Overview
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with childhood onset that frequently persists into adulthood 1. It is characterized by symptoms that can significantly impact daily functioning 1.Diagnosis
Management
For moderate to severe ADHD during the perinatal period, pharmacotherapy can be considered, with largely reassuring safety data 1.
In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms and alcohol craving 2.
In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms, but not to reduce cannabis use 2.
In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or reduce cocaine use 2.
In patients with ADHD and nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms, but not to reduce nicotine use 2.
For patients with ADHD and any substance use disorder (SUD), psychostimulants are recommended to improve ADHD symptoms and treatment retention, but not to reduce substance use 2. Atomoxetine is also recommended to improve ADHD symptoms, but not to decrease substance use 2.Special Populations
ADHD frequently persists into adulthood, with approximately 3% of adult women having a diagnosis 1. Symptoms can become more challenging to manage during the perinatal period 1.
There is a high comorbidity between ADHD and bipolar disorder (BD); approximately 7.95% of adults with ADHD also have BD, and 17.11% of adults with BD have ADHD 3. Earlier onset of BD is observed in patients with comorbid ADHD 3.
ADHD and substance use disorders (SUDs) are highly comorbid 2.Key Recommendations
Mitigate risks associated with ADHD that worsen during the perinatal period via individualized treatment planning 1. (Evidence: Expert opinion)
Provide psychoeducation, self-management strategies or coaching, and psychotherapies for ADHD during the perinatal period 1. (Evidence: Expert opinion)
In patients with ADHD and any SUD, psychostimulants are recommended to improve ADHD symptoms and treatment retention 2. (Evidence: Strong)
In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms and alcohol craving 2. (Evidence: Weak)
In patients with ADHD and nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms 2. (Evidence: Weak)References
1 Scoten O, Tabi K, Paquette V, Carrion P, Ryan D, Radonjic NV et al.. Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period. American journal of obstetrics and gynecology 2024. link
2 Cunill R, Castells X, González-Pinto A, Arrojo M, Bernardo M, Sáiz PA et al.. Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use. Adicciones 2022. link
3 Schiweck C, Arteaga-Henriquez G, Aichholzer M, Edwin Thanarajah S, Vargas-Cáceres S, Matura S et al.. Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews 2021. link