Treatment Of Adult Attention-deficit/hyperactivity Disorder Research Articles

Exploratory meta-analysis on lisdexamfetamine versus placebo in adult ADHD.

BackgroundRecent studies have promised that lisdexamfetamine (LDX) is effective in the treatment of adults with attention-deficit hyperactivity disorder (ADHD).ObjectivesThis systematic review was undertaken to summarize LDX efficacy, acceptability, and tolerability in adult ADHD. All randomized controlled trials (RCTs) of lisdexamfetamine compared with placebo were included for synthesis. Clinical trials published between January 1991 and January 2014 were evaluated.MethodsThe database of MEDLINE®, EMBASE™, CINAHL®, PsycINFO® and Cochrane Controlled Trials Register were searched in January 2014. Studies were also searched in ClinicalTrials.gov and the EU Clinical Trials Register database. Study eligibility criteria, participants, and interventions were considered. All RCTs of LDX vs placebo reporting final results of: 1) severity of ADHD symptoms and executive function deficit, 2) response or remission rates, 3) overall discontinuation rate, or 4) discontinuation rate due to adverse events were included. The language of the papers was not restricted. All abstracts of studies gathered from the database were examined. After excluding irrelevant trials, the full text version of relevant studies were assessed and extracted for outcomes of interest. Examination of risks of bias, based on the Cochrane bias assessment, was carried out. The efficacy outcomes consisted of the mean end point or change scores for ADHD rating scales, the response rate, and the remission rate. The overall discontinuation rate and the discontinuation rate due to adverse events were measured for acceptability and tolerability, respectively. A random effect model was applied for the synthesis of relative risks (RRs), and weighted mean differences or standardized mean differences (SMDs) with 95% confidence intervals (CIs).ResultsA total of 806 final study or safety participants were included. The dosage of lisdexamfetamine was 30 to 70 mg/day. The pooled mean scores of mean change and mean end point scores between LDX- and placebo-treated groups also had a significant difference (SMD [95% CI] of −0.97 [−1.15, −0.78], I2=18%). The pooled response rates for adult ADHD between the two groups had a significant difference (RR [95% CI] of 1.99 [1.50, 2.63], I2=0%). Based on the Behavior Rating Inventory of Executive Function – Adult version (BRIEF-A), the pooled end point mean scores for the Global Executive Composite (GEC) for the LDX-treated groups was greater than that of placebo-treated groups (MD [95% CI] of −9.20 [−14.11, −4.29], I2=34%). The pooled overall discontinuation rates between the two groups had no significant difference (RR [95% CI] of 0.82 [0.59, 1.14], I2=0%). Similarly, the pooled discontinuation rates due to adverse events between the two groups was not significantly different (RR [95% CI] of 1.77 [0.71, 4.40], I2=0%).ConclusionThe number of included studies was limited (five RCTs), but based on this meta-analysis, LDX is efficacious and well tolerated in the treatment of adult ADHD. Additionally, it also improved the executive function deficits in this population. However, its acceptability is no higher than placebo. These findings should be carefully interpreted and considered as preliminary outcomes. To confirm these results, further studies are warranted. LDX is a viable alternative psychostimulant for adult ADHD.

Health state utilities associated with adult attention-deficit/hyperactivity disorder.

ObjectivesWith growing awareness of the importance of adult attention-deficit/hyperactivity disorder (ADHD) treatment, cost-effectiveness analyses, including utilities, are needed to compare the value of treatment options. Although utilities have been reported for childhood ADHD, little is known about utilities representing adult ADHD. Therefore, the purpose of this study was to estimate utilities associated with adult ADHD.MethodsHealth-state descriptions of adult ADHD were drafted based on literature review, interviews with four clinicians, and clinical trial data. Health states were revised based on a pilot study with 26 participants. Final health states were rated in time trade-off interviews with general population respondents in London and Edinburgh, UK.ResultsA total of 158 participants completed interviews (mean age =47.0 years; 49.4% female; Edinburgh =80 participants). Mean (standard deviation [SD]) utilities were 0.82 (0.17), 0.68 (0.28), and 0.67 (0.28) for health states describing treatment responders (health state A), nonresponders (health state B), and untreated patients (health state C), respectively. Most participants rated health state A as preferable to B (n=92; 58.2%) and C (n=97; 61.4%). The majority rated B and C as equal (n=125; 79.1%). Paired Student’s t-tests found that A had a significantly greater mean utility than B (t=10.0; P<0.0001) and C (t=10.2; P<0.0001).ConclusionThe current study provides utilities that may be used in cost–utility models of treatment for adult ADHD. Results reflected clear differences between health states representing treatment responders and nonresponders/untreated patients. Current utilities were comparable to those previously reported for childhood ADHD.

