Objective:

To carry out an in-depth analysis of the evolution and current management of ADHD, paying attention to the neurobiological model narrative, statistical data, information on drug efficacy and safety, trends in adult population and non-pharmacological alternatives.

Methods:

A bibliographical search was carried out (December 2017) on ADHD and associated trends through Medline and the Cochrane Library. Clinical practice guidelines (NICE, Spanish guideline), regulatory agencies databases (Spanish Medicines Agency, EMA, FDA) and other complementary sources of information (drug bulletins, news media, websites) were also explored. Moreover, data on drug prescription and national consumption were requested from the Health Department of Navarre and the Department of Basic Common Services Portfolio (Ministry of Health).

Results/Conclusions:

ADHD is a phenomenon of variable prevalence and increasing drug consumption. The evolution of the ADHD concept has constantly changed in a substantial way and its etiology remains unknown. Arguments in favour of a biologic hypothesis lack consistency and no reliable biological markers have been found. Symptom-based scales are poorly correlated with relevant dysfunction outcomes. More and better designed research studies are expected on non-pharmacological therapies, playing behavioural therapy a lead role because of its potential usefulness. Drug treatment might provide some efficacy in the short term, with no clear improvement in longterm relevant outcomes. While adults are increasingly diagnosed and treated for ADHD, methylphenidate seems to be gradually replaced by lisdexamfetamine. Cardiovascular, psychiatric and endocrine adverse events should be closely monitored. According to a prudence-based medicine approach, drugs should always be considered as a short and exceptional help.

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