What is the diagnosis and treatment for Adult Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

Adults with Attention Deficit Hyperactivity Disorder (ADHD) should be treated with a combination of medication and behavioral strategies, prioritizing stimulants like methylphenidate or amphetamine-based medications as first-line treatment, alongside cognitive behavioral therapy (CBT) to improve executive functioning skills and emotional self-regulation. According to the most recent study 1, adults with ADHD are more likely to present with inattentive symptoms, and diagnosis requires a comprehensive evaluation using tools like the Adult ADHD Self-Report Scale (ASRS-V1.1). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, outlines specific criteria for diagnosing ADHD, including an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms, onset before age 12, and presence in two or more settings.

Key considerations in treating adult ADHD include:

• Medication: Stimulants like methylphenidate (Ritalin, Concerta) at doses ranging from 10-60 mg daily or amphetamine-based medications (Adderall, Vyvanse) at 5-70 mg daily, adjusted based on response and side effects 1.
• Behavioral strategies: Organizational systems, time management techniques, breaking tasks into smaller steps, and minimizing distractions are essential components of treatment.
• Cognitive behavioral therapy (CBT): Targeted CBT treatments have been developed specifically for ADHD and help people develop executive functioning skills, with literature suggesting that CBT is most effective when used in combination with medication 1.
• Diagnosis: Requires a comprehensive evaluation by a healthcare provider experienced in adult ADHD, as symptoms often overlap with other conditions.

It is crucial to prioritize the most recent and highest-quality study 1 when making treatment decisions for adult ADHD, considering the complexity of the condition and the need for individualized treatment approaches.

From the FDA Drug Label

Atomoxetine capsules are indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) The efficacy of atomoxetine capsules was established in seven clinical trials in outpatients with ADHD: four 6 to 9-week trials in pediatric patients (ages 6 to 18), two 10-week trial in adults, and one maintenance trial in pediatrics (ages 6 to 15) Atomoxetine hydrochloride is approved for ADHD in pediatric and adult patients.

Adult Attention Deficit Disorder is treated with atomoxetine, and the recommended dosage is as follows:

• Dosing of adults - Atomoxetine capsules should be initiated at a total daily dose of 40 mg and increased after a minimum of 3 days to a target total daily dose of approximately 80 mg administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon/early evening.
• After 2 to 4 additional weeks, the dose may be increased to a maximum of 100 mg in patients who have not achieved an optimal response. The maximum recommended total daily dose in adults is 100 mg 2, 2, 2.

From the Research

Diagnosis of Adult Attention Deficit Disorder

• Adult attention-deficit/hyperactivity disorder (ADHD) can persist into adulthood in at least 30 percent of patients, with 3 to 4 percent of adults meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., diagnostic criteria 3
• Diagnosis relies on a thorough clinical history, supported by a number of rating scales that take five to 20 minutes to complete, depending on the scale 3
• A comprehensive clinical interview, rating scales for past and present symptoms, and collateral information from multiple informants are essential for diagnosis 4, 5
• The diagnostic assessment should also include an evaluation of a broader spectrum of psychiatric and somatic conditions, as ADHD is often comorbid with other disorders 4

Treatment of Adult Attention Deficit Disorder

• Clinical guidelines recommend stimulants and the nonstimulant atomoxetine as first-line treatments, followed by antidepressants 3
• Cognitive behavior therapy has also been shown to be helpful as adjunctive treatment with medication 3
• Methylphenidate (MPH) is a commonly used medication for ADHD in adults, exhibiting a multimodal mechanism of action and showing moderate effectiveness in reducing core ADHD symptoms and emotion regulation deficits 6
• Adult ADHD is primarily treated with pharmacotherapy assisted by behavior interventions, and caution should be exercised when using stimulants during pregnancy and the postpartum period 7

Comorbidities and Complications

• ADHD is often comorbid with alcohol and substance abuse, anxiety, and personality disorders, and the diagnostic assessment should take these conditions into account 4, 7
• Adult ADHD patients often suffer from unemployment, financial difficulties, and an unsuccessful personal life, highlighting the need for a comprehensive treatment approach 7
• A number of conditions, such as thyroid disease, mood disorders, and substance use disorders, have symptoms similar to those of ADHD and should be considered in the differential diagnosis 3