Guideline for Screening, Diagnosis and Treatment of ADHD in Adults with Substance Use Disorders

Currently there is no guideline for the screening, diagnosis and treatment of adult attention deficit/hyperactivity disorder (ADHD) in patients with a substance use disorder (SUD). The aim was to develop such a guideline, starting out from a systematic review and based on the methodology of the Scottish Intercollegiate Guideline Network (SIGN). Due to the lack of scientific evidence on some of the topics, the guideline is a combination of evidence based and practice based recommendations. Given the high prevalence of ADHD in treatment seeking SUD patients and the availability of valid screening instruments, all treatment seeking SUD patients should be screened for ADHD. Diagnosis of ADHD should be based on clinical observation and history taking, including informant data. Integrated treatment of ADHD and SUD is recommended, including pharmacotherapy, psycho-education, coaching, and cognitive behavioral therapy (CBT). The lack of scientific data and the overall lack of expertise in the field are significant obstacles to the implementation of the guideline. Intensive training programs in the substance abuse sector need to be organized to implement these guidelines.

Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double-blind randomized trial.

This study examines the effects of parental lisdexamfetamine (LDX) treatment on parent-child interactions. Participants were 30 parents (27% were male) and their children aged 5-12 years, both diagnosed with DSM-IV attention-deficit/hyperactivity disorder (ADHD). Optimal LDX dose (30, 50, or 70 mg/day) was determined for parents during a 3-week open-label titration, followed by a within-subjects trial of the acute impact of LDX and placebo on observable parent-child interactions. Two laboratory-based, parent-child interactions simulating typical family tasks (e.g., homework, joint play) were conducted within 2 weeks, once with the adult on a blinded optimal dose of LDX and once on placebo (phase I). Parents were then randomly assigned to continue blinded treatment with LDX or placebo for another month followed by a third interaction task (phase II) to assess the ongoing effects of LDX on parent-child interactions. The primary outcome was the change in rate of parenting behaviors coded during the parent-child interaction tasks. Secondary outcomes included observed rates of children's inappropriate behaviors during the laboratory tasks and changes in parental ADHD symptom severity (ADHD-Rating Scale). Twenty parents (67%) completed the trial. In phase I, medication was associated with a significant reduction in negative talk by parents (p = 0.0066, d = -0.47). There was a Medication × Task interaction (p = 0.0235) with a reduction in children's negative behaviors in the homework phase only (p = 0.0154, d = -0.58). In phase II, LDX was associated with significant increases in praise by parents (d = 0.81) and reductions in parental commands (d = -0.88) and children's inappropriate behaviors (d = -0.84) (all p-values < 0.05). While not reaching statistical significance, LDX was also associated with large reductions in parental verbalizations (d = -0.82), moderate increases in parental responsiveness (d = 0.55), and large reductions in the ratio of commands to verbalizations during the non-homework task (d = -1.05) (all p-values < 0.10). Significant reductions in parental ADHD symptoms vs. placebo were observed (p < 0.005). Loss of appetite, dry mouth, headaches, and delayed sleep onset were the most common adverse events. Improvements in parent-child interactions emerged over time with LDX treatment of parental ADHD. Results suggest that pharmacological treatment of parental ADHD may improve outcomes in parents and their children.

Micronutrient Treatment for Adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) in adults is disabling and can be difficult to treat. Specific medications are effective, but concerns

Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: Update on recommendations from the British Association for Psychopharmacology

Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal burden. The present guidelines summarise current literature, generating expert consensus recommendations for the treatment of ADHD in children and adults. These guidelines also provide a review of recent research in the fields of neuroimaging, neuropsychology and genetics of ADHD. Novel discoveries in these areas have informed physiological models for the disease. Since the publication of the previous British Association for Psychopharmacology guidelines in 2008, new drugs have been licensed and further compounds are being investigated. The publication of randomised controlled trials of psychological interventions has contributed to the range of treatment options for ADHD. As the disorder has been diagnosed more frequently there has been greater focus on comorbid conditions and how they impact treatment. Services have continued to develop for the treatment of ADHD in adults and care agreements have been introduced to facilitate access to treatment.

Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD

Few studies have examined the impact of childhood attention deficit hyperactivity disorder (ADHD) symptoms on adult ADHD functional outcomes. To address this issue dimensionally, ADHD symptoms in childhood and adulthood and their relation to educational deficits and work disability are studied in a clinical sample of adult patients with previously untreated ADHD. About 250 adults diagnosed systematically with ADHD according to DSM-IV were prospectively recruited. Primary outcomes were high school dropout and being out of the work last year. Childhood ADHD symptoms, sex differences, comorbidities of other mental disorders, and adult ADHD symptoms were examined by historical data, clinician interviews, and questionnaires. High levels of ADHD symptom severity in childhood were related to dropping out of high school [odds ratio (OR) = 3.0], as were higher numbers of hyperactive–impulsive symptoms in childhood. Significantly, more women than men were long-term work disabled (OR = 2.0). After adjusting for age and gender, persisting high levels of ADHD inattention symptoms in adulthood (OR = 2.5), number of comorbid disorders, and particularly anxiety disorders were significantly related to long-term work disability. Childhood hyperactive–impulsive symptoms and overall severity of childhood ADHD symptoms were associated with high school dropout rates; however, persisting ADHD inattention symptoms and comorbid mental disorders in adulthood were more correlated to occupational impairment. These findings underline proposals for studies on early recognition and interventions for ADHD and psychiatric comorbidity. They further suggest that inattentive symptoms be a focus of adult ADHD treatment and that workplace interventions be considered to prevent long-term work disability.

Pharmacological and clinical dilemmas of prescribing in co‐morbid adult attention‐deficit/hyperactivity disorder and addiction

The present article reviews whether available efficacy and safety data support the pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD) in patients with concurrent substance use disorders (SUD). Arguments for and against treating adult ADHD with active SUD are discussed. Findings from 19 large open studies and controlled clinical trials show that the use of atomoxetine or extended-release methylphenidate formulations, together with psychological therapy, yield promising though inconclusive results about short term efficacy of these drugs in the treatment of adult ADHD in patients with SUD and no other severe mental disorders. However, the efficacy of these drugs is scant or lacking for treating concurrent SUD. No serious safety issues have been associated with these drugs in patients with co-morbid SUD-ADHD, given their low risk of abuse and favourable side effect and drug-drug interaction profile. The decision to treat adult ADHD in the context of active SUD depends on various factors, some directly related to SUD-ADHD co-morbidity (e.g. degree of diagnostic uncertainty for ADHD) and other factors related to the clinical expertise of the medical staff and availability of adequate resources (e.g. the means to monitor compliance with pharmacological treatment). Our recommendation is that clinical decisions be individualized and based on a careful analysis of the advantages and disadvantages of pharmacological treatment for ADHD on a case-by-case basis in the context of active SUD.

EPA-0626 – Long-term safety of methylphenidate hydrochloride modified release (MPH-LA) in the treatment of attention deficit hyperactivity disorder (ADHD) in adults

A previous 40-week, randomised, double-blind placebo-controlled core study [comprising of dose confirmation (9-week), real-life dose optimisation (5-week) and maintenance of effect phases (6-month)] reported the safety of MPH-LA in the treatment of adult ADHD. Here, we report the long-term safety from the extension phase (6-month) of this core study. During the extension phase, patients initiated treatment with MPH-LA 20 mg/day; up-titrated to an optimal dose of 40, 60 or 80 mg/day in increments of 20 mg/week. Safety was analysed from baseline of maintenance of effect phase ( core study); and from baseline of extension phase to end of extension phase. Adverse events (AEs) and serious adverse events (SAEs) were reported. Incidence of AEs occurring anytime starting from baseline of the maintenance of effect phase (core study) until the end of extension phase was 80.5%. The incidence of AEs occurring in the extension phase period was 69.8% (Table). Incidence of serious AEs (SAEs) reported during both periods were similar (0.7%). Most common AEs were nasopharyngitis, headache, decreased appetite, dry mouth and nausea. No deaths were reported. No new or unexpected results were observed for laboratory findings, vital signs or ECGs. None of the patients had QT, QTcB or QTcF ≥500ms during the study. Long-term treatment with MPH-LA in adult ADHD patients was well-tolerated. Table: Number (%) of patients with most frequent AEs and SAEs AEs occuring anytime starting from the baseline of maintenance of effect phase (core study) to the end of extension phase AEs occuring anytime in the extension phase (Preferred Term ≥5%) N=298 n (%) N=298 n (%) Total AEs 240(80.5) 208(69.8) Nasopharyngitis 79(26.5) 57(19.1) Headache 62(20.8) 42(14.1) Decreased appetite 26(8.7) 23 (7.7) Dry mouth 24(8.1) 20 (6.7) Nausea 18(6.0) 15 (5.0) Upper respiratory tract infection 17(5.7) 14(4.7) Diarrhoea 15(5.0) 6 (2.0) Total SAEs 2(0.7) 2(0.7) Pancreatitis 1 (0.3) 1 (0.3) Exostosis 1 (0.3) 1 (0.3) Non-Hodgkin's lyrnphorna 1 (0.3) 1 (0.3)

