Cortese Samuele, Bellgrove Mark A, Brikell Isabell, Franke Barbara, Goodman David W, Hartman Catharina A, Larsson Henrik, Levin Frances R, Ostinelli Edoardo G, Parlatini Valeria, Ramos-Quiroga Josep A, Sibley Margaret H, Tomlinson Anneka, Wilens Timothy E, Wong Ian C K, Hovén Nina, Didier Jeremy, Correll Christoph U, Rohde Luis A, Faraone Stephen V
Developmental EPI (Evidence synthesis, Prediction, Implementation) Lab, Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
World Psychiatry. 2025 Oct;24(3):347-371. doi: 10.1002/wps.21374.
Attention-deficit/hyperactivity disorder (ADHD) was once thought to be solely a childhood condition. Now it is well established that it can persist into adulthood, with an estimated worldwide prevalence of around 2.5%. Additionally, up to 70% of individuals with childhood-onset ADHD continue to experience impairing symptoms as adults, even if they no longer meet the criteria for a formal diagnosis. The validity of adult ADHD initially faced strong criticism. Today, empirical research supports its descriptive validity (identifying characteristic signs and symptoms), predictive validity (concerning specific outcomes, courses, and responses to treatment), and concurrent validity (evidence related to its underlying causes and biological mechanisms). Despite this progress, unresolved questions and ongoing debates about adult ADHD persist. This paper summarizes current empirical evidence, alongside uncertainties and controversies, regarding the definition, epidemiology, diagnosis, etiology, neurobiology, and management of ADHD in adults. Crucially, we also include perspectives from individuals with lived experience of this condition, highlighting their views on unmet needs and priorities for improving care. Key uncertainties and controversies on adult ADHD include: a) the possibility of late-onset ADHD; b) the significance of emotional dysregulation as a core symptom; c) the definition and characterization of functional impairment; d) the persistence of comorbid psychiatric and somatic conditions after accounting for confounders; e) the relevance of executive dysfunction in the definition of the condition; f) the use of objective diagnostic measures; g) the long-term effects of treatments; and h) the role of non-pharmacological interventions. Further research on adult ADHD is urgently needed. Funding for studies on this condition lags behind that for childhood ADHD and other mental disorders in adulthood. Hopefully, efforts by clinicians, researchers and other stakeholders will ultimately help ensure that adults with ADHD are better understood, supported, and empowered to thrive.
注意力缺陷多动障碍（ADHD）曾被认为仅是一种儿童期疾病。如今已明确它可延续至成年期，据估计全球患病率约为2.5%。此外，高达70%的儿童期起病的ADHD患者成年后仍有损害症状，即便他们不再符合正式诊断标准。成人ADHD的有效性最初遭强烈质疑。如今，实证研究支持其描述效度（识别特征性体征和症状）、预测效度（关乎特定结果、病程及对治疗的反应）和同时效度（与潜在病因及生物学机制相关的证据）。尽管有此进展，但关于成人ADHD的未解决问题和持续争论依然存在。本文总结了关于成人ADHD的定义、流行病学、诊断、病因、神经生物学及管理的当前实证证据，以及不确定性和争议。至关重要的是，我们还纳入了有此疾病亲身经历者的观点，突出了他们对未满足需求及改善护理优先事项的看法。关于成人ADHD的主要不确定性和争议包括：a）成人起病ADHD的可能性；b）情绪调节障碍作为核心症状的重要性；c）功能损害的定义和特征；d）在考虑混杂因素后共病精神和躯体疾病的持续性；e）执行功能障碍在该疾病定义中的相关性；f）客观诊断措施的使用；g）治疗的长期效果；h）非药物干预的作用。迫切需要对成人ADHD进行进一步研究。对此疾病研究的资金投入落后于儿童ADHD及成年期其他精神障碍的研究。有望临床医生、研究人员和其他利益相关者的努力最终能有助于确保成人ADHD患者能被更好地理解、支持并赋能以蓬勃发展。
