What does research say about Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

ADHD is a neurodevelopmental disorder that requires a multimodal treatment approach, combining medication and behavioral interventions, to effectively manage symptoms and improve outcomes, as recommended by the most recent clinical practice guideline 1.

Key Characteristics of ADHD

• ADHD is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning and development.
• The disorder affects approximately 5-7% of children and 2.5% of adults worldwide, with a high persistence into adulthood 1.
• ADHD has a strong genetic component, with heritability estimated at 70-80%, and is associated with differences in prefrontal cortex function and structure, affecting executive functions like attention regulation, impulse control, and working memory.

Treatment Options

• First-line medications include 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.
• Non-stimulant options include atomoxetine (Strattera, 40-100 mg daily), guanfacine (Intuniv, 1-4 mg daily), and clonidine (0.1-0.4 mg daily).
• Behavioral therapy, particularly cognitive-behavioral therapy, parent training, and educational interventions, is also effective in managing ADHD symptoms.

Importance of Timely and Adequate Treatment

• Untreated or inadequately treated ADHD can negatively affect many long-term outcomes, including academic achievement, employment status, and traffic accidents 1.
• Timely and adequate treatment is crucial to improve outcomes and reduce the risk of comorbidities, such as conduct disorder, obesity, and sleep problems.
• A comprehensive treatment plan should be individualized and multimodal, taking into account the age, severity of symptoms, and individual needs of the patient, as well as involving the patient's partner, family, or close relationships 1.

From the FDA Drug Label

INDICATIONS AND USAGE Dextroamphetamine sulfate tablets are indicated in: ... Attention Deficit Disorder with Hyperactivity: As an integral part of a total treatment program that typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in pediatric patients (ages 3 years to 16 years) with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate to severe distractibility, short attention span, hyperactivity, emotional liability, and impulsivity. The research says that Attention Deficit Hyperactivity Disorder (ADHD) is characterized by symptoms such as:

• Moderate to severe distractibility
• Short attention span
• Hyperactivity
• Emotional liability
• Impulsivity These symptoms are typically treated with a combination of psychological, educational, and social remedial measures, in addition to medication such as amphetamine 2 or atomoxetine 3.

From the Research

Overview of ADHD Research

• ADHD is a chronic, distressing, and interfering neurobiologically based disorder that is primarily treated with medications 4.
• However, most individuals treated with medications continue to evidence at least some residual symptoms and functional impairments 4.
• Research suggests that psychosocial interventions, such as cognitive-behavioral therapy (CBT), can be effective in treating ADHD symptoms in adults and adolescents 4, 5.

Treatment Strategies for ADHD

• Several treatment strategies are available for ADHD, including pharmacological and non-pharmacological interventions 6.
• Pharmacological treatments, such as stimulants and non-stimulants, can be effective in reducing ADHD symptoms 7, 8.
• Non-pharmacological treatments, such as CBT, can also be effective in reducing ADHD symptoms and improving functional outcomes 4, 5.

Efficacy of CBT for ADHD

• Research suggests that CBT can be an effective treatment for adults with ADHD, with improvements in core symptoms, emotional symptoms, and social functional outcomes 5.
• CBT combined with medication may present broader improvements in executive functions, but not in clinical symptoms, than CBT alone 5.
• The efficacy of CBT for ADHD symptoms in children and youth with autism spectrum disorder (ASD) is also supported by research, with reductions in hyperactivity and inattention symptoms 8.

Considerations for Treatment Selection

• The selection of treatment for ADHD should be individualized, taking into account the patient's specific needs and circumstances 6, 7.
• Clinicians should consider the potential benefits and limitations of different treatment strategies, including pharmacological and non-pharmacological interventions 6, 8.
• The quality of evidence for different treatment strategies can vary, and clinicians should be aware of the strengths and limitations of the available evidence 8.