EPA-0672 – Efficacy outcomes in age and sex subgroups from two clinical trials of lisdexamfetamine dimesylate in the treatment of adults with attention-deficit/hyperactivity disorder

Symptoms of attention-deficit/hyperactivity disorder (ADHD) persist into adulthood in many patients. Analyse post hoc the impact of sex and age on the efficacy of lisdexamfetamine dimesylate (LDX) in the treatment of adult ADHD. In NRP104.303, a 4-week, double-blind, forced-dose study, adults with ADHD were randomized (2:2:2:1) to receive LDX 30, 50 or 70 mg/day, or placebo. NRP104.304 was a 12-month, open-label, dose-optimized, extension to NRP104.303. In both studies, the primary efficacy outcome was the change from baseline in ADHD Rating Scale (ADHD-RS) total score. In NRP104.303 (N=420), least-squares mean changes from baseline to endpoint in ADHD-RS total score (standard error) were significantly greater for LDX (range across doses, −16.2 [1.06] to −18.6 [1.03]) than placebo (−8.2 [1.43]). Post hoc analyses revealed similar improvements with LDX in sex (male, LDX −16.7 [1.50] to −18.6 [1.53], placebo, −8.9 [2.12]; female, LDX −15.5 [1.56] to −19.3 [1.46], placebo −8.0 [2.02]) and age (18−39 years, LDX −15.3 [1.34] to −18.9 [1.31], placebo −5.6 [1.87]; 40−55 years, LDX −16.1 [1.81] to −17.1 [1.87], placebo −12.8 [2.52]) subgroups. In study NRP104.304 (N=349), improvements from baseline to endpoint in mean (standard deviation) ADHD-RS total score were similar between the overall population (−24.8 [11.7]) and sex and age subgroups (male −24.5 [11.5]; female −25.2 [12.0]; 18−39 years −25.3 [11.4]; 40–55 years −24.1 [12.2]). In short- and long-term adult studies, LDX was associated with improvements in ADHD symptoms in sex and age-related subgroups. Supported by funding from Shire.

Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen mit assoziierter Symptomatik und komorbiden psychiatrischen Erkrankungen: Diagnostik und medikamentöse Behandlung

Adult attention deficit/hyperactivity disorder (ADHD) is characterised by inattention and/or hyperactivity and impulsivity and is a frequent psychiatric disorder with childhood onset. In addition to core symptoms, patients often experience associated symptoms like emotional dysregulation or low self-esteem and suffer from comorbid disorders, particularly depressive episodes, substance abuse, anxiety or sleep disorders. It is recommended to include associated symptoms and comorbid psychiatric disorders in the diagnostic set-up and in the treatment plan. Comorbid psychiatric disorders should be addressed with disorder-specific therapies while associated symptoms also often improve with treatment of the ADHD core symptoms. The most impairing psychiatric disorder should be treated first. This review presents recommendations for differential diagnosis and treatment of adult ADHD with associated symptoms and comorbid psychiatric disorders with respect to internationally published guidelines, clinical trials and expert opinions.

AZD3480, a Novel Nicotinic Receptor Agonist, for the Treatment of Attention-Deficit/Hyperactivity Disorder in Adults

