Treatment of adult ADHD: Is current knowledge useful to clinicians?

Torgersen, Terje; Gjervan, Bjørn; Rasmussen, Kirsten

doi:10.2147/ndt.s1223

Cited by 40 publications

(38 citation statements)

References 60 publications

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“…6,23,37,40 Comorbidity was much higher than in most controlled studies of CS treatment in adult ADHD. 10 In line with previous research, there were no significant differences between the sexes in ADHD symptoms, but the females had significantly higher levels of psychiatric symptoms as measured by SCL-90 (Global Severity Index, 1.93 vs 1.40).…”

Section: Discussionsupporting

confidence: 89%

Predictive Factors for More Than 3 Years’ Duration of Central Stimulant Treatment in Adult Attention-Deficit/Hyperactivity Disorder

Torgersen¹,

Gjervan²,

Nordahl³

et al. 2012

Journal of Clinical Psychopharmacology

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There is effective short-term central stimulant (CS) treatment of attention-deficit/hyperactivity disorder (ADHD) symptoms in adult ADHD, and despite this, many patients discontinue the treatment too early. The present study examines the duration of CS treatment in a Norwegian cohort of adult ADHD to identify predictors for long treatment duration (≥ 3 years). The data were based on the medical records of a sample of 117 of all 119 adult ADHD patients diagnosed over a period of 8 years in a specific catchment area and treated with CS. A logistic regression model was applied to identify possible predictors for long treatment duration. The sample was severely impaired in terms of comorbidity, educational achievement, and employment. The median duration of CS treatment was 33.0 months. Use of extended-release formulations of methylphenidate predicted long treatment duration positively (odds ratio, 4.420 [95% CI, 1.875-10.419]), whereas baseline antisocial personality disorder predicted long treatment duration negatively (odds ratio, 0.210 [0.085-0.518]). This study showed that it is possible to treat severely impaired and highly comorbid adult ADHD patients with CS over years. The finding that extended-release formulations of methylphenidate predict long treatment duration supports previous research, and it is important to show this association in naturalistic samples such as in the present study. Comorbid antisocial personality disorder was a negative predictor of long CS treatment duration. Univariate analyses also indicate that comorbid substance use disorder is related to shorter duration of CS treatment.

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Section: Discussionsupporting

confidence: 89%

Predictive Factors for More Than 3 Years’ Duration of Central Stimulant Treatment in Adult Attention-Deficit/Hyperactivity Disorder

Torgersen¹,

Gjervan²,

Nordahl³

et al. 2012

Journal of Clinical Psychopharmacology

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“…Randomised placebo-controlled trials demonstrate superior efficacy of amphetamines in adults with ADHD (Torgersen 2008) and in treatment of cocaine dependence (Grabowski 2004a). Our literature search did not find any studies evaluating the efficacy of amphetamines in ADHD with substance use disorder.…”

