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Adult ADHD: Future Directions for Practice and Research

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The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders

Abstract

Pharmacotherapy with stimulants is a mainstay of treatment of ADHD, but it is still challenged by stigma around their use and also for potential side effects leading to their interruption. As the stigma surrounding ADHD, the first aim of future research should deepen the relationship between genotype and phenotype of adult ADHD and their relationship with treatment outcomes. In this context, there are interesting findings regarding some drug-responsive transcripts among differentially expressed genes (DEGs) that have been suggested as potential biomarkers able to predict response to ADHD drugs, and as potential targets for the development of treatments to improve specific dimensions of ADHD phenotype. However, it should be emphasized that while many of data have been collected on children and adolescents and using animal models, this kind of research in adults with ADHD is still in its infancy. This is not a trivial thing, considering the different trajectories of ADHD over the lifespan as well as the comorbidity profiles of child and adult ADHD that change and only partly overlap. Moreover, there are only a few studies on ADHD remitters and the predictive power/accuracy of currently identified biomarkers is individually low.

There is growing evidence suggesting the potential of ADHD medication to lead to some brain changes, which appear to be persistent even after treatment interruption. The long-term efficacy of ADHD pharmacological agents on behavioral as well as neuroplasticity in adults with ADHD is an area that merits further investigation. Indeed, more evidence will give insights on “the best duration” rather than a long-life treatment perspective in people with a neurodevelopmental disorder such as ADHD.

However, treatment using pharmacological agents alone may not be enough to relieve ADHD symptoms and induce satisfactory functional improvement. Given the consistent rate of nonresponse to treatment of psychiatric disorders, and also of ADHD, there is a compelling need to develop new and alternative treatment interventions in order to improve effectiveness of current treatment options by targeting residual symptoms. In this chapter, we discuss evidence up to date regarding the utility of noninvasive brain stimulation techniques (NIBS) considered as a promising new approach to reduce some ADHD dimensions of pathology. Furthermore, on the basis of growing knowledge regarding the role of inflammation and of the gut microbiota in the development of those pathophysiological mechanisms underlying many psychiatric disorders, we suggested them as new therapeutic targets for future research.

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Pallanti, S., Salerno, L. (2020). Adult ADHD: Future Directions for Practice and Research. In: The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-39051-8_20

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