Laboratory studies have found that acute stimulation of nicotinic acetylcholine receptors improves cognition in adult attention-deficit/hyperactivity disorder (ADHD). Clinical trials of nicotinic agonists have been mixed, underscoring the need to understand the mechanisms for individual differences in clinical response. Using cognitive models within a clinical trial framework may provide insight into these differences. This was a within-subjects, randomized, placebo-controlled double-blind trial of the nicotinic agonist AZD3480 (also termed TC-1734) at doses of 5 mg and 50 mg and placebo in adults with ADHD. The order of the 2-week treatment periods was randomized, and a 3-week wash out separated each drug treatment period. Response inhibition (Stop Signal Task [SST]) and clinical efficacy (Investigator Rated Conners Adult ADHD Rating Scale [CAARS-INV]) were the a priori primary outcome measures of cognitive and clinical effects. We hypothesized that AZD3480 treatment would improve SST performance and clinical symptoms (CAARS-INV Total ADHD Symptoms Score). Thirty subjects were randomized, with 24 included in the intent-to-treat analyses. SST performance and total ADHD symptoms were significantly improved with 50 mg of AZD3480. CAARS-INV ratings of inattention, memory problems, and emotional lability/impulsivity were significantly improved with 50 mg of AZD3480. These results support previous work suggesting that nicotinic agonists are viable as treatments for adult ADHD. Measuring cognitive endophenotypes related to both the disorder and mechanism of treatment may help further rational drug development for dimensional features that cross-cut psychiatric disorders.

Psychotherapy for adult attention deficit/hyperactivity disorder: a comparison with cognitive behaviour therapy

Attention deficit/hyperactivity disorder (ADHD), a disorder generally associated with children, has become a valid disorder for adults in the last decade. The first line treatment of adult ADHD is medications, but historically there have been limitations to medication as the only treatment. Psychotherapy has become a feasible modality in the treatment of ADHD for those who have residual symptoms. The aim of this review of literature is to compare cognitive behaviour therapy with other psychotherapeutic treatment for effectiveness in improving symptoms of ADHD in adults and adolescences. The evidence-based practice approach by Stillwell et al. is adopted to guide the systematic review. The use of this small evidence utilization project that led to a synthesis of available research will provide direction for future research and expand knowledge in treatment for adult ADHD.

Psychosocial Therapy in the Treatment of Adults With Attention-Deficit/Hyperactivity Disorder

Optimal management of attention-deficit/hyperactivity disorder (ADHD) requires a comprehensive treatment approach that reduces symptoms and improves quality of life. Psychosocial therapy, an important adjunct to pharmacotherapy for patients with ADHD, enables patients to improve functional performance across domains of life and maximizes the benefits of symptom reduction achieved via medication. This article evaluates the main types of psychosocial therapies used in the treatment of adult ADHD and discusses treatment goals within the context of skill acquisition and strength optimization. Factors influencing the success of psychosocial therapy and the role of a comprehensive treatment approach are also examined. The sequenced presentation of symptom reduction and skill acquisition plays a key role in coordinating psychosocial therapy and pharmacotherapy in a multimodal strategy for the effective treatment of adult ADHD.

A Pilot Study of the Impact of Stimulant Pharmacotherapy in College Students with ADHD on Alexithymia and Psychological Mindedness

Objective: Alexithymia is increasingly recognized in a number of psychiatric disorders, but a possible relationship between alexithymia and adult attention-deficit/hyperactivity disorder (ADHD) has not been studied. It is not known if psychostimulants decrease symptoms of both ADHD and alexithymia. This relationship is examined in a small naturalistic and longitudinal study. Participants: Ten consecutive stimulant-naive college students seek assessment and treatment for ADHD during the academic year. Method: Participants completed three self-report instruments quantifying ADHD symptomatology, alexithymia, and psychological mindedness prior to initiation of stimulant pharmacotherapy and after three and six months of medication treatment without formal psychotherapy. Results: ADHD symptoms decreased significantly from baseline to three months and remained low at six months. Decreases in alexithymia and increases in psychological mindedness changed more slowly, with significant differences occurring at six months compared to baseline. Conclusions: This study suggests that stimulant pharmacotherapy in college students with ADHD decreases ADHD symptoms and alexithymia while increasing psychological mindedness. These results have implications for untreated adult ADHD patients seeking psychotherapy.

Evaluation of a Stress Management Training Program for Adults With ADHD-A Pilot Study.

We conducted a pilot study to examine the feasibility, acceptance, and subjective effectiveness of a new stress management training program tailored to the needs of adults with attention deficit hyperactivity disorder (ADHD). After a baseline evaluation of perceived chronic stress and coping strategies, 18 adults with ADHD participated in four sessions of stress management training and completed posttests on chronic stress and additional measures. Participants rated the acceptance and effectiveness of the training as high. Positive effects were found with respect to perceptions of excessive demands at work, chronic worry, and general stress experience. The findings suggest that stress management training is a valuable adjuvant for the treatment of ADHD in adults. Further development and evaluation of the intervention is desirable.

