Treatment Of Adult Attention-deficit/hyperactivity Disorder Research Articles

Dispensing of attention-deficit hyperactivity disorder medications for adults in Aotearoa New Zealand

aim: To report dispensing trends for attention-deficit hyperactivity disorder (ADHD) in Aotearoa New Zealand, focussing on adults in order to highlight increasing demand for ADHD treatment by adults and to prompt discussion. method: Demographic and dispensing data for ADHD were obtained from the Pharmaceutical Collection between the years 2006 and 2022. This was stratified according to child (<18 years) and adult (≥18 years) populations. Population dispensing rates for methylphenidate and atomoxetine were calculated. Key findings are reported to reveal demographic and dispensing trends for medication treated ADHD in Aotearoa New Zealand. results: More males are dispensed ADHD medication than females, although this is less evident for adults (54.8% male). Māori adults are dispensed ADHD medication at a lower rate (10.1%) than Māori children (22.9%). There was a 10-fold increase in dispensing of ADHD medication for adults compared to a three-fold increase for children over the study period. New dispensing for adults doubled between 2011 and 2022. conclusion: Medication treatment for adult ADHD is increasing in Aotearoa New Zealand and includes treatment for persisting childhood ADHD and new diagnoses made in adulthood. Despite increases, dispensing rates for ADHD remain lower than prevalence estimates, suggesting a significant treatment gap. Addressing the treatment gap for ADHD may reduce negative effects of ADHD, but wider social influences should also be considered.

The need for speed? Exploring the risks and benefits of pharmacological treatment for adult ADHD in prisons

Attention deficit/hyperactivity disorder (ADHD) is overrepresented in prison populations globally. Although pharmacological treatment has generally been demonstrated to be an effective tool for managing ADHD symptoms in the general population, it remains controversial in the prison context. This is primarily due to concerns about the diversion and abuse of medication. To evaluate the impact of pharmacological ADHD treatment for adults who are or have been in prison, a narrative literature review was completed and seven international studies were identified. Further research into the use of stimulant medication in prisons, particularly within the Australian context, is recommended.

Reducing Risk in the Treatment of Attention-Deficit/Hyperactivity Disorder Among Adults With Comorbidities.

Recent widely publicized shortages in the U.S. supply of first-line medications for treatment of attention-deficit/hyperactivity disorder (ADHD) are thought to reflect increases in public awareness, help seeking, and treatment. ADHD is one of the most common neurodevelopmental disorders and is typically identified in childhood. In adulthood, ADHD symptoms are less likely to include hyperactivity, but inattention, impulsivity, and emotional dysregulation are common. Clinical evaluation of symptomatic adults who were not diagnosed as children requires corroboration of ADHD diagnostic symptoms in childhood and careful differentiation of ADHD from frequently co-occurring psychiatric and substance use disorders. Treatment of adult ADHD can result in improved functioning across multiple dimensions and comorbid disorders. Existing guidelines and consensus statements recommend an integrated approach to treating ADHD and all existing comorbid disorders, prioritizing the disorder that is creating the most difficulty for the individual. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 8-11.].

UK adult ADHD services in crisis.

The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.

A review of recent treatments for adults living with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a neuro-developmental disorder prevalent among children and adults. Adults living with ADHD can experience significant distress affecting their daily functioning on emotional, physical, interpersonal, familial and financial levels. Intervention programmes may be a way to mitigate these challenges. This review identified good evidence-based intervention studies for adults with ADHD and described the usefulness of these interventions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were searched from 2009 to 2019 across four medical- and psychological-focused electronic databases using EBSCOhost. All articles selected for the review's thematic meta-synthesis were appraised by attaining a threshold score of at least 61%, using the Smith-Franciscus-Swartbooi appraisal tool. Two autonomous reviewers engaged in the review process. The study adhered to all ethical principles pertaining to systematic review practice. Forty studies were identified for summation, including pharmacological, non-pharmacological and neuro-stimulation approaches. Most interventions used a multimodal approach. Results indicated the most effective stimulant and non-stimulant as methylphenidate and atomoxetine, respectively. Effective non-pharmacological approaches to treatment were identified as cognitive-behavioural treatment, mindfulness-based approaches, psycho-education and dialectical-focused therapies. Bright light treatment and neurofeedback were reported as the most efficacious neuro-stimulatory methods. Pharmacological and non-pharmacological approaches, as well as neuro-stimulation or a blend of these approaches were acknowledged as the most effective recent modalities in the treatment of adult ADHD. This review reported on the most current approaches to treat adult ADHD. This will facilitate a better understanding and informed decisions with regard to dealing with adult ADHD.

