From the Guidelines
For adult-onset ADHD, the most effective treatment approach involves a combination of psychotherapy and medication, with stimulants being the first-line medication option, as they have been shown to be effective in 70% to 80% of people with ADHD 1. When evaluating and treating adult-onset ADHD, it is essential to start with a comprehensive assessment by a mental health professional or psychiatrist. This typically involves:
- Clinical interviews
- Rating scales
- Possibly neuropsychological testing If diagnosed, treatment usually combines:
- Medication: Stimulants, such as amphetamine-based stimulants (e.g., amphetamine, dexamphetamine, lisdexamfetamine) or methylphenidate, are the preferred first-line options, as a recent meta-analysis proposed amphetamines for adults as the preferred therapy 1.
- Psychotherapy: Cognitive Behavioral Therapy (CBT) is effective, typically 12-20 weekly sessions
- Lifestyle changes: Implement organizational strategies, use reminders/planners, establish routines, and practice stress management techniques It is crucial to weigh the risks of exposure to medications against the risks of untreated or inadequately treated ADHD, as discontinuing psychostimulant treatment during pregnancy can lead to worse mental health outcomes and significant impairments in functioning in the pregnant individual 1. Start with the lowest effective dose of medication and titrate up as needed, monitoring for side effects and adjusting accordingly. Combining medication with therapy and lifestyle changes provides a comprehensive treatment strategy, targeting both the neurochemical imbalances and behavioral patterns associated with ADHD. Regular follow-ups are crucial to assess progress and make necessary adjustments.
From the FDA Drug Label
Atomoxetine capsules are indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. The decision to prescribe drug treatment medication will depend upon the physician’s assessment of the chronicity and severity of the patient’s symptoms.
The evaluation and treatment options for Adult-Onset Attention Deficit Hyperactivity Disorder (ADHD) include:
- A comprehensive treatment program that may include psychological, educational, and social measures
- Drug treatment with atomoxetine, which 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
- Assessment of chronicity and severity of symptoms by a physician to determine the need for drug treatment
- Psychological and educational interventions as part of a total treatment program
- Social support as part of a total treatment program The maximum recommended total daily dose in adults is 100 mg 2.
From the Research
Evaluation Options for Adult-Onset Attention Deficit Hyperactivity Disorder (ADHD)
- Screening tools, such as the Adult ADHD Self-Report Screening Scale for DSM-5, can identify adults requiring evaluation for ADHD 3
- Clinical interviews and longitudinal family histories provide critical information that diagnoses ADHD and differentiates ADHD from psychiatric comorbidities 3, 4
- A comprehensive clinical interview that reviews representative symptoms starting in childhood that continue to cause impairment into adulthood is necessary for an accurate diagnosis of ADHD in adults 4
- It is often helpful to interview or obtain information from family, friends, coworkers, or school records to aid in diagnosis 4
Treatment Options for Adult-Onset Attention Deficit Hyperactivity Disorder (ADHD)
- First-line pharmacologic treatment of ADHD usually consists of treatment with a psychostimulant, and a variety of short-acting and long-acting formulations are available for use in adults 3, 5
- Long-acting medication formulations are often preferable for adults with ADHD, as they provide symptom control throughout the entire day and into the evening 3
- Nonpharmacologic treatments, such as psychosocial interventions, may be beneficial in treating both ADHD and comorbidities 5
- Treatment with stimulant or nonstimulant medications for ADHD can be life-changing for adults with ADHD, increasing productivity at home and work, reducing anxiety and impulsive behaviors, and improving interpersonal and community relationships 6
Considerations for Treatment
- Important safety concerns, including the potential for drug dependence and serious cardiovascular events, must be considered before prescribing stimulants 3
- Risk of abuse is a major concern, as stimulant treatments are controlled substances, and children with ADHD show increased risk of substance abuse 5
- Comorbidity with ADHD impacts treatment compliance, treatment response, and patient insight, and better clinical tools for assessing these conditions are needed 5