Pharmacological treatment of adult ADHD

This article reviews recent advances in the pharmacological treatment of adult attention deficit hyperactivity disorder (ADHD), focusing on the literature of the last 18 months. Recent works highlight the growing number of treatment options and focus on the effects of pharmacological treatment in special areas of adult ADHD including emotional dysregulation, social functioning or driving performance. Significant clinical improvement was demonstrated in special subgroups, for example, in substance dependent or prison populations with adult ADHD. In our earlier meta-analysis, we estimated the effect size for the pharmacotherapy of adult ADHD in short-term placebo-controlled studies to be in the medium-to-high range (Cohen-d = 0.65). We now replicate these results with the help of most recent studies: stimulants had greater efficacy than nonstimulants. Recent studies are consistent with prior reports and indicated that pharmacological treatment of adult ADHD is effective in improving symptoms and other domains, such as social dysfunction, functional impairment and executive functions. Furthermore, we calculated effect sizes from the most recent studies and they are almost identical with prior estimates, and in terms of Cohen-d typically indicate medium-to-high effect sizes for the pharmacotherapy of adult ADHD.

Pharmacotherapy for Parents with Attention-Deficit Hyperactivity Disorder (ADHD)

Given the high heritability of the disorder, attention-deficit hyperactivity disorder (ADHD) is common among parents of children with ADHD. Parental ADHD is associated with maladaptive parenting, negative parent-child interaction patterns and a diminished response to behavioural parent training. We describe our previous research demonstrating that stimulant medications for mothers with ADHD are associated with reductions in maternal ADHD symptoms. Although limited beneficial effects on self-reported parenting were also found in our study, the impact of ADHD medications on functional outcomes related to parenting and family interactions may not be sufficient for many families. Many questions remain with regard to how best to treat multiplex ADHD families in which a parent and child have ADHD. In particular, future studies are needed: (1) to evaluate how best to sequence pharmacotherapy, psychosocial treatment for adult ADHD and behavioural parenting interventions; (2) to determine the best approach to maintaining treatment effects over the long term for both parents and children; and (3) to identify individual predictors of treatment response.

Adolescent Attention Deficit Hyperactivity Disorder in the Secure Treatment Setting

This article examines issues related to adolescent and young adult attention deficit hyperactivity disorder (ADHD) in juvenile justice treatment settings. Characteristics of ADHD are first discussed including diagnostic criteria, gender, and prevalence in both community and secure settings. Next, the importance of adolescent ADHD to the juvenile justice system is examined, including risk for psychosocial impairments, antisocial problems, and aggressive behavior while in secure treatment settings and the issue of psychiatric comorbidity in ADHD youths. Recommendations for assessment of the ADHD adolescent are discussed. Evidence-based treatments are next reviewed and suggestions for modifying extant ADHD evaluation and treatment criteria for use with juvenile detainees are presented. Finally, we discuss issues pertaining to ethnicity in adolescent ADHD and how these issues are of importance to the evaluation and treatment of adolescent and young adult ADHD in the secure treatment setting.

P-1130 - Psychodynamic psychotherapy and Adult Attention Deficit Hyperactivity Disorder (ADHD)

Introduction Cognitive Behavioral and related psychotherapies such as Meta-Cognitive Psychotherapy are the most commonly cited and researched psychotherapy modalities in treating Adult Attention Deficit Hyperactivity Disorder (ADHD). The structure and goals of these therapies can be directly adapted to address ADHD symptoms. However, Psychodynamic Psychotherapy is not generally thought of as a common treatment alternative in ADHD. Indeed, psychoanalytically derived psychotherapies are not regularly utilized in the treatment of neurobiological disorders/ADHD. Adults with ADHD have commonalities in psychological developments due to secondary effects ADHD may have on the infant-caregiver interactions and the formation of later psychological structures. Research in the treatment of Adult ADHD demonstrates how patients share common defensive configurations secondary to common sequelae of ADHD such as underachievement and social maladjustment. Objectives The purpose of this abstract is to examine how the application of psychodynamic theory can be successfully utilized in several ways as a beneficial adjunct treatment of ADHD. Case examples of psychodynamic treatments of adults with ADHD will be presented as will common clinical issues in ADHD treatment. Methods This poster will present 4 case studies selected from a clinical population of a large metropolitan ADHD in Toronto, Canada and will discuss how psychotherapeutic techniques were utilized in conjunction with psychopharmacological agents to treat the symptoms of Adult ADHD. Conclusions The use and application of psychodynamic theory can be successfully utilized in significant ways as a beneficial adjunct treatment of ADHD as part of an integrative treatment approach which utilizes both psychotherapeutic and psychopharmacological approaches.