Recommendation forLong-term Management ofAdult Attention-Deficit/Hyperactivity Disorder inMilitary Populations, Veterans, andDependents: A Narrative Review.

In addition to the higher burden of mental health disease in the military, there is a compounding antecedent association between behavioral health comorbidities and the treatment of attention-deficit/hyperactivity disorder (ADHD) in this population. Despite the low prevalence of new-onset ADHD in adults globally, the rate of stimulant (i.e., amphetamines) prescription is increasing. Stimulants can exacerbate mental health disease (often masquerading as ADHD symptomatology), precluding optimal treatment of the underlying etiology and imposing unnecessary dangerous side effects. This study aimed to evaluate the long-term safety and efficacy of stimulants for managing adult ADHD. A nine-member multidisciplinary team reviewed a PubMed search with the terms "adult," "ADHD," and "stimulant." Targeted PubMed and Google Scholar searches for "adult ADHD" paired with Food and Drug Administration -approved ADHD medications and Google Scholar literature using forward and reverse snowballing methods were performed for high-quality studies focusing on long-term treatment in ADHD. An evidence table and clinical algorithm were developed from the review. Of the 1,039 results, 50 articles were fully reviewed, consisting of 21 descriptive and experimental studies, 18 observational, and 11 systematic reviews and meta-analyses. Illustrative cases within the structured discussion of the results highlighted ADHD and psychiatric comorbidities, risks, harms, and benefits of stimulant use, medication mechanisms of action, and limitations of the current evidence. The dearth of high-quality studies on long-term ADHD management in adults fails to establish a causal relationship between stimulant use and physiological harm. Despite mixed evidence supporting the benefit of stimulants, there is clear evidence regarding the risk of harm. The serious risks of stimulants include arrhythmias, myocardial infarction, stroke/transient ischemic attack, sudden death, psychosis, and worsening of behavioral health disease. Additionally, there is a possible long-term risk of harm due to chronic sympathetic load (i.e., cardiovascular system remodeling). Stimulants pose a greater risk for addiction and abuse compared to other evidence-based nonstimulant medications that have similar effectiveness. Both stimulants and nonstimulants might promote favorable neuroanatomical changes for long-term improvement of ADHD symptoms, but nonstimulants (atomoxetine) have the pharmacological advantage of also mitigating the effects of sympathetic load (sympatholysis) and anxiety (anxiolysis). Given the physiological uncertainty of extended stimulant use for adults, especially older adults with vulnerable cardiovascular systems, clinicians should proceed cautiously when considering initiating or sustaining stimulant therapy. For long-term treatment of ADHD in adults, clinicians should consider nonstimulant alternatives (including behavioral therapy) due to the comparatively lower side effect risk and the possible additional benefit in patients with behavioral health comorbidities. Long-term safety of stimulant use for adults with ADHD is uncertain, as existing studies are limited in quality and duration. This is particularly important for military populations with higher rates of mental health conditions. Managing ADHD and related conditions requires prioritizing cardiovascular safety, especially for older adults. Nonstimulant options can be helpful, especially in comorbid psychiatric disease. Before treating ADHD, ruling out and controlling other behavioral health conditions is essential to avoid masking or worsening underlying issues and reducing unnecessary medication side effects.

