Pharmacotherapy for Attention-deficit–Hyperactivity Disorder
Pharmacotherapy for Attention-deficit–Hyperactivity Disorder
US Psychiatry 2009;2(1):17-28
Abstract
Attention-deficit–hyperactivity disorder (ADHD), one of the most common psychiatric disorders worldwide, is characterized by developmentally inappropriate levels of inattention and/or hyperactivity–impulsivity. Pharmacotherapy is an important treatment option for ADHD, either on its own or in combination with behavioral, educational, and family interventions. Although stimulants are the most widely prescribed medications for ADHD, with numerous studies demonstrating their efficacy and safety in children, adolescents, and adults, there are other agents that have been shown to be effective and that can be useful when stimulants are not indicated. Differences exist between Europe and North America in terms of the availability of pharmacological agents, guidelines for the use of drugs, and perceptions about therapeutic options. This article describes the pharmacological and clinical characteristics of different medications approved globally for the treatment of ADHD and the factors that contribute to varying treatment choices, therapeutic options, and perceptions about ADHD in Europeand North America.
Keywords
Attention-deficit–hyperactivity disorder (ADHD), stimulants, children, adults, pharmacotherapy
Disclosure: This article was supported by funding from Shire Development Inc.
Received: October 20, 2008 Accepted: November 28, 2008
Correspondence: Stephen V Farone, PhD, Department of Psychiatry, State University of New York, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210. E: farone@upstate.edu
Attention-deficit–hyperactivity disorder (ADHD), one of the most common psychiatric disorders worldwide, is characterized by developmentally inappropriate levels of hyperactivity–impulsivity and/or inattention.1 ADHD has been estimated to affect 5–12% of children worldwide,2–4 with approximately 30–70% of those with ADHD in childhood showing persistence of ADHD symptoms into adolescence5,6 and up to 66% into adulthood.6–10 Children diagnosed with ADHD are impaired across a number of major domains, including their functioning at school, at home, and with their peers.11 Schoolbased impairments include lower than expected or erratic grades, poor organizational and study skills, difficulty in test taking, and failure to complete homework.11 Children with ADHD perform less effectively in school than unaffected children in that they achieve poorer grades in academic subjects, have to repeat school grades more frequently, have more special educational placements, and require more out-of-class tutoring.12 The behavioral difficulties associated with ADHD include continuous friction with peers, parents, and teachers, often leading to placement in special classes, suspension and/or expulsion,13 and social rejection by their peers due to aggression, impulsivity, and noncompliance with rules.14 As they grow up, children with ADHD become disproportionately involved in the consumption of cigarettes, alcohol, and illicit drugs, and appear to maintain their risk for continued addictions later in life.15
Adults diagnosed with ADHD may still be hyperactive, impulsive, or inattentive, but their symptoms usually manifest in different ways from children.16 Symptom-wise, adults with ADHD often show overt hyperactivity symptoms less frequently than inattention-based symptoms; however, as in children, adults with ADHD experience significant impairments across several domains.17–20 These include immaturity, social maladjustment, higher rates of separation and divorce, fewer years of education, lower socioeconomic status, lower occupational achievement, lower rates of professional employment, increased work difficulties, poor work performance, more frequent changes in employment, and higher rates of quitting or being fired from jobs.18,21
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