ADHD in adolescence and adulthood, with a special focus on the dopamine transporter and nicotine

• Published in: Dialogues in clinical neuroscience Vol. 8; no. 1; pp. 29 - 36
• Main Authors: Krause, Johanna, Krause, Klaus-Henning, Dresel, Stefan H., la Fougère, Christian, Ackenheil, Manfred
• Format: Journal Article
• Language: English
• Published: France Taylor & Francis 2006; Les Laboratoires Servier
• Subjects: adolescence; Adolescent; Adult; adulthood; Age Factors; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - metabolism; Attention Deficit Disorder with Hyperactivity - pathology; attention deficit hyperactivity disorder; brain imaging techniques; Clinical Research; Corpus Striatum - pathology; diagnosis; Diagnostic Imaging - methods; Dopamine Plasma Membrane Transport Proteins - metabolism; dopamine transporter; Drug Therapy, Combination; Humans; methylphenidate; Methylphenidate - therapeutic use; Neurobiology - methods; nicotine; Nicotine - therapeutic use; single photon emission computed tomography; therapy
• ISSN: 1294-8322; 1958-5969; 1958-5969
• DOI: 10.31887/DCNS.2006.8.1/jkrause

The persistence of attention deficit hyperactivity disorder (ADHD) into adolescence and adulthood has now been accepted as a clinical entity. The rate of prevalence among adults is assumed to be from 2% to 4%. With increasing age, a symptom change has to be considered; disturbance of attention becomes more prominent, whereas hyperactivity often diminishes or changes to inactivity. Neuroimaging studies show a high striatal dopamine transporter (DAT) availability in most adults with ADHD; this can be reduced by stimulants. Nicotine seems to have a stimulant-like action on the DAT. In most adults with ADHD, therapy has to be multimodal, combining psychotherapy and medication. Methylphenidate is the first-line drug in adult ADHD; further options are amphetamine and noradrenaline reuptake inhibitors. Nonresponders to methylphenidate seem to have no elevated DAT availability prior to therapy. Combination with other psychiatric disorders occurs frequently in adults with ADHD; in these patients additional pharmacological treatment with special regard to the comorbid disease is recommended.