Attention deficit disorders persisting in adulthood: A review

The diagnostic term "minimal brain dysfunction" (MBD) has in the past been applied in child psychiatry to encompass a number of behavioral and learning problems with which children may present. Clements¹ cited, in order of frequency, an extended array of symptoms subsumed under this syndrome: (1) hyperactivity; (2) perceptual motor impairment; (3) emotional lability; (4) incoordination; (5) short attention span; (6) impulsivity; (7) disorders of memory and cognition; (8) specific learning disabilities; (9) deficits of speech and hearing; and (10) equivocal neurological findings. The construct validity of MBD and its congeners (Hyperactivity, Hyperkinetic Syndrome) has, however, come under general disrepute. Controversy has arisen over imprecise definitions, etiological speculations, pharmacological manipulations, and the moral and political implications of applying the term indiscriminately. Yet interest in such a distinct entity remains unabated, as may be surmised by the establishment of the Attention Deficit Disorders (ADD) in the recently revised psychiatric nomenclature.². The course of an MBD-like syndrome past childhood and adolescence seems to be extremely variable, probably a reflection of its etiological heterogeneity. While some children may adapt satisfactorily to the demands of adulthood, the literature suggests that residua such as learning difficulties and antisocial behavior tendencies may linger. These symptoms may provide clues to suspect the persistence of ADD in adults who might otherwise carry other psychiatric diagnoses. Therapeutic modalities are discussed, cautious conclusions are drawn, and suggestions are made for elaboration of further research.