Attention-Deficit Hyperactivity Disorder (ADHD) in Adults

Attention-Deficit Hyperactivity Disorder (ADHD) in Adults

Key Issues in Mental Health Vol. 176 Series Editors A. Riecher-Rössler Basel M. Steiner Hamilton

Attention-Deficit Hyperactivity Disorder (ADHD) in Adults Volume Editors Wolfgang Retz Homburg/Saar Rachel G. Klein New York, N.Y. 9 figures and 18 tables, 2010 Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney

Key Issues in Mental Health Formerly published as Bibliotheca Psychiatrica (founded 1917) Prof. Dr. Wolfgang Retz Institut für Gerichtliche Psychologie und Psychiatrie Universitätskliniken des Saarlandes Kirrberger Strasse Homburg/Saar (Germany) Rachel G. Klein, MD Department of Child and Adolescent Psychiatry New York University Child Study Center New York, N.Y. (USA) Library of Congress Cataloging-in-Publication Data Attention-deficit hyperactivity disorder (ADHD) in adults / volume editors, Wolfgang Retz, Rachel G. Klein. p. ; cm. -- (Key issues in mental health, ISSN 1662-4874; v. 176) Includes bibliographical references and indexes. ISBN 978-3-8055-9237-6 (hardcover : alk. paper) 1. Attention-deficit disorder in adults. I. Retz, Wolfgang. II. Klein, Rachel G. III. Series: Key issues in mental health, v. 176. 1662-4874; [DNLM: 1. Attention-Deficit Disorder with Hyperactivity--diagnosis. 2. Adult. 3. Attention-Deficit Disorder with Hyperactivity--therapy. W1 BI429 v.176 / WM 190 A883 2010] RC394.A85A884 2010 616.85 89--dc22 2009037557 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2010 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN 1662 4874 ISBN 978 3 8055 9237 6 e-isbn 978 3 8055 9238 3

Contents VII Preface Retz, W. (Homburg/Saar); Klein, R.G. (New York, N.Y.) Chapter 1 1 Attention-Deficit Hyperactivity Disorder in Adults: An Overview Wender, P.H. (Boston, Mass.); Tomb, D.A. (Salt Lake City, Utah) Chapter 2 38 Family and Twin Studies in Attention-Deficit Hyperactivity Disorder Freitag, C.M. (Frankfurt); Retz, W. (Homburg/Saar) Chapter 3 58 Molecular Genetics of Attention-Deficit Hyperactivity Disorder Retz, W. (Homburg/Saar); Freitag, C.M. (Frankfurt) Chapter 4 78 Neurophysiology of Adult Attention-Deficit Hyperactivity Disorder Baehne, C.G.; Fallgatter, A.J. (Würzburg) Chapter 5 88 Brain Imaging in Adult Attention-Deficit Hyperactivity Disorder Schneider, M. (Venray); Rösler, M.; Retz, W. (Homburg/Saar) V

Chapter 6 105 Attention-Deficit Hyperactivity Disorder in Adults: Diagnosis and Prevalence Stieglitz, R.-D. (Basel) Chapter 7 126 Comorbidity in Adult Attention-Deficit Hyperactivity Disorder Klein, R.G.; Mannuzza, S. (New York, N.Y.) Chapter 8 144 Adult Attention-Deficit Hyperactivity Disorder Functional Impairment, Conduct Problems and Criminality Rösler, M. (Homburg/Saar) Chapter 9 159 Psychotherapy in Adult Attention-Deficit Hyperactivity Disorder Philipsen, A.; Richter, H.; Matthies, S.; Hesslinger, B. (Freiburg) Chapter 10 174 Psychopharmacological Treatment of Attention-Deficit Hyperactivity Disorder in Adults Trott, G.-E. (Aschaffenburg) 187 Author Index 189 Subject Index VI Contents

Preface Despite a long research history and robust findings about genetics, life course, and treatment of attention-deficit hyperactivity disorder (ADHD), the disorder remains a matter of public controversies and scientific debates. Descriptions of children suffering from developmentally inadequate inattention, motor overactivity and impulsivity by European as well as American physicians go back to the 19th century. In the 20th century, empirical studies across the world substantially advanced our knowledge of epidemiology, etiology, pathophysiology and treatment of the syndrome. Nevertheless, controversy about the diagnosis remains, as evidenced by different diagnostic standards in the Diagnostic and Statistical Manual of the American Psychiatric Association (4th ed.; DSM-IV), and the International Classification of Diseases (10th ed.; ICD-10), which is more restrictive and is the obligatory diagnostic standard for European psychiatrists. Due to the immense international scientific support for the DSM-IV approach to the diagnosis of ADHD, it is applied in this volume of Key Issues in Mental Health. Although disbelieved for many decades, longitudinal studies performed since the 1970s in the USA, Canada and other countries have clearly shown that ADHD persists into adulthood and is associated with high risk for comorbid psychiatric disorders and social impairment. Until recently, in Germany and other European countries, the lifespan perspective of this disorder has failed to be recognized. In the last decade, scientific and clinical interest in ADHD have increased dramatically in Germany, but there remains a deep transatlantic gap regarding treatment opportunities, and views about the benefits of treatment, for adult ADHD patients, in spite of ample empirical evidence supporting treatment efficacy. In this volume of Key Issues in Mental Health, we have brought together scientists from the USA and Germany to provide an overview about several important aspects VII

of ADHD across the lifespan. The topics include epidemiology, neurobiology, psychopathology, longitudinal course, comorbidity and social impairment. Moreover, diagnostic problems and therapeutic options regarding this disorder are discussed. In the first chapter, Paul H. Wender and David A. Tomb give a synopsis of adult ADHD from the authors extended work at the University of Utah. Formal and molecular genetic studies are reviewed by Christine M. Freitag and Wolfgang Retz in chapters 2 and 3, followed by chapter 4, where Christina G. Baehne and Andreas J. Fallgatter report findings from neurophysiological studies of adult ADHD. An overview of morphological and functional imaging studies in adult ADHD is provided by Marc Schneider and coworkers in chapter 5. The subsequent chapters refer to clinical aspects of ADHD in adults, starting with diagnostic issues of adult ADHD, presented in chapter 6 by Rolf-Dieter Stieglitz. The very important issue of comorbidity in adult ADHD is reviewed by Rachel G. Klein and Salvatore Mannuzza in chapter 7, and in chapter 8 aspects of social dysfunctioning in adults with ADHD are discussed by Michael Rösler. The last two chapters give insights into therapeutic approaches in adult ADHD. In chapter 9, Alexandra Philipsen and coworkers report on psychotherapeutic approaches for adults with ADHD, with a main focus on the development of a group therapy in Germany, and in chapter 10 Götz-Erik Trott summarizes options of pharmacological treatment. In order to continue the tradition of Key Issues in Mental Health, the editors and contributing authors endeavored to give an overview of the most relevant research and treatments in an important field of contemporary psychiatry. We hope that this volume will be a useful tool for physicians and therapists who work with ADHD patients. Wolfgang Retz Rachel G. Klein VIII Preface