A narrative review looked at past research on adults with ADHD, not a new group of people. The authors ran an Ovid search for papers from the past 10 years. They did not say how many studies they reviewed or how they chose them.
The review found that ADHD in adults often comes with other conditions. These include mood, anxiety, impulse-control, personality, substance use, learning and sleep disorders. Many of these conditions have symptoms that can look like ADHD.
Adults with ADHD appeared to benefit from stimulant medicine in ways similar to children, including better driving. Stimulants showed a larger effect than nonstimulants, and methylphenidate beat a placebo by a modest margin. In one Norwegian study, adults who had stimulant treatment as children were more likely to be in work.
On later substance use, the cited evidence was mixed. Much of it came from children and teens followed into young adulthood. A follow-up of 112 children found no evidence that childhood stimulant treatment raised or lowered later risk. A pooled review of six long-term studies of youths linked childhood stimulant treatment to lower risk.
The authors noted that therapy and driving studies were small. Studies on substance use were not randomized trials. No randomized, double-blind trials had compared psychotherapy with medicine.
The authors suggest that clinicians should be able to spot these other conditions, and they name combined cognitive behavioral therapy and medicine as the current first choice for adults.
Talk to a clinician about your own situation.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- NCS-R (cited in Kooij, 2012): share of adults with ADHD who also had another disorder, 38.3% with a mood disorder, 47.1% with an anxiety disorder, 19.6% with impulse-control disorders and 15.2% with substance use disorders.
- Faraone and Glatt, 2010: size of the treatment effect in adults across 19 trials of 13 drugs, 0.73 for stimulants vs. 0.39 for nonstimulants.
- Koesters et al., 2009: methylphenidate compared with placebo in adults across 16 studies, d = 0.42 (95% confidence interval = [0.20, 0.63]).
- Norwegian retrospective study (cited in Kooij, 2012): being in work as an adult, 24% of 414 adults with ADHD vs. 79% of 357 controls, with childhood stimulant therapy the strongest predictor (odds ratio = 3.2; p = .014). What the terms mean:
- Effect size is a measure of how big a difference a treatment made, where larger numbers mean a bigger difference.
- d is a kind of effect size. Roughly, 0.2 is small, 0.5 is moderate and 0.8 is large. A minus sign shows the direction of the change, not its size.
- 95% confidence interval is the range where the true value most likely falls.
- Odds ratio compares the odds of an outcome between two groups, where 1 means no difference.
- p shows how likely a result this strong would be by chance alone, where smaller means less likely.
Source: Kooij J, Huss M, Asherson P, et al.. Distinguishing Comorbidity and Successful Management of Adult ADHD. Journal of Attention Disorders (2012). doi:10.1177/1087054711435361