Day 1: Late-Breaking Updates From the National Academy of Sciences Conference on Adult ADHD

Tuesday, December 12, saw a historic meeting at the National Academy of Sciences addressing one of the nation’s most pressing mental health issues: the crisis in adult ADHD.

Held in conjunction with the CDC, the FDA, the DEA, and the Substance Abuse and Mental health Services Administration (SAMHSA), this meeting is bringing together the nation’s researchers, educators, and clinicians—including representatives from The American Professional Society of ADHD and Related Disorders (APSARD)—and individuals with lived experience from Children and Adults Living With ADHD (CHADD) and Attention Deficit Disorder Association (ADDA).

A Call for Equity

Craig Surman, MD, the scientific coordinator for the Adult ADHD Research Program at Massachusetts General Hospital began the conference with an excellent review of the consequences of untreated ADHD, including increased mortality rates, academic failure, economic disadvantage, and the need to promote equitable care for individuals with ADHD in disadvantaged populations and communities of color. The gene times environment interactions for genetic predisposition exacerbated among those from disadvantaged backgrounds highlighted the need for more equitable ADHD care within the health care ecosystem.

Later, Tamara Rosier, PhD, an ADHD coach with a lived ADHD experience, discussed the level of “shame they carry as exhausting” and highlighted, that we are still “missing so many adults” due to inequitable access to care. The ongoing struggle of living with ADHD was further highlighted by Russ Ramsey, who helped cofound the University of Pennsylvania adult ADHD program and struck a chord with the panel when he commented “that adults with ADHD are working twice as hard for half the results.”

ADHD Prevalence and Mortality

Ann Childress, MD, president of The American Professional Society of ADHD (APSARD), presented data highlighting that adult ADHD is one of the most common mental health conditions in the United States, with a prevalence of 4.4% in adults and 2.8% in seniors. In addition to being highly prevalent, Dr Childress cited information that untreated ADHD becomes progressively more fatal as comorbid conditions, such as depression, anxiety, insomnia, and substance use disorder begin stacking on top of the progressively devastating consequences of untreated ADHD. 

The mortality rate among individuals with ADHD is 150% times higher than that of the general population. For those with ADHD and 1 associated comorbid condition, the mortalkity rate is 450% times higher than the general population, and for those with ADHD and 2 comorbidities, the mortality rate is a staggering 850% that of the general population.

New Study Highlights Care Gaps

A ‘hot of the press’ study conducted by Dr Childress and Dr Greg Mattingly in conjunction with APSARD and CHADD, surveyed hundreds of individuals with ADHD and hundreds of clinicians caring for ADHD.

Highlighting dramatic gaps in care, over half of adults diagnosed with ADHD stated they were currently receiving no ADHD treatment. Primary barriers listed by both patients and clinicians included cost and insurance-created barriers—all of which were accentuated by this past year’s ADHD crisis and medication shortages—further fragmenting the pre-existing barriers in the ADHD health care ecosystem. This study highlighted that despite widespread usage of stimulants, only 23% of patients stated that they were fully satisfied with their current stimulant treatment. Over half of adults with ADHD stated that they were still experiencing difficulties with driving, difficulty with interpersonal relationships, difficulty with intimate relationships, and difficulties with financial insecurity associated with living with ADHD.

Overlapping Cognitive Symptoms of Adults With and Without ADHD

Margaret Sibley, PhD, clinical psychologist at Seattle Children’s Hospital and associate professor at the University of Washington reviewed data on the overlapping cognitive symptoms of adults with and without ADHD. Noting that the average adult has 3 symptoms of ADHD without any actual diagnosis, she highlighted the need for careful clinical assessment beyond just treating a chief complaint of attention or cognitive difficulties. She pointed out that ADHD symptoms often become increasingly elevated so that such symptoms not only cause functional impairment but are exacerbated by damaged self-esteem and altered self-image.

In addition, Dr Sibley highlighted the lack of equitable National Institute of Health (NIH) research funding for adult ADHD research. Despite affecting a larger total number of adults than children, the NIH is estimated to spend 78 million on pediatric ADHD research as compared to only 5.5 million for ADHD research in adults. This is approximately 10% of the $650 million spent by the NIH on depression research.

Currently Available ADHD Treatment Options

David Goodman, MD, APSARD secretary and assistant; clinical professor at Johns Hopkins University, then gave a thorough review of the impact of ADHD medications that have been developed for children, adolescents, and adults. He reviewed the role of various formulations of methylphenidate and amphetamine molecules. He then highlighted the role of non-stimulant options, including sustained-release clonidine and guanfacine in children, atomoxetine in children and adults, and the more recent FDA approval of viloxazine XR for both children and adults with ADHD.

Dr Goodman then reviewed the impressive body of literature from studies around the world that showed the improved functional outcomes of adults when appropriately diagnosed and treated for ADHD.

Breakthroughs in ADHD Neurology Research

This was followed by 2 robust panel discussions highlighting the increased understanding of the role of the prefrontal cortex and associated neural networks in individuals with ADHD. Amy Arnsten, PhD, Yale School of Medicine, led an insightful discussion of novel ADHD compounds in discovery, including Otsuka‘s centanafadine, which recently reported positive trials for both adults and children with ADHD, along with a recent positive double-blind trial for solriamfetol in adults. Novel pathways, including metabotropic glutamate modulation, nicotinic 7 receptors, cortisol-releasing hormone antagonists, and D1 receptor partial agonists were all discussed as potential future ADHD treatment options.

Stay Tuned for More

Day 1 ended with a robust discussion of this past year’s crisis in ADHD care and the dramatic impact on patients, clinicians and our entire mental health care ecosystem.

Check back tomorrow for another late-breaking update on day 2 from the National Academy of Sciences update on adult ADHD.

Visit our hub for the latest updates from the meeting.

Greg Mattingly, MD
Associate Clinical Professor, Washington University; 
President, Midwest Research Group;
Co-Chair, US Psych Congress;
President-Elect, American Professional Society for ADHD and Related Disorders