New study finds best treatments for adults with ADHD

Talking therapy and brain stimulation are not as good as drugs for treating adults with ADHD, according to the largest study of its kind.

Stimulant drugs and another medication – atomoxetine – appear to be the best treatment for managing symptoms of the condition, the study suggests.

Attention Deficit Hyperactivity Disorder (ADHD) used to be a condition commonly associated with childhood, but health officials estimate that up to 4% of the adult population in the UK have ADHD.

The new study, published in The Lancet Psychiatry, pooled together all studies on treating ADHD in adults.

Experts from the University of Oxford and the University of Southampton examined 113 trials involving more than 14,800 people.

They wanted to assess how well symptoms were controlled 12 weeks after a person had started treatment based on both doctor and patient reports.

They found that stimulants are the only ADHD treatment in adults which reduce symptoms, according to both patient and doctor ratings, and are well tolerated.

Another type of drug – Atomoxetine – was also found to effectively reduce symptoms, according to both doctors and patients, but appeared to be less well tolerated compared to a placebo, or dummy drug.

Only doctors reported that talking therapies, “cognitive remediation”, mindfulness, “psychoeducation”, and transcranial direct current stimulation – or brain stimulation – were better than placebo.

But the authors said that ADHD medications are not well tolerated by everyone.

And they cautioned that their findings were based on averages, so for some people these treatments may be beneficial.

Lead researcher Dr Edoardo Ostinelli, from the University of Oxford, said: “We focused on average effect sizes, average performance of interventions, and especially for pharmacological treatments.

“It could be of course, that specific individuals may prefer some treatment or non-pharmacological treatments, while some others may actually not benefit from them.”

And commentators said that the study did not examine the effects of drugs and other treatments when taken as a combination.

They also said that the study did not examine long-term treatment.

But the authors of the review say their analysis is the “most comprehensive” available and should inform future treatment guidelines.

Dr Ostinelli added: “This network meta-analysis is a pivotal step toward optimising ADHD treatment strategies in adults. By providing a comparative evaluation of pharmacological and non-pharmacological options, it lays the groundwork for more informed, patient-centred care.”

Professor Samuele Cortese, from the University of Southampton, added: “There is significant variation in the way ADHD in adults is managed worldwide.

“Our study represents the most comprehensive evidence synthesis on the treatments for ADHD and should inform future guidelines.”

Andrea Bilbow, chief executive of the National Attention Deficit Disorder Information and Support Service, said that controversy surrounding ADHD medications do not come from patients or the medical community.

“For me, the controversy around medication does not come from within the patient population or the medical, it’s external,” she said. ” (It is) often people who perhaps don’t understand the condition, and don’t understand the medication, and don’t understand the impact the medication can have on the lives of people with ADHD.”

On rising rates of diagnoses in adults, she added: “Here we are today, with a huge number of adults who slipped through the net as children and so I think what we’re doing now is playing catch up as there’s more awareness raising.

“And yes, social media has a role to play in raising awareness and adults suddenly realising, ‘I think this is why I’ve struggled my whole life and I ought to go and find out if this is what’s happening to me’.

“So that’s, I think that’s what accounts for the huge increase in diagnosis, not just in the UK