Addresses for correspondence: Lorraine E. Wolf, Ph.D., Clinical Director, Office of Disability Services & Assistant Clinical Professor of Psychiatry, School of Medicine, Boston University, 19 Deerfield Street, Boston, Massachusetts 02215. Voice/TTY: 617-353-3658; fax: 617-353-9646.
lwolf{at}bu.edu
Jeanette Wasserstein, Ph.D., Co-Director, Comprehensive Neuropsychological Services & Assistant Clinical Professor of Psychiatry, Mount Sinai School of Medicine, 277 West End Avenue, Suite 1C, New York, New York 10023. Voice: 212-724-1107; fax: 212-724-2597.
cnsnyc{at}aol.com
This concluding paper raises some final questions and issues
that the authors feel should receive more emphasis in future
research on ADHD in adults. One significant problem for our
field is the upward extension of child-based models and approaches
without proper adaptation to adults. With adults differing patterns
of comorbidity and symptom heterogeneity pose new conceptual,
diagnostic, and treatment challenges. As an illustration, we
review ten common presenting complaints in adults and their
link to the underlying core ADHD deficits of hyperkinesis, inattention,
and impulsivity. While these core symptoms are often overt problems
in children, in adults subtler executive dysfunction appears.
Even though the growing consensus is that ADHD is a disorder
of executive functions (EF), the details of the EF/ADHD connection
remain unclear and may be far more complex in adults. That complexity
is mirrored in the widening anatomic representation of EF, extending
beyond the frontal lobes into the subcortex and other nonfrontal
regions. More research will be needed to follow the developmental
trajectory of executive dysfunction in ADHD over the life cycle
and tie this to the developmental neuropsychology of EF. Psychosocial
context and nongenetic familial influence are also critical
variables that need greater consideration when characterizing
and measuring ADHD symptoms in adults. Finally, until we have
reached consensus on adult subject selection, we may not be
able to enhance diagnostic rigor or expand our conceptual framework
for understanding the underlying pathophysiology of ADHD in
adults.