Practice Guidelines Development: The APSARD United States Guidelines for the Diagnosis and Treatment of ADHD in Adults

Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder arising in children that persists in many people for the remainder of their lives. While several diagnostic and treatment guidelines in the United States (US) have been developed for childhood ADHD, no guidelines have been published in the US for adults with ADHD. With the increase of care seeking by adults with ADHD accompanied by increasing ADHD medication prescriptions in the past few years, the American Professional Society for ADHD and Related Disorders Association (APSARD) has recognized the need for diagnostic and treatment guidelines for the US. The development of clinical practice guidelines follows a rigorous scientific process of literature review, conflict of interest management, levels of participation of the working group members, clinical recommendations based on published research, a ranking of the quality of data, and a Delphi process to evaluate the rank order of clinical recommendations with little published research available. The Institute of Medicine (now The National Academy of Medicine) and the American Psychiatric Association have established protocols for each of the aforementioned phases of the manuscript development. This article reviews this process in detail and conveys the complexity of the endeavor. [ Psychiatr Ann . 2023;53(10):449–454.]

START – physical exercise and person-centred cognitive skills training as treatment for adult ADHD: protocol for a randomized controlled trial

BackgroundCore symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse.ObjectiveTo implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants’ experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment.MethodsThis is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18–65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later.DiscussionData collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024.Trial registrationClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).

Adult Attention-Deficit/Hyperactivity Disorder: a Narrative Review of Biological Mechanisms, Treatments, and Outcomes.

Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous and complex neurodevelopmental disorder related to disruptions in various neuronal structures and pathways, dopamine (DA) transporter, and receptor genes, resulting in cognitive and regulation deficits. This article reviews recent research on the biological mechanisms and markers, clinical manifestations, treatments, and outcomes of adult ADHD as well as current controversies within the field. New research identifies white matter disruptions in multiple cortical pathways in adults with ADHD. New treatments for ADHD in adults such as viloxazine ER have shown preliminary effectiveness in addition to research showing transcranial direct current stimulation can be an effective treatment for adults with ADHD. Although questions exist about the effectiveness of current assessments of and treatments for adult ADHD, recent findings represent a step towards improving the quality of life and outcomes for individuals experiencing this life-long, chronic health condition.

390 A Mixed Methods Review of Endpoint Measures Utilized in Adult ADHD Medication Clinical Trial Design

OBJECTIVES/GOALS: To evaluate the clinical trial designs of stimulant medications approved for the treatment of adult Attention-Deficit/Hyperactivity Disorder (ADHD) and identify discrepancies between safety and efficacy outcome measure criteria. METHODS/STUDY POPULATION: There are 24 stimulants currently approved and marketed for the treatment of adult ADHD: 12 amphetamine (AMP)-based and 12 methylphenidate (MPH)-based formulations. A mixed methods review of clinical trials that have evaluated the safety and efficacy of these drugs will be performed using qualitative and quantitative data, including inclusion and exclusion criteria, primary and secondary outcome measures, manufacturer recommendations, and package inserts, as well as FDA recommendations for industry. After compiling a list of clinical trials for each of the 24 drugs, this information will be analyzed for themes and trends in the assessment of safety and efficacy with particular attention paid to differing criteria between individual drugs and/or the two subclasses of prescription stimulants. RESULTS/ANTICIPATED RESULTS: The FDA has published recommendations for ADHD medication clinical trial design, including suggested outcome measures utilizing validated assessment tools. However, the FDA notes that these assessments may be altered to fit study populations and indicate that other primary and secondary endpoint measures may be acceptable. As such, efficacy assessments for these drugs may vary greatly, and the specific criterion selected for each drug’s study population and outcome measures may suggest more specific indications and usage conditions for optimal efficacy. DISCUSSION/SIGNIFICANCE: Regulatory officials consider AMP- and MPH-based stimulants equivalent therapeutic options for the treatment of ADHD. A study of clinical trial criteria reveals that differing mechanisms have been used to evaluate safety and efficacy. This discrepancy may have implications that affect clinical decision-making and patient experiences.

Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement.

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.

Do ADHD Treatments Improve Executive Behavior Beyond Core ADHD Symptoms in Adults? Evidence From Systematic Analysis of Clinical Trials.

We sought to understand the effect of current treatments for attention deficit hyperactivity disorder (ADHD) on executive functioning deficits, which are often comorbid with ADHD, via a systematic analysis of adult ADHD treatment studies evaluating change in behavioral measures beyond the core symptoms of Diagnostic and Statistical Manual of Mental Disorders ADHD. The standardized mean difference for behavioral measures of executive functioning was determined from controlled trials of adults with ADHD and compared with effects on core ADHD symptoms. Several studies of atomoxetine revealed small to large standardized mean differences. Nonreplicated studies revealed small to medium effects for triple-bead mixed amphetamine salts, lisdexamfetamine, and forms of cognitive behavioral therapy. Proportional effect versus core ADHD symptoms ranged from 0.78 to 1.16 for atomoxetine, and from 0.65 to 1.44 across all the studies. ADHD treatments have effects on executive functioning behavior beyond core ADHD symptoms in adults. Clinicians can measure and treat this morbidity using available clinical tools.

Long-term treatment of adult ADHD in a naturalistic setting: clinical predictors of attrition, medication choice, improvement, and response

Objectives: The aim of this study was to identify clinical predictors of treatment attrition, medication choice, improvement and response to pharmacotherapy in adult attention-deficit/hyperactivity disorder (ADHD). Methods: 150 ADHD patients were enrolled and naturalistically followed-up for at least 4 months. Conners’ Adult ADHD Rating Scales–Observer: Screening Version (CAARS-O:SV) were used to measure ADHD severity. Results: 58 subjects (38.7%) were lost at follow-up, while 75 (50%) completed follow-up assessment, on average after 26.05 ± 11.99 weeks; 35 were treated with atomoxetine (ATX) and 40 with methylphenidate (MPH). Treatments were moderately effective (d = 0.72) and 37 patients (49.3%) were responders (≥30% CAARS-O:SV decrease). Patients lost at follow-up had lower inattentive symptoms, less generalized anxiety and family history of bipolar disorder, more amphetamine use disorder than follow-up completers. Compared to ATX-treated subjects, MPH-treated patients had greater severity of hyperactivity/impulsivity and were more frequently diagnosed with alcohol use disorder. While MPH and ATX showed similar efficacy, more pronounced improvements were observed in patients with combined ADHD, anxiety and substance use disorders. ADHD severity and comorbid substance use positively predicted response. Conclusions: Consensus-based hierarchical treatment of ADHD comorbidity is not consistently supported. Comorbid anxiety, mood and substance use disorders should not discourage the treatment of adult ADHD.

Toward Operationalizing Executive Function Deficits in Adults With ADHD Using the Behavior Rating Inventory of Executive Function—Adult Version (BRIEF-A)

