et al, 2007), which, for the first time, gave evidence-based guidance on the need to diagnose and treat ADHD in adults as well as in children; and in response to the relative lack of training and support in this area for professionals working within adult mental health services. The aim of UKAAN is to support clinicians in the development of clinical services for adults with ADHD. Contributors Marios Adamou (MD, MA, MSc, LL.M , MBA, PhD, PGCE, MRCPsych, CMgr MCMI, DOccMed, FHEA, FRSA, FRSPH) is a consultant psy- chiatrist for the Service for Adults with ADHD in South West Yorkshire Partnership NHS Foundation Trust. He has been working in the area of Service Development for over 8 years having set up services for patients with bipolar disorder and adult ADHD. Dr Adamou has postgraduate qualifications in history, law, business administration, medical education, and occupational medicine. His publications include practical manuals on setting up Services for patients with bipolar disorder and adult ADHD. He has extensive research experience in multinational studies and has been the principal investigator in Phase III studies for adults with ADHD. His main research interests are in employment and medico-legal issues of adults with ADHD. ix x • author biographies Professor Philip Asherson (MB, BS, MRCPsych, PhD) is Professor of Molecular Psychiatry at the MRC Social, Genetic and Developmental Psychiatry centre at the Institute of Psychiatry, King’s College London, and consultant psychiatrist at the Maudsley Hospital. He earned his medical degree from The Royal London Hospital and his doctoral degree from the University of Wales. He was an MRC Clinical Research Fellow in the Department of Psychological Medicine and Institute of Medical Genetics at the University Of Wales College Of Medicine in Cardiff, where he worked on molecular genetic studies of schizophrenia. His current work focuses on clinical, quantitative genetic, and molecular genetic studies of ADHD across the lifespan. He has contributed to the development of mental health services for adults with ADHD in the UK. He is President of the UK Adult ADHD Network (www.UKAAN.org), a professional network that aims to support clinical research, education, and service provision for adults with ADHD. He was a member of the guideline development group for the National Institute of Health and Clinical Excellence (NICE) and contributed to published guidelines from NICE, the British Association of Psychopharmacology and the European Network Adult ADHD consensus paper. Current research includes follow- up studies of ADHD from childhood to adulthood, investigation of mood instability and emotional regulation in ADHD, treatment of ADHD in young offenders, defining the psychopathology of ADHD; and quantita- tive and molecular genetic studies of ADHD and associated cognitive- neurophysiological endophenotypes. He has published more than 220 peer reviewed articles, including guideline documents on diagnosis and treatment of ADHD in adults. Blanca Bolea (MD, Esp. Psiq (Spain), Dip. Estudios Avanzados) is currently a consultant psychiatrist at Trincay Medical Services, Cayman Islands. She graduated from the University of Zaragoza in Spain and underwent specialist training in Madrid. She subsequently worked at the Maudsley Hospital (London, UK) and in the Hopital Cantonale de Marsans (Switzerland). She joined the psychopharmacology unit at Bristol University in 2005 and worked in the psychopharmacology clinic under the supervision of Professor David Nutt, with whom Dr Bolea founded author biographies • xi the Bristol Adult ADHD Clinic in 2007. Current research interests include neurosteroids and their relationship with ADHD, and environmental influences in pregnancy related to ADHD outcomes in children. David Coghill (MB ChB, MRCPsych) is a reader in child and adolescent psychiatry, Department of Psychiatry, University of Dundee. Dr Coghill is head of the Developmental Research Group within the Department of Psychiatry, University of Dundee. This group has a particular interest in the neuropsychopharmacology of ADHD and has recently completed a large study into the effects of stimulant medication on neuropsycho- logical functioning in ADHD. Dr Coghill’s other areas of interest are the interactions between basic and clinical sciences in ADHD and disrup- tive behavior disorders, psychopharmacological treatments in child psychiatry and the use of evidence based approaches to care within real world settings. In