From the Guidelines
ADHD symptoms include both inattentive and hyperactive-impulsive manifestations, and for diagnosis, children need six or more symptoms from either category, while adults need five, with symptoms present for at least six months, appearing before age 12, occurring in multiple settings, and causing significant impairment, as stated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, referenced in the study by Scoten, published in the American Journal of Obstetrics and Gynecology in 2024 1.
Key Symptoms
- Inattentive symptoms: difficulty sustaining attention, making careless mistakes, struggling to follow instructions, being easily distracted, forgetfulness, and avoiding tasks requiring sustained mental effort
- Hyperactive-impulsive symptoms: fidgeting, inability to stay seated, excessive talking, interrupting others, difficulty waiting turns, and feeling restless
Diagnosis and Treatment
- Diagnosis is based on the presence of symptoms in multiple settings, significant impairment, and symptoms not being better explained by another mental disorder
- Treatment may include medication, such as stimulants like methylphenidate or amphetamine compounds, or non-stimulants like atomoxetine, and behavioral therapy, as recommended by the American Academy of Pediatrics and the National Institute for Health and Care Excellence guidelines, and supported by studies such as those published in Pharmacology and Therapeutics in 2022 1 and Neuropsychopharmacology in 2024 1
Importance of Early Recognition and Treatment
- Early recognition and appropriate treatment can significantly improve functioning and quality of life, as highlighted in the study by Scoten, published in the American Journal of Obstetrics and Gynecology in 2024 1
- Untreated ADHD can have negative impacts on many life domains, including academic achievement, employment status, and social relationships, as noted in the study published in Pharmacology and Therapeutics in 2022 1
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) A diagnosis of ADHD (DSM-IV) implies the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and that were present before age 7 years. For the Inattentive Type, at least 6 of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes, lack of sustained attention, poor listener, failure to follow through on tasks, poor organization, avoids tasks requiring sustained mental effort, loses things, easily distracted, forgetful For the Hyperactive-Impulsive Type, at least 6 of the following symptoms must have persisted for at least 6 months: fidgeting/squirming, leaving seat, inappropriate running/climbing, difficulty with quiet activities, “on the go,” excessive talking, blurting answers, can’t wait turn, intrusive.
ADHD Symptoms include:
- Inattentive symptoms:
- Lack of attention to details/careless mistakes
- Lack of sustained attention
- Poor listener
- Failure to follow through on tasks
- Poor organization
- Avoids tasks requiring sustained mental effort
- Loses things
- Easily distracted
- Forgetful
- Hyperactive-Impulsive symptoms:
- Fidgeting/squirming
- Leaving seat
- Inappropriate running/climbing
- Difficulty with quiet activities
- “On the go”
- Excessive talking
- Blurring answers
- Can’t wait turn
- Intrusive 2
From the Research
ADHD Symptoms Overview
- ADHD symptoms include inattention, hyperactivity, and impulsivity, affecting approximately 9% of school-age children 3
- These symptoms can be evaluated using ADHD-specific questionnaires, and the recommended evaluation includes documenting the type and severity of symptoms, verifying normal vision and hearing, and screening for comorbid psychologic conditions 3
Treatment Options
- Stimulants such as methylphenidate and dextroamphetamine are the pharmacologic agents of first choice for managing ADHD, with individual children responding better to one stimulant medication than another 3
- Non-stimulant medications like atomoxetine are also effective in reducing core symptoms of ADHD, with studies showing significant improvement in emotional and behavioral problems among youths with ADHD 4
- Combined therapy of methylphenidate and atomoxetine has been shown to enhance the effectiveness of monotherapy, with significant improvement in symptoms and tolerability 5
Efficacy of Different Medications
- Methylphenidate and atomoxetine have been compared in several studies, with results showing that both medications are effective in improving ADHD symptoms, but with some differences in efficacy for specific symptoms such as aggressive behavior and somatic complaints 4, 6
- Amphetamine (AMP) and methylphenidate (MPH) have been recognized as first-line treatments for ADHD, with a higher efficacy relative to atomoxetine (ATX), although ATX has been shown to be effective in controlling impulsivity 7