Objective: Although group findings document that executive function deficits (EFDs) contribute to the morbidity associated with adult attention-deficit/hyperactivity disorder (ADHD), it is unclear whether easy-to-use assessment methods can aid in the identification of EFDs at the individual level. The aim of the present study was to assess whether the Behavior Rating Inventory of Executive Function—Adult Version (BRIEF-A), a well-standardized, self-report instrument that assesses behavioral concomitants of EFDs, can serve that purpose. Methods: 1,090 consecutively referred 18- to 55-year-old adults of both sexes who were clinically referred for the evaluation and treatment of ADHD between June 2016 and December 2021 completed a battery of scales assessing several non-overlapping domains of functioning. Because the BRIEF Global Executive Composite (GEC) offers a single point summary of all other BRIEF-A scales, we used receiver operator characteristic (ROC) curves to identify the optimal cutoff on the BRIEF-A GEC to categorize patients as having executive dysfunction. Results: We averaged the optimal BRIEF-A GEC cut-points from the ROC curve analyses to categorize patients with (N = 480; 44%) and without (N = 610; 56%) EFDs (BRIEF-A GEC score ≥ 70 or < 70, respectively). Adults with ADHD with EFDs had significantly more severe ADHD symptoms (ADHD Self-Report Scale scores ≥ 24: 94% vs 41%, P < .001); higher levels of psychopathology (Adult Self Report Total Problems T-scores ≥ 64: 75% vs 19%, P < .001), emotional dysregulation (69% vs 23%, P < .001), mind wandering (84% vs 48%, P < .001), and symptoms of autism (Social Responsiveness Scale T-scores ≥ 66: 24% vs 3%, P < .001); and worse quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire mean scores: 44.4 ± 8.2 vs 51.9 ± 8.5, P = .001) compared to those without EFDs. There were no major differences in outcomes by age, sex, or race. Conclusions: The BRIEF-A helped identify a sizeable minority of adults with ADHD with behavioral concomitants of EFDs that added substantial morbidity and disability beyond that expected by having ADHD alone.

Methylphenidate Differentially Affects Intrinsic Functional Connectivity of the Salience Network in Adult ADHD Treatment Responders and Non-Responders.

Simple SummaryMethylphenidate is frequently used to treat attention-deficit/hyperactivity disorder (ADHD). It has been reported to correct (aberrant) connectivity between brain regions. However, previous neuroimaging research has not provided a coherent picture. One possible reason is that methylphenidate may not necessarily result in a satisfactory clinical treatment response of every patient. This suggests that neuroimaging research about methylphenidate’s mode of action could benefit from subdividing patients into groups of treatment “Responders” and “Non-Responders”. However, previous research has not applied this idea so far. Here, we used machine learning techniques to discern Responders from Non-Responders based on clinical symptoms. Fifty-three stimulant-naïve adult ADHD patients underwent functional magnetic resonance imaging to determine functional connectivity at rest. Measurements were repeated after 6 weeks’ treatment with methylphenidate. We found that, prior to treatment, a specific part of the so-called salience network was hypo-connected with the bilateral putamen in the patient sample as a whole, compared with 50 healthy controls. After methylphenidate treatment, this aberrant connectivity was restored to almost “normal” levels in Responders, but not in Non-Responders. Involvement of the putamen is reminiscent of early positron emission tomography findings, already suggesting modulation of dopaminergic brain regions for the successful treatment of ADHD with methylphenidate.Positron emission tomography (PET) studies have shown involvement of the striatum when treating adult attention-deficit/hyperactivity disorder (ADHD) with methylphenidate (MPH). Results from resting-state functional magnetic resonance imaging (rs-fMRI) for the same issue were less unequivocal. Here, a new analytical framework was set up to investigate medication effects using seed-based rs-fMRI analysis to infer brain regions with alterations in intrinsic functional connectivity (IFC) corresponding with ADHD symptom reduction. In a within-subjects study design, 53 stimulant-naïve adult ADHD patients were investigated before and after 6 weeks of MPH treatment, using two major clinical symptom scales and rs-fMRI. The same data were acquired in a sample of 50 age- and sex-matched healthy controls at baseline. A consensual atlas provided seeds for five predefined major resting-state networks. In order to avoid biasing of medication effects due to putative treatment failure, the entire ADHD sample was first categorized into treatment Responders (N = 36) and Non-Responders (N = 17) using machine learning-based classification with the clinical scales as primary data. Imaging data revealed medication effects only in Responders. In that group, IFC of bilateral putamen changed significantly with medication and approached almost normal levels of IFC. Present results align well with results from previous PET studies, with seed-based rs-fMRI as an entirely different neuroimaging method.

Prevalence of attention deficit hyperactivity disorder in an adult mental health service in the Republic of Ireland.

