Sitting on a plane back from Berlin, Germany, I thought I’d convey information about adult ADHD you may not readily find. I had the opportunity to be invited to a small meeting of international experts on adult ADHD from several countries (2 from North America, 3 from Europe). The purpose of the gathering was to exchange the current state of the art for adult ADHD in the respective countries. It was fascinating discussion because all the experts agree on what adult ADHD is. This agreement occurs despite varying levels of research in the individual countries. It appears that the experts are relying on the internationally published medical literature for guidance. The opponents to the validity of adult ADHD claim that the disorder is largely a U.S. phenomenon and doesn’t exist elsewhere in the world. These folks have apparently not left the U.S. to discuss it with other psychiatrists. Nor are they aware of the ongoing international research funded and conducted by the World Health Organization.

In some European countries (Germany, United Kingdom and Netherlands) there are centers with experts conducting research on adult ADHD and providing care. However, there are also countries (France, Italy, and Spain) that remain opposed to the diagnosis. Unfortunately, not believing in the disorder doesn’t mean the disorder doesn’t exist in the population. Because you close your eyes doesn’t mean the world goes away.

To advance care, there have been three publications recommending preliminary diagnosis and treatment guidelines internationally- CADDRA (Canada), NICE (United Kingdom) and European Consensus (several European countries). I was the pre-publication peer reviewer for the European consensus paper. To date, the United States experts have not yet issued such guidelines. It may be that we’ll wait until DSM-V (to be published in May 2013) better refines the diagnostic criteria for adults with ADHD. Canada and the European experts have not felt the need to wait because clinical guidance is necessary now in order to provide evidence-based treatment to adults with ADHD.

To compound the international difficulty in receiving care for adult ADHD, the medications available are severely limited and determined by country. Immediate release methylphenidate is the most commonly available but immediate release dextroamphetamine is less available. Atomoxetine, Concerta, Vyvanse, and Adderall are also variably available country to country. There are some countries where you may not enter with a stimulant medication (Italy and Japan). My patients traveling abroad need to be aware of this before leaving the U.S. For those countries that permit stimulants, I provide a note on my letterhead that states this person is under my medical care and should be allowed to carry medication. Medicines alway need to be in the prescription bottle appropriately labeled by the pharmacist.

I am very fortunate to be able to participate in international research on this disorder and cultivate a world-wide network of ADHD experts. This allows me to bring state of the art care and treatment back home to my patients, in addition to contributing to the world’s published research literature.