The current scientific literature supports Attention Deficit Disorder and Hyperactivity Disorder (ADHD) to be diagnosable even in adults if they show a history of chronic and pervasive hyperactivity, inattention, and impulsivity with childhood onset. Numerous follow-up studies of the past decade point out that between 30 and 70% of children who had ADHD continue to show similar deficits in adulthood. The diagnostic criteria for ADHD in adulthood (see Utah 32 criteria) state that there should be four of the following characteristics and at least one of these should be particularly intense and pervasive: persistent motor hyperactivity from childhood, attention deficit persisting from childhood, affective lability, inability to complete tasks, excitable and explosive temperament, poor interpersonal relationships or inability to maintain relationships over time, impulsiveness, and poor tolerance to stress.  Psychiatric comorbidity and differential diagnosis represent a major issue in clinical practice both in children as, even more, in adults. Studies on adults with ADHD show that approximately 24-35% of the cases also have oppositional defiant disorder, 17-25% have a conduct disorder and 7-18% have a personality disorder. The link between intellectual disabilities and ADHD is quite common, with co-occurrence rates varying from 30 to 50%. This association may significantly exacerbate behavioral problems associated with ADHD and make the psychiatric diagnostic, with correct framework of specific mental disorders, more complicated. However, the main area of ​​co-morbidities or differential diagnosis is represented by mood disorders. The detection of adults with ADHD, mood disorders, and difficulty controlling anger is frequent in clinical practice. Bipolar Disorder is found in 21-25% of children with ADHD and even higher percentages in the combined subtype (with both inattention and hyperactivity). The correct identification of comorbidity or differential diagnosis between ADHD and Bipolar Disorders would be very difficult for the clinician, especially when there is also an intellectual disability or borderline intellectual functioning (between 70 and 85 IQ points). It must always be borne in mind that a deficiency in emotional self-regulation is one of the nuclear components of ADHD. Depression in adolescents and adults with ADHD requires a careful monitoring and cautious choice of the treatment, as the risk to develop a Bipolar Disorder is increased of the 50%. The oldest formal recognition and clinical depiction of what is today identified as ADHD was the inclusion of behaviors such as hyperactivity, distractibility, and impulsiveness under the term Minimal Brain Dysfunction (MBD). This clinical depiction dates back to the mid-60s. The concept of MBD brought together a combination of disorders that today are diagnosed separately as learning disabilities, ADHD, and mood or emotional disorders.


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Marco O. Bertelli, Giulia Vannucchi