Attention deficit hyperactivity disorder in the European adult population: prevalence, disease awareness, and treatment guidelines

Abstract

Background:

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder with childhood onset and persistence into adolescence and adulthood.

Methods:

Our literature review reports scientific publications and guidelines on the treatment of adult ADHD, with a particular focus on European countries, identified by literature searches in Medline and Embase. The final literature search was performed in July 2012, incorporating literature from 1974 to 2012. The primary research parameters were ‘Europe’ (including single European countries), ‘ADHD’, ‘attention deficit disorder’, ‘attention deficit’, ‘attention disorder’, and ‘hyperactivity’. Secondary search parameters were ‘comorbid’, ‘epidemiology’ or ‘prevalence’, ‘disease management’, ‘drug therapy’, or ‘therapy’. The main searches were also limited to adults and English language publications. The papers identified by this literature review were selected for inclusion by consensus of the authors based on clinical relevance.

Results:

Appropriate resources for the diagnosis and treatment of adult ADHD in Europe are scarce, and many cases go untreated, particularly because of the frequent presence of psychiatric comorbidities. Apart from atomoxetine, and an extended-release form of methylphenidate in Germany, no other medications have been approved for starting treatment in adult ADHD patients in the European Union. However, a variety of stimulant and non-stimulant medications are used off-label, and a number of studies have confirmed that these medications are well tolerated and effective in adult patients with ADHD.

Conclusions:

Our results emphasize the need for broader access to effective treatments for adult ADHD patients in Europe.

Keywords::

• Adult ADHD
• Attention-deficit/hyperactivity disorder (ADHD)
• Atomoxetine
• Epidemiology
• Methylphenidate
• Psychopharmacology
• Treatment guidelines

Transparency

Declaration of funding

This publication was supported by Eli Lilly & Co.

Declaration of financial/other relationships

W.D., A.K., and A.M. have disclosed that they are full time employees of Eli Lilly & Co. J.A.R.-Q. was on the speakers’ bureau and/or acted as consultant for Eli Lilly, Janssen-Cilag, Novartis, Shire, and Rubió in the last 3 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Janssen-Cilag, Shire, and Eli Lilly. The ADHD Program chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli Lilly, Janssen-Cilag, Shire, and Rubió. E.S. was on the speakers’ bureau and/or acted as consultant and/or conducted Phase III studies for Eli Lilly, Janssen-Cilag, Novartis, Shire, and Medice and received study support for an investigator initiated trial from Eli Lilly. E.S. also received travel awards for taking part in psychiatric meetings from Shire and Eli Lilly. J.A.R.-Q., A.M., A.K., W.D., and E.S. participated in the planning, conduct, interpretation of the study results, and the writing of the manuscript. All authors have approved the final version of the manuscript submitted.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

Thomas Wagner and Michael Riley, Trilogy Writing and Consulting GmbH, Frankfurt, provided medical writing and editorial support, respectively, that was funded by Eli Lilly & Co. Statistical consulting was provided by Deborah Quail from Eli Lilly & Co.