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In addition, hyperactivity and poor concentration should be present in adulthood, along with two of five additional symptoms: affective lability; hot temper; inability to complete tasks and disorganization; stress intolerance; and impulsivity.

The Utah criteria include the emotional aspects of the syndrome.

Second, the criteria for ADHD do not describe the subtle cognitive-behavioral symptoms that may affect adults more than children.

Third, the most effective treatment is long-term use of a schedule II drug with potential for abuse.3The family physician's role as diagnostician is further complicated by the high rates of self-diagnosis of ADHD in adults.

See related patient information handout on attention-deficit/hyperactivity disorder in adults, written by the authors of this article.

While the symptoms of ADHD have been extended developmentally upward to adults, most of the information about the etiology, symptoms and treatment of this disorder comes from observations of and studies in children. The criteria for ADHD emphasize a childhood presentation, and there is growing evidence that the diagnostic features of ADHD take a different form in adults.

A thorough history should include an emphasis on past school performance and conduct, previous and current psychiatric therapies, and reports of specific symptoms of inattention, distractibility and disorganization.While many of the symptoms are reported by others in the patient's life, the problem often expressed by adults with ADHD is frustration over the inability to be organized.1 Prioritizing is another common source of frustration.Important tasks are not completed while trivial distractions receive inordinate time and attention.The episodes of hot temper, typified by frequent angry eruptions out of proportion to the precipitants, often “blow over” more quickly for the patient than for coworkers and family members.Affective lability is characterized by brief, intense affective outbursts ranging from euphoria to despair to anger, and is experienced by the ADHD adult as being out of control.

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