(2012). Emotional dysregulation in adult ADHD: what is the empirical evidence? Expert Review of Neurotherapeutics: Vol. 12, No. 10, pp. 1241-1251.

Objectives. This trial was performed to test the efficacy and safety of an extended-release formulation of methylphenidate (MPH ER). Methods. A total of 162 adults with ADHD according to DSM-IV were treated for 8 weeks with either two daily individually body weight-adjusted doses of MPH ER up to 1 mg/kg per day (N = 84) or placebo (N = 78). The primary efficacy outcome was the Wender–Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) 8 weeks after randomization. Secondary efficacy measures were the ADHD Diagnostic Checklist (ADHD-DC), the Conners Adult Attention Deficit Disorder Scale (CAARS-S:L), the Clinical Global Impression (CGI) and the Sheehan Disability Scale (SDS). Results. At week 8 a significantly higher decline of the total WRAADDS score was found in the MPH ER group as compared to the placebo group (P = 0.0003). The rates of responders were 50% in the MPH ER and 18% in the placebo group (P < 0.0001). Furthermore, similar effects were observed for the secondary efficacy variable: ADHD-DC score (P = 0.004), CAARS-S:L score (P = 0.008) and the SDS score (P = 0.017). 50% of the MPH ER group and 24.4% of the placebo group were improved “much” or “very much” according to the CGI rating (P = 0.0001). MPH ER treatment was well tolerated. At week 2 also the mean heart rate was significantly higher in the MPH ER group as compared to the placebo group (P = 0.01). No differences between the study groups were observed regarding mean blood pressure at any visit. Conclusions. This clinical trial demonstrated statistically significant and clinical relevant effects of MPH ER in adults with ADHD for several self- and investigator-rated ADHD psychopathology and also functional efficacy measures.

Die Diagnose einer ADHS basiert auf dem Nachweis typischer psychopathologischer Merkmale, die sich bis in das Kindesalter zurückverfolgen lassen müssen. Entwicklungspsychopathologische Veränderungen der Symptomatik sind dabei zu berücksichtigen. Für eine zeitlich ökonomische, valide und reliable Diagnosestellung und Dokumentation der Diagnostik empfiehlt sich ein strukturiertes Vorgehen mithilfe standardisierter Instrumente. Hierfür steht inzwischen eine Reihe von Selbst- und Fremdbeurteilungsverfahren in deutscher Sprache zur Verfügung, mit denen sich die aktuelle und kindliche Symptomatik erfassen lässt. Für die Diagnostik im klinischen Alltag bietet sich als diagnostisches Hilfsmittel die „Integrierte Diagnose von ADHS im Erwachsenenalter“ (IDA) an, welche den Untersucher in standardisierter Form durch die erforderlichen diagnostischen Schritte führt. Es wird ein Überblick über die Verfügbarkeit standardisierter Instrumente gegeben und die aktuelle Datenlage bezüglich der Validität und Reliabilität von IDA dargestellt. Ascertaining the diagnosis of ADHD in adults according to DSM-IV requires determination of the presence of symptoms of inattention, hyperactivity and impulsivity during both childhood and adulthood. Developmental changes of psychopathology, age-related comorbidity and functional and psychosocial problems associated with ADHD have to be taken into account during the diagnostic process. The use of standardised instruments might improve validity and reliability of the diagnosis. These diagnostic tools comprise self and expert ratings as well as observer ratings for the retrospective assessment of childhood and the evaluation of current ADHD symptoms. Here we give an overview of the standardised instruments that are available in German language and present data regarding the validity and reliability of a structured guide for the integrated diagnosis of adult ADHD (IDA) which has been constructed in order to provide a feasible tool for diagnosis of ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is commonly accompanied by functional impairments within personal, professional, and social context as well as further psychological distress. The role of perceived stress has been examined in this regard, although little is known about the influence of stress coping strategies. We examined the dynamics between ADHD symptomatology, stress coping strategies, and life impairments in a sample of 230 clinical and non-clinical adult individuals. ADHD was associated with low probability of choosing adaptive but high probability of implementing maladaptive stress coping strategies as well as with increased life impairments. Adaptive stress coping showed little effects beyond the associations between ADHD and life impairments, whereas some maladaptive coping strategies increased current life impairments over and above the effects of ADHD and further psychological distress. The present findings emphasize the need of professional support in adults with ADHD and the necessity to include stress coping strategies in respective treatment approaches aimed at reducing life impairments.