ADHD: Not Just for Kids

By Patrick E. Clarke, Office of Communications

Studies suggest that approximately four percent of adults may have attention deficit hyperactivity disorder, or ADHD. The symptoms of ADHD in adults are the same as those in children, but they manifest somewhat differently in adults. Adults with ADHD may have poor time management skills, have trouble with multi-tasking, become restless with downtime, and avoid activities that require sustained concentration.

“People are more aware of ADHD. But in adults, the condition is still often unrecognized,” said Tiffany Farchione, M.D., medical officer, Division of Psychiatry Products, in FDA’s Center for Drug Evaluation and Research. Many people may continue to have ADHD symptoms into adulthood, however, they can often learn to adapt to their condition and still lead productive and successful lives.

According to the Diagnostic and Statistical Manual of Mental Disorders, an adult diagnosed with ADHD can have symptoms of inattention that include being easily distracted and being forgetful in daily activities. Adults may also have symptoms of hyperactivity-impulsivity, such as being persistently on the move, talking excessively, and often interrupting or intruding on others.

A diagnosis of ADHD in an adult is only given when it’s known that some of the symptoms were present early in childhood, usually under the age of seven. “Most people can remember if they had the kinds of problems as young children that kids with ADHD have,” said Farchione.

Stimulant Medications

Stimulant medication can help control ADHD symptoms. When prescribing stimulants for adults, doctors must consider additional factors. Adult patients are often taking medications for other conditions that could interact with ADHD medicines. There has been some concern about stimulants and possible cardiovascular side effects.

“Two recently-completed studies on stimulant use did not find an association between use of stimulant medications and an increased risk of serious cardiovascular events,” said Farchione.

One of these studies¹ on stimulant use evaluated heart attacks, sudden deaths, and strokes in a sample of adults. This study did not find an increased risk of cardiovascular events in adults treated with ADHD medications.

Stimulants used to treat ADHD include:

Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Focalin)
Dextroamphetamine-amphetamine (Adderall)
Lisdexamfetamine (Vyvanse)

Stimulant drugs are available in short and long-acting forms. Stimulants seem to influence how the brain controls impulses and regulates behavior and attention. They work on two chemicals – dopamine and norephinephrine -- in the prefrontal cortex of the brain.

“The prefrontal cortex is like the brain’s filter – it helps you pay attention to important things and to ignore unimportant things,” said Farchione. “Although the exact mechanism of action of the stimulants is unknown, they seem to affect the prefrontal cortex and improve an individual’s ability to filter information,” said Farchione.

Side effects

Side effects of stimulants can include insomnia, anorexia, nausea, decreased appetite, weight loss, headache, increased blood pressure, faster pulse, abdominal pain and shifting moods. “Most of the time side effects occur when a person starts on the medication or the dosage is raised, but may resolve with continued use,” said Farchione.

Those using stimulants should read the section of the label named, “Information About Medications.” It provides an overview of potential side effects, allergic reactions, and expiration dates. Reading that section of the label is “the best thing a person can do,” said Farchione.

In addition, FDA recommends that patients treated with ADHD medications be monitored for changes in heart rate and blood pressure.

Other treatments

Stimulants aren’t the only treatment options. Three non-stimulant medications include Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine). “These medications generally take longer to work than the stimulant medications,” said Farchione. “So, it may take several weeks for a person to see an effect.”

Therapy can also help an adult with ADHD. Psychotherapy focuses on helping patients develop skills to resolve specific issues, such as learning how to reduce impulsive behavior and improving time management and organizational skills.