Treatment for Adult ADHD with ASRS Score of 35
For an adult with an ADHD score of 35 on the Adult Self-Report Scale (ASRS), first-line treatment should include FDA-approved stimulant medication combined with evidence-based behavioral therapy.
Understanding the ASRS Score
A score of 35 on the ASRS indicates significant ADHD symptomatology, as scores above 23-26 on the 18-item scale suggest a high likelihood of adult ADHD 1. This score falls well above the clinical threshold and warrants comprehensive treatment.
Pharmacological Treatment
First-Line Treatment
- Stimulant medications (methylphenidate or amphetamine derivatives) are the first-line pharmacological treatment for adult ADHD 2
- For adults over 70kg: Start with 40mg daily of methylphenidate or 5-10mg daily of amphetamine/Adderall
- Increase after minimum 3 days to target dose of approximately 80mg for methylphenidate or appropriate amphetamine equivalent
- Maximum recommended dose: 100mg daily for adults 3
- May be administered as a single morning dose or divided doses (morning and late afternoon)
Second-Line Treatment
If stimulants are ineffective, contraindicated, or poorly tolerated:
- Atomoxetine: Start at 40mg daily, increase after minimum 3 days to target dose of 80mg daily 3
- Extended-release guanfacine or clonidine may be considered 4, 2
- Bupropion may be an option, particularly if there is comorbid depression 5
Non-Pharmacological Treatment
- Evidence-based behavioral therapy should be implemented concurrently with medication 4, 2
- Cognitive-behavioral therapy focused on organizational skills, time management, and impulse control
- Psychoeducation about ADHD for the patient and family members
- Skills training for specific deficits in executive functioning
Treatment Monitoring
- Follow-up within 2-4 weeks after medication initiation or adjustment 2
- Regular assessment of:
- Symptom improvement using standardized scales
- Vital signs, weight, and potential side effects
- Emergence of psychiatric symptoms or tics
- Functional improvement in daily activities
Special Considerations
- Screen for comorbid conditions that may complicate treatment, including anxiety, depression, substance use disorders, and bipolar disorder 4, 5
- Contraindications for stimulant treatment include glaucoma, symptomatic cardiovascular disease, hyperthyroidism, hypertension, concurrent MAOI use, and history of psychosis or mania 2
- For patients with hepatic impairment, dose adjustments may be necessary 3
- For patients taking CYP2D6 inhibitors (e.g., paroxetine, fluoxetine), lower starting doses and slower titration are recommended 3
Long-Term Management
- Periodic reevaluation of medication effectiveness and continued need 3
- Ongoing behavioral support to develop compensatory strategies for persistent symptoms
- Treatment may be needed for extended periods, as ADHD is often a chronic condition 3, 6
Treatment Efficacy
The combination of medication and behavioral therapy provides the most comprehensive approach to managing adult ADHD symptoms and improving quality of life 4, 5. Stimulant medications have the strongest evidence base for reducing core ADHD symptoms, while behavioral interventions help develop compensatory strategies for executive function deficits.
Remember that ADHD treatment is not just about symptom reduction but also about improving functional outcomes in work, relationships, and overall quality of life.