Section: Amphetaminesmentioning

confidence: 88%

ADHD with comorbid substance use disorder: review of treatment

Magon¹,

Müller²

2012

Adv. psychiatr. treat

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SUMMarySubstance use disorders are a frequent co morbidity in adult attentiondeficit hyperactivity disorder (ADHD). This review discusses the relationship between adult ADHD and substance use disorder, including use of licit and illicit substances such as nicotine, alcohol, cocaine and cannabis. We discuss treatment studies in this area and provide a treatment algorithm to guide clinicians in the management of adult ADHD comorbid with different forms and severities of substance use disorder. Declaration of intereStU.M. has received research grant support from JanssenCilag and honoraria and/or travel expenses for conference presentations from BristolMyers Squibb, Eli Lilly, JanssenCilag, PharmaciaUpjohn, and UCB Pharma. Box 1 Main clinical issues of ADHD comorbid with substance misuse• Substance use disorders are a frequent comorbidity in ADHD• Significant challenges exist in assessing and treating ADHD in the context of substance use disorder comorbidity• No clear treatment guidelines and care pathways exist to guide clinicians to manage ADHD with comorbid substance use disorder• Issues in relation to exacerbation of substance use disorder, future risk of substance misuse and diversion of psychostimulants complicate treatment Patients with ADHD and substance use disorders tend to commence early and experiment more freely with substance misuse compared with patients with substance use disorder without ADHD (Krause 2002a). Two recent studies, the UMASS project and Milwaukee study (Barkley 2008) demonstrate important findings. Compared with matched controls, adults with ADHD were more likely to be past or current users of substances and used these substances in greater amounts. They were also more likely to receive treatment for previous alcohol and drug use disorders. The UMASS project and the Milwaukee study further demonstrate that children growing up with ADHD may carry a greater risk for using alcohol and tobacco, while clinic-referred adults with ADHD seem more likely to use marijuana, cocaine and lysergic acid diethylamide (LSD). Substances most commonly used by adults with aDHD (Box 3)Nicotine Studies in both adults and adolescents have found ADHD to be associated with earlier initiation of regular cigarette smoking and higher rates of lifetime smoking (41-42% v. 26% for ADHD and non-ADHD respectively) (Pomerleau 1995). Significant associations between ADHD symptoms and cigarette smoking have been found in both general population (Kollins 2005) and longitudinal studies (Milberger 1997;Molina 2003). Attention-deficit hyperactivity disorder has been shown to be an independent risk factor for tobacco use specifically in clinical and highrisk samples, even after controlling for comorbid conduct disorder (Milberger 1997;Molina 2003). Milberger et al (1997) followed 6-to 17-year-olds with and without ADHD for 4 years and found that ADHD was specifically associated with a higher risk of initiating cigarette smoking even when controlling for social class, psychiatric comorbidity and intelligence.Factors such as i...

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“…There is a documented and often unmet need for interventions aimed at supporting young people with ADHD and/or ASD in their transition between adolescence and adulthood [1] [2] [3] [4]. The transition from adolescence to adulthood is a critical stage in any individual's life.…”

Section: Introductionmentioning

confidence: 99%

Internet-Based Support and Coaching for Adolescents and Young Adults with Neuropsychiatric Disorders—The Implementation of an Intervention from an Organizational Perspective

Gillberg¹,

Wentz²

2017

Health

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There is a documented and often unmet need for interventions aimed at supporting young people with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) in their transition between adolescence and adulthood. Difficulties with social interaction, initiation difficulties, and impairments in executive function can complicate visits at a clinic, i.e. traditional treatment, for individuals with neuropsychiatric disorders (NPD). A model for internet-based support and coaching aimed at young people with ASD and/or ADHD was developed and tested at three treatment sites in western Sweden. The implementation was analyzed against an inventory according to which implementations are more likely to be successful if an intervention: 1) has advantages compared to other existing methods, 2) matches the individual and organizational values, norms and work practices of its recipients, 3) is perceived as easy to use, and 4) is adaptable to local conditions and the recipients' needs. Data were collected through group interviews with professionals involved in the implementation of the intervention. The implementation of the intervention showed promising results on measures such as access, delivery/quality of healthcare services, and equality of distribution of healthcare services. The identified impediments to successful implementation related to a wide range of factors and levels, including the design of the intervention, technical issues, attitudes of staff, organizational culture, and organizational structure at the implementation sites in terms of patient stock, work division, and resource allocation. The results are consistent with previous studies that stress the need for multi-component implementation strategies.

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Treatment of adult ADHD: Is current knowledge useful to clinicians?

Cited by 40 publications

References 60 publications

Predictive Factors for More Than 3 Years’ Duration of Central Stimulant Treatment in Adult Attention-Deficit/Hyperactivity Disorder

Predictive Factors for More Than 3 Years’ Duration of Central Stimulant Treatment in Adult Attention-Deficit/Hyperactivity Disorder

ADHD with comorbid substance use disorder: review of treatment

Internet-Based Support and Coaching for Adolescents and Young Adults with Neuropsychiatric Disorders—The Implementation of an Intervention from an Organizational Perspective

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