Vol.:(0123456789) 1 3 Journal of Neural Transmission (2021) 128:1085–1098 https://doi.org/10.1007/s00702-021-02336-w PSYCHIATRY AND PRECLINICAL PSYCHIATRIC STUDIES - REVIEW ARTICLE Lifetime evolution of ADHD treatment Federico Mucci 1  · Barbara Carpita 1  · Giovanni Pagni 2  · Alessandra Della Vecchia 2  · Sarah Bjedov 3  · Andrea Pozza 4  · Donatella Marazziti 2,5 Received: 23 November 2020 / Accepted: 9 April 2021 / Published online: 15 May 2021 © The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2021 Abstract Attention-defcit hyperactivity disorder (ADHD), has been traditionally considered a neurodevelopmental disorder afect- ing children and adolescents characterized by inattention, hyperactivity, disruptive behavior, and impulsivity. Although still debated, it is evident that ADHD is also present in adulthood, but this diagnosis is rarely carried out, mainly for the frequent comorbidity with other psychiatric and/or substance abuse disorders. Given the need to shed more light on the pharmacological treatment of ADHD, we performed a naturalistic review to review and comment on the available literature of ADHD treatment across the lifespan. Indeed, stimulants are endowed of a prompt efcacy and safety, whilst non-stim- ulants, although requiring some weeks to be fully efective, are useful when a substance abuse history is detected. In any case, the pharmacological management of ADHD appears to be still largely infuenced by the individual experience of the clinicians. Further longitudinal studies with a careful and detailed characterization of participants across diferent phases of the lifespan are also required to provide relevant confrmations (or denials) regarding pharmacological treatments amongst the diferent age groups. Keywords ADHD · Pharmacological treatment · Lifespan management · Stimulants · Non-stimulants Introduction Attention-defcit/hyperactivity disorder (ADHD) is a neu- rodevelopmental disorder defned as “a persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with functioning or development” (APA 2013). Although in the past it was considered a purely childhood disease, with a prevalence rate ranging from 4 to 7% (Spen- cer et al. 2007; Katzman et al. 2017), it is now evident that it may persist into adulthood in about two thirds of the cases (Kessler et al. 2005; Wender et al. 2001; Caye et al. 2016; Agnew-Blais et al. 2016). Given the mounting aware- ness regarding this disorder and the improved diagnostic tools, currently there is an increasing rate of ADHD diag- nosis amongst both children and adults (Polanczyk et al. 2014). The Diagnostic and Statistic Manual of Mental Dis- order (DSM-5, American Psychiatric Association, 2013) recognizes three diferent ADHD subtypes: a predominantly hyperactive-impulsive type (ADHD-PH), a predominantly inattentive type (ADHD-PI) and a combined type (ADHD- C) for those showing both hyperactive/impulsive and inat- tentive symptoms. It is noteworthy that no agreement does exist on the prevalence of these subtypes that results quite heterogeneous in the available studies. Generally, ADHD girls show a higher rate of ADHD-PI than ADHD-C (Carl- son et al. 1997; Biederman et al. 2002). On the contrary, ADHD-PH and ADHD-C, frequently associated with con- duct problems, are the most prevalent subtypes amongst boys (Milich 2001), while ADHD-PI is less common and often comorbid with learning disabilities, or anxiety and mood disorders (Gaub and Carlson 1997a, b). Furthermore, clinical symptomatology and comorbidity tend to difer accordingly to the age. Adults are more likely * Federico Mucci federico.mucci@med.unipi.it 1 Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy 2 Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, Pisa, Italy 3 Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia 4 Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy 5 UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy