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23 Jun 2019

Brown TE et al. Prim Care Companion CNS Disord 2019; 21: 18m02397

This study was funded by Shire, now part of Takeda

An understanding of functional impairments associated with adulthood ADHD is required in order to appropriately diagnose and manage ADHD in this population. This study aimed to address the type and severity of daily life impairments experienced by adults with ADHD currently taking pharmacotherapy compared with adults without ADHD. Identification of unmet needs in ADHD treatment from the perspectives of adults with ADHD was also an aim of this study.

Adults with ADHD* completed a 30-minute online survey in December 2016. This survey aimed to explore participants’ experiences with ADHD treatment and the impact of ADHD on their everyday activities across work/school, home and social environments. Adults without ADHD who did not hold a prescription for ADHD medication completed a 15-minute version of the survey. Satisfaction with current medication was analysed in ADHD subgroups by mean satisfaction scores.

In total, 616 adults with ADHD and 299 adults without ADHD completed the survey. The mean (standard deviation [SD]) age of the ADHD and non-ADHD groups was 39.0 (12.4) years and 43.1 (17.0) years, respectively. Participants were mostly white (ADHD vs non-ADHD, 84.0% vs 89.4%) and female (ADHD vs non-ADHD, 70.0% vs 70.3%).

Everyday life

Compared with adults without ADHD, adults with ADHD were more likely to report effects or challenges in:

  • Organising and activating to work (e.g. being organised in daily life, being organised and productive at work, and school work; all p < 0.0001)
  • Sustaining attention and concentration (e.g. reading [p < 0.001] and writing [p < 0.0001])
  • Sustaining energy and effort (e.g. finishing tasks and lack of motivation; both p < 0.001)
  • Managing affect/emotionality (e.g. feeling held back [p < 0.001], feeling overwhelmed [p < 0.0001], and anxiety [p < 0.05])
  • Working memory and accessing recall (e.g. forgetfulness, poor short-term memory and poor long-term memory; all p < 0.0001)
  • Interpersonal relationships (e.g. social gatherings [p < 0.0001], relationships [p < 0.0001], communication [p < 0.0001], appropriateness in social situations [p < 0.0001], and caring for children and parental responsibilities [p < 0.05]).

Home

Compared with adults without ADHD, adults with ADHD were more likely to have difficulty with:

  • Completing a task (15.5% vs 58.6%; p < 0.0001)
  • Paying bills on time (12.0% vs 28.4%; p < 0.0001)
  • Keeping the household organised (19.0% vs 52.8%; p < 0.0001)
  • Managing household chores (19.0% vs 48.1%; p < 0.0001)
  • Caring for pets (5.0% vs 11.0%; p = 0.0116)
  • Caring for children or handling parental responsibilities (3.0% vs 11.7%; p = 0.0003).

Social life

Compared with adults without ADHD, adults with ADHD were more likely to:

  • Have difficulty in focusing when with friends and family (6.0% vs 29.2%; p < 0.0001)
  • Have difficulty holding conversations (10.0% vs 31.7%; p < 0.0001)
  • Be late to social events (6.5% vs 26.3%; p < 0.0001)
  • Not be able to sit through a movie (7.0% vs 19.0%; p < 0.0001)
  • A tendency to forget names (23.0% vs 37.5%; p = 0.002)
  • Forget to call friends (12.5% vs 29.9%; p < 0.0001)
  • Feel awkward (23.0% vs 7.5%; p = 0.0002)
  • Have difficulty making friends (14.5% vs 21.1%; p = 0.0405)
  • Have difficulty maintaining friendships (11.0% vs 21.9%; p = 0.0007).

School/work

Compared with adults without ADHD, adults with ADHD were more likely to have difficulty with:

  • Focusing on work (10.4% vs 50.4%; p < 0.0001) or school (18.2% vs 45.7%; p = 0.0187) tasks
  • Being organised (11.3% vs 42.3%; p < 0.0001)
  • Being productive (11.3% vs 34.3%; p < 0.0001)
  • Completing tasks on time (5.2% vs 28.3%; p < 0.0001).

Relationships

Compared with adults without ADHD, adults with ADHD were more likely to experience:

  • Problems with interpersonal communication (11.5% vs 27.1%; p < 0.0001)
  • Frustrating (9.0% vs 35.1%; p < 0.0001) or irritating (8.0% vs 26.8%; p < 0.0001) friends and family
  • Difficulties maintaining friendships (10.0% vs 21.6%; p = 0.0003)
  • Challenges being in romantic relationships (9.5% vs 16.1%; p = 0.0217).

Experiences with medication

  • The 616 adults with ADHD took either short-acting medication (SA; n = 166), long-acting medication (LA; n = 201) or augmenters(AU; n = 249).
  • Overall, ADHD participants were satisfied with their current medication (mean [SD] satisfaction scores: LA, 7.85 [1.83]; SA, 7.55 [1.89]; AU, 7.77 [1.77]).
  • No significant differences were reported in mean satisfaction scores between the ADHD participant subgroups in terms of onset (LA, 8.06 [2.03]; SA, 7.89 [1.97]; AU, 7.80 [1.90]; p > 0.05) and symptom control (LA, 7.91 [1.89]; SA, 7.48 [2.06]; AU, 7.65 [1.87]; p > 0.05) with current medication.
  • The LA subgroup reported significantly greater mean satisfaction scores with regard to medicine regimen/schedule (8.90 [1.51]) than the SA and AU subgroups (7.90 [2.00] and 7.66 [2.12], respectively; both p < 0.05).
  • The LA subgroup also reported significantly greater mean (SD) satisfaction scores with regard to duration of treatment effect (7.45 [2.23]) than the SA and AU subgroups (6.64 [2.26] and 6.58 [2.24], respectively; both p < 0.05).
  • Duration of treatment effect was rated as an important factor when choosing a medication by 43.5% of adults with ADHD. Additionally, the most frequently reported reason for augmentation in ~70% of the AU subgroup was that one dose did not last long enough. However, some patients may avoid LA formulations due to safety/tolerability concerns.
  • For the total ADHD group, participants reported that medication wearing off negatively affected their ability to manage schoolwork/homework (53.4%), work (49.0%), household responsibilities (50.5%), emotional responses or mood (39.0%), relationships (spouse/partner, 27.3%; colleagues, 24.8%; friendships, 20.9%; parents, 17.1%; children 21.6%), and their ability to be a responsible parent (21.4%).

The authors acknowledged several limitations that could affect the generalisability of these data to a heterogeneous ADHD population. Firstly, participants were recruited through a research panel and therefore may not accurately reflect an entire population of patients with ADHD. Secondly, more women than men were recruited into this study, despite the gender ratio of ADHD being almost 1:1. Thirdly, non-ADHD participants did not match participants with ADHD exactly in terms of sociodemographic characteristics. Finally, this study relied on self-reported diagnoses and participants were from the US, which may limit the relevance of these results to other countries.

The authors concluded that despite pharmacological intervention, many adults with ADHD may experience substantial impairment in multiple aspects of their daily life. They also noted that, overall, the LA subgroup were more satisfied with the performance of their medication. With this in mind, the authors suggested that this emphasises the need for clinicians to tailor a treatment regimen to patients and enquire about their daily functioning at specific time points throughout the day.

Read more about the impact of ADHD on the daily lives of adults currently taking ADHD medication here

 

*Participants were based in the US and recruited through research participant panels; a $3 incentive in panel points was offered. Eligibility criteria for participants with ADHD included: self-reported ADHD diagnosis, aged ≥18 years, currently taking ≥1 prescribed medication for ADHD, treatment initiated ≥6 months before screening, and no patient-reported diagnosis of a mental health disorder that would affect ability to complete the survey. For participants without ADHD, the same criteria applied, except they did not have a diagnosis of ADHD and could not be taking ADHD medication
Stratification groups were as follows: SA, participants taking short-acting medication ≤2 times a day; LA, participants taking long-acting medication once daily; AU, participants augmenting their current ADHD treatment by taking short-acting medication 2 times a day, long-acting medication >1 time per day, or a long-acting medication plus a short-acting medication
Based on an 11-point scale (0 = very dissatisfied to 10 = very satisfied)

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: 18m02397.

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