Attention Deficit Hyperactivity Disorder (ADHD) is well recognised in childhood. However, recognition that it commonly persists into adulthood is relatively recent. This study is the 2nd phase of a two-phase epidemiological investigation of the prevalence of adult ADHD in outpatients in Ireland. In phase-1, 634 participants were screened with Adult ADHD Self-Report Scale (ASRS) and Wender Utah Rating Scale (WURS). Those scoring positive in both scales have been invited to participate in the 2nd phase where the scales Conners' Adult ADHD Diagnostic Interview (CAADID), Mini International Neuropsychiatric Interview (MINI), and Global Assessment of Functioning (GAF) were administered, plus clinical evaluation based in DSM-5. 131 were eligible, 110 participated (84.0%). Using the CAADID (DSM-IV criteria) 71 were diagnosed with ADHD. Projecting to the total sample (N = 634) the prevalence was 13.25%, CI:95%:10.71-16.14. Converting the DSM-IV criteria to DSM-5, 89 had ADHD (prevalence:16.72%, CI: 13.9-19.86). Using clinical evaluation, 86 were diagnosed with ADHD (prevalence:16.09%, CI:13.31-19.18). Only 3 cases were diagnosed before with ADHD. Comorbidity was higher in those with ADHD, with the median number of additional diagnoses 2 (min 0 max 8, IQR 3) Also, they had significantly higher rates of depression and recurred depression. Agreement between DSM-IV and DSM-5 was high (rho = 0.90, p < .0001). High rates of undiagnosed ADHD were found to be present among AMHS attendees. Clinicians in AMHS need to be knowledgeable and alert to possible ADHD among their caseloads, and offer appropriate intervention. Interventions are urgently required to increase the detection and treatment of adult ADHD.

Adult attention deficit hyperactivity disorder: principles of diagnosis and treatment

Monika Jasinskaitė1, Rasa Saulytė1, Vytautas Steponavičius1, Justinas Balčiūnas1, Brigita Baks2 1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania 2 Vilnius City Mental Health Center, Vilnius University, Faculty of Medicine, Clinic of Psychiatry, Vilnius, Lithuania Abstract Introduction. Attention deficit hyperactivity disorder (ADHD) most commonly occurs in childhood but may persist into adulthood [1]. Nearly 60% of patients diagnosed with ADHD in childhood, symptoms persist into adulthood [2]. Significant differences in the symptoms, diagnosis, and management of ADHD in children and adults. For a variety of reasons, adult ADHD is a disorder that has not been thoroughly evaluated by psychiatrists. The diagnosis and treatment of adult ADHD in Lithuania are not widely applied and regulated [1]. Aim: to select and analyze current literature data presenting clinic, diagnostics and recommendations for the treatment of adult ADHD. Methodology: a systematic review of the literature was conducted based on the scientific database PubMed, a selection of 3 advisory years of publications addressing the problem of adult ADHD. Results. A systematic analysis of the literature provides the main clinic, diagnostic and treatment recommendations for adult ADHD. 167 bibliographic records were identified during the search. Selected articles by title and summary. Publications were selected according to exclusion and inclusion criteria. 27 publications identified that met the criteria and the aim of the work. Conclusions. The most common symptoms in adults with ADHD are difficulty in planning and organizing their daily activities, impulsivity, and restlessness. In addition, adults are characterized by comorbid mental illness. Treatment for ADHD is complex and includes medical treatment, psychotherapy, learning life skills, and assistance in integrating into a study or work environment. Keywords: dysfunction; attention-deficit; hyperactivity; adults.

Insomnia Disorder in Adult Attention-Deficit/Hyperactivity Disorder Patients: Clinical, Comorbidity, and Treatment Correlates.

