Recognizing Gaps in Treatment for Attention-Deficit Hyperactivity Disorder (ADHD)

Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder characterized primarily by impairments in attention, hyperactivity, and impulsivity¹. Although it is often seen as a childhood disorder, research has found that approximately 60% of individuals diagnosed with ADHD in childhood continue to experience symptoms into adulthood, with 41% of those experiencing significant impairment². In the United States, it is estimated that 6.5 million children and adolescents are managing ADHD, with 15.5 million adults having an official diagnosis, spotlighting the widespread impact of this complex condition

Associated Features of ADHD and Their Impact

For patients, the features of ADHD may extend beyond its three core symptoms to associated features^5,6. “In addition to inattention, hyperactivity, and impulsivity, ADHD is often accompanied by associated features such as executive function deficits and emotional dysregulation,” explained Board-Certified Psychiatrist Dr. Ann Childress. In adults with ADHD, executive dysfunction may occur nearly as often as the core symptoms. A study of children with the condition also found that 89% showed impairment in at least one executive function^7-9. Emotional dysregulation occurs in up to 45% of children and 70% of adults with ADHD and is often more frequent or severe in girls and women with the disorder^5,10-12.

Executive function deficits include working memory, planning, time management, decision making, and organization, whereas emotional dysregulation includes mood lability, irritability, anger outbursts, low frustration tolerance, and impulsive motivational response^,6,13-16. These symptoms can lead to difficulties in work and academic settings, strained relationships with family, friends, and colleagues, and are associated with higher rates of depression and anxiety^5,11.

“Unfortunately, overlapping symptoms between ADHD and psychiatric disorders such as anxiety and depression can lead to misdiagnosis and delay effective treatment,” shared Dr. Childress. “This poses significant challenges, as securing a diagnosis and developing an effective treatment plan with a healthcare provider are two critical factors in managing the condition’s varying symptoms.”

Unmet Needs in the Current Treatment Landscape

Current pharmacological treatments for ADHD can be effective in addressing core symptoms but may be less impactful for emotional dysregulation and lability in adults^17,18. Further, 25% of stimulant treatment responders may experience executive function impairments¹⁹. Due to the varied symptom profiles and high degree of residual symptoms for emotional dysregulation seen across patients, treatment responses vary considerably, with differences in efficacy, required dosages, tolerability, and side effects²⁰. Stimulants, in particular, are frequently associated with adverse effects such as insomnia, nausea, mood lability, and potential cardiovascular events, affecting both children and adults, while common side effects of non-stimulant ADHD medications include fatigue, decreased appetite, and sleep problems like insomnia or drowsiness. ^21-24

“These challenges underscore the significant unmet needs in ADHD treatment and the importance of ongoing research,” said Dr. Childress. “Advancing understanding of the disorder and developing well-tolerated, effective therapeutic options remain critical to addressing the limitations of current medications and improving outcomes for patients of all ages living with ADHD.”

Education Through Credible Resources

Beyond treatment advances, access to reliable education and support is essential for individuals and families navigating ADHD. Organizations like CHADD (Children and Adults with Attention-Deficit Hyperactivity Disorder) play a critical role in providing support for those managing the condition. For more information and resources, visit www.chadd.org.

References:

1. American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev).
2. Sibley MH, et al. J Child Psychol Psychiatry. 2017;58(6):655-62.
3. Danielson ML, et al. J Clin Child Adolesc Psychol. 2024;53(3)343-60.
4. Staley BS, et al. R. MMWR Morb Mortal Wkly Rep. 2024;73:890–895.
5. Soler-Gutiérrez AM, et al. PLoS One. 2023.6;18(1):e0280131.
6. van Stralen J. Atten Defic Hyperact Disord. 2016;8(4):175-87.
7. Kosheleff AR, et al. J Atten Disord. 2023;27(7):669-97.
8. Adler L, et al. Int J Methods Psychiatr Res. 2017;26(1):e1555.
9. Senkowski D, et al. Neuropsychol Rev. 2024;34(2):548-67.
10. Bodalski EA, et al. J Atten Disord. 2023;27(13):1540-58.
11. Shaw P, et al. Am J Psychiatry. 2014;171(3):276-93.
12. Perugi G, et al. Expert Opin Pharmacother. 2019;20(12):1457-70.
13. Willcutt EG, et al. Biol Psychiatry. 2005;57(11):1336-46.
14. Silverstein MJ, et al. J Atten Disord. 2020;24(1):41-51.
15. Ramos AA, et al. Clin Neuropsychol. 2020;34(5):873-98.
16. Faraone SV, et al. J Child Psychol Psychiatry. 2019 Feb;60(2):133-150. doi: 10.1111/jcpp.12899. Epub 2018 Apr 6. PMID: 29624671.
17. Lenzi F, et al. Neurosci Biobehav Rev. 2018;84:359-67.
18. Moukhtarian TR, et al. Eur Psychiatry. 2017;44:198-207.
19. Biederman J, et al. Eur Neuropsychopharmacol. 2011;21(7):508-15.
20. Luo Y, et al. Front Hum Neurosci. 2019;11;13:42.
21. Schein J, et al. J Med Econ. 2024;27(1):653-62.
22. De Crescenzo F, et al. Evid Based Ment Health. 2017;20:4-1.
23. Cortese S, et al. Lancet Psychiatry. 2018;5:727-38.
24. ADHD medications: How they work & side effects. Cleveland Clinic.

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