Addressing Unmet Needs in Attention-Deficit/Hyperactivity Disorder in Adults

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common conditions in children and adolescents; it often causes difficulties with attention, impulsivity, and hyperactivity. Although ADHD is often diagnosed during childhood, it can affect people across the lifetime.¹ Despite the numerous options available to treat ADHD, there remain significant unmet needs in this patient population, especially in adults.

Diagnosing Adult ADHD

The estimated lifetime prevalence of ADHD is approximately 9% in children and adolescents. Approximately 16 million US children, adolescents, and adults have ADHD.^2,3 The estimated lifetime prevalence of adult ADHD may be as high as 5%.⁴  

The American Psychiatric Association originally referred to ADHD as attention-deficit disorder (ADD) to describe people who have attention problems but who are not impulsive or hyperactive. However, the term ADD is no longer used, and ADHD is now described as any one of three types based on symptom presentation: predominantly inattentive, predominantly hyperactive/impulse, and combined. The table to the right shows the DSM-5 criteria for ADHD and symptoms for each type in adults (Table 1).⁵

Adults must meet the same DSM-5 criteria for ADHD as children; however, those 17 years or older must meet at least 5 symptoms of inattention and hyperactivity and impulsivity.⁶  

In clinical trials, adult ADHD symptoms are often evaluated using the Adult ADHD Investigator System Report Scale, or AISRS. This scale consists of 18 items based on each criterion of the DSM-5 for adult ADHD. It assesses for symptom frequency, severity, and pervasiveness. The AISRS has been utilized in clinical trials and found to be sensitive to drug effects in adults.⁷ 

Burden of Adult ADHD  

Over 80% of adult patients with ADHD are currently not diagnosed and/or not receiving treatment by psychiatrists.⁸ While clinical guidelines can help inform symptom evaluation and treatment of children and adolescents, no such guidelines are available for adult ADHD in the US. Therefore, it can be very challenging to identify ADHD symptoms in adults.⁹ An ADHD diagnosis is often missed due to the overlap of symptoms with those of other psychiatric conditions.¹  

Up to 90% of those diagnosed in childhood continue to struggle with symptoms into adulthood.¹⁰ Since ADHD is a lifelong disorder, patients must be closely monitored and treatment plans should be re-evaluated if the patient is not experiencing sufficient symptom relief. 

Treating Adult ADHD 

There are many treatment options available for adults with ADHD. In addition to pharmacological therapies, cognitive behavioral therapy is an effective treatment for ADHD.¹

Medications for ADHD fall into two main categories: stimulants and nonstimulants. Stimulant medications were first developed to treat ADHD. While they can help many people manage their symptoms, some patients would prefer not to take a stimulant due to side effects or how it makes them feel. 

All available stimulant medications are controlled substances monitored by the Drug Enforcement Agency (DEA), which can create access issues. These medications also have a potential for abuse.¹¹  

Nonstimulant medications can also cause side effects. These can include somnolence, decreased appetite, nausea, dry mouth, constipation, dizziness, and sweating. However, these medications are not controlled substances and therefore are not regulated by the DEA and do not carry the same restrictions. They also may have a lower risk of abuse potential.¹  

Addressing Unmet Needs in Adult ADHD  

Despite the treatment options available, many adults still struggle to manage their ADHD symptoms and many of these options are not approved for adults.^9,12 There is a clear need for medications that are approved for adults with ADHD, including those intolerant due to side effects or are otherwise contraindicated.¹¹  

Qelbree^® (viloxazine extended-release capsules) is an FDA-approved medication indicated to treat ADHD in adult and pediatric patients 6 years and older.¹³ It is the first nonstimulant therapy that has been approved for adults with ADHD in 20 years (Figure).¹⁴

IMPORTANT SAFETY INFORMATION

Please see full Important Safety Information to the top left. 

This medication is a selective norepinephrine reuptake inhibitor taken by mouth whole or sprinkled once daily.¹³  

Qelbree is also the first 2-bead Microtrol™ technology delivery of viloxazine for rapid and extended-release for full-day exposure.^13,15

Please see full Prescribing Information, including Boxed Warning. 

Learn more about this nonstimulant approach to treating adult ADHD: https://www.qelbreehcp.com/

References

1. Tampi RR, Tampi DJ, Elahi M. “Adult Attention-deficit/Hyperactivity Disorder (aADHD).” Psychiatric Times. Available at: https://www.psychiatrictimes.com/view/adult-attention-deficit-hyperactivity-disorder Accessed: April 15, 2022.
2. Centers for Disease Control and Prevention (CDC). Attention-deficit/hyperactivity disorder (ADHD)—Data and statistics about ADHD. CDC website. Accessed October 30, 2021. https://www.cdc.gov/ncbddd/adhd/data.html.
3. Culpepper L, Mattingly G. Challenges in identifying and managing attention-deficit/hyperactivity disorder in adults in the primary care setting: a review of the literature. Prim Care Companion J Clin Psychiatry. 2010;12(6):PCC.10r00951.
4. Caye A, Swanson J, Thapar A, et al. Life span studies of ADHD-conceptual challenges and predictors of persistence and outcome. Curr Psychiatry Rep. 2016;18(12):111.
5. Epstein JN, Loren RE. Changes in the definition of ADHD in DSM-5: subtle but important. Neuropsychiatry (London). 2013;3(5):455-458.
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013.
7. Adler LA, Shaw DM, Alperin S. ADHD diagnostic and symptom assessment scales for adults. In: Adler LA, Spencer TJ, Wilens TE, eds. Cambridge University Press; 2015:224-232.
8. Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01600.
9. Adler LA, Farahbakhshian S, Romero B, Flood E, Doll H. Healthcare provider perspectives on diagnosing and treating adults with attention-deficit/hyperactivity disorder. Postgraduate Medicine. 2019;131(7):461-472.
10. Sibley MH, Arnold LE, Swanson JM, et al. Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. Am J Psychiatry. 2021;179:142-151.
11. Budur K, Mathews M, Adetunji B, Mathews M, Mahmud J. Non-stimulant treatment for attention deficit hyperactivity disorder. Psychiatry (Edgmont). 2005;2(7):44-48.
12. Brown TE, Romero B, Sarocco P, et al. The patient perspective: unmet treatment needs in adults with attention-deficit/hyperactivity disorder. Prim Care Companion CNS Disord. 2019;21(3):18m02397.
13. Qelbree [package insert]. Rockville, MD: Supernus Pharmaceuticals, Inc.
14. FDA. “Novel Drug Approvals for 2021.” Available at: https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2020 Accessed: June 15, 2022.
15. Data on file. Supernus Pharmaceuticals, Inc.

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