Introduction: Several investigations have been performed on insomnia symptoms in adult attention-deficit/hyperactivity disorder (ADHD). However, the relationship between insomnia disorder and adult ADHD has been neglected in research. The main objective of the current study is to analyze the differences between adult ADHD patients with and without insomnia disorder, in terms of ADHD clinical severity, medical and psychiatric comorbidity, psychopharmacological treatment, and quality of life.Material and Methods: Two hundred and fifty-two adult patients with ADHD (mean age 37.60 ± 13.22 years; ADHD presentations—combined: 56.7%, inattentive: 39.7%, hyperactive/impulsive: 3.6%) were evaluated with an exhaustive clinical and psychological evaluation protocol including semistructured interviews (for comorbidities and ADHD assessment) and symptom rating scales for ADHD. The diagnosis of ADHD and insomnia disorder was made according to DSM-5 criteria. Furthermore, the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale were administered.Results: Insomnia disorder was found in 44.4% of adult ADHD patients and was more common in combined presentation (64.3%) and in patients with more ADHD severity. Comorbidities (both medical and psychiatric), especially mood disorders (42%), anxiety disorder (26.8%), personality disorder (39.3%), and any substance use disorder (11.6%), were associated with a higher insomnia disorder prevalence. ADHD stimulant treatment was related to lower insomnia disorder compared to patients without medication, as well as ADHD stable treatment. Additionally, worse health-related quality of life was associated with insomnia disorder.Conclusion: Insomnia disorder is highly prevalent in adult ADHD and is related to higher ADHD severity and more psychiatric and medical comorbidities. Some stimulants and stable pharmacological ADHD treatment are associated with better outcomes of insomnia disorder.

Evaluating Guanfacine Hydrochloride in the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Adult Patients: Design, Development and Place in Therapy.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate and impairing levels of inattention, hyperactivity, or impulsivity, or a combination of these characteristics. It is estimated to affect around 4% of adults worldwide. In the past few decades, prescriptions for ADHD drugs (psychostimulants and non-psychostimulants) have increased significantly. However, the efficacy and safety of adult ADHD medications remains controversial. Guanfacine extended-release (GXR) is a non-psychostimulant ADHD drug that is a selective α2A-adrenergic receptor agonist, first approved for treatment of adult ADHD in Japan in June 2019. Our aim was to provide an overview of GXR pharmacology and review the studies on efficacy and safety that have been conducted in adults with ADHD. The beneficial actions of guanfacine are thought to be attributed to the strengthening of prefrontal cortical network connections, which regulate attention, emotion, and behavior via the activity at post-synaptic α2A receptors. Current evidence of GXR efficacy and safety suggests that GXR is an effective monotherapy treatment option for adults with ADHD.

Adult attention deficit hyperactivity disorder and early maladaptive schemas.

The purpose of the current study is to present the early maladaptive schemas in adult attention deficit hyperactivity disorder (ADHD). The study sample comprised 107 participants, including 55 adult ADHD and 52 healthy volunteers. The age of the participants ranged between 18 and 32 years. Structured Clinical Interview Form for DSM-IV Axis I (SCID-I) and Structured Clinical Interview Form for DSM-III-R Disorders (SCID-II) were applied to all participants and Diagnostic Interview for ADHD (DIVA) for ADHD group based on DSM-5 criteria. The participants filled the Young Schema Questionnaire (YSQ-S3), Adult ADHD Self-Report Scale (ASRS), Wender Utah RatingScale-25 (WURS), Beck Depression Inventory (BDI) and The Beck Anxiety Inventory (BAI). All maladaptive schemas were found to be statistically significantly higher in the ADHD group. As compatible with ADHD core symptoms, "Failure," "Emotional Inhibition," "Insufficient Self-Control" and "Social Isolation" were the most seen maladaptive schemas in the ADHD group. "Approval Seeking," "Entitlement/Grandiosity" and "Punitiveness" were found the weakest schemas in the ADHD group. This study besides supporting the theory of early maladaptive schemas suggests that identifying and modifying maladaptive schemas interventions based on specific schemas can be an important and useful method for psychotherapy in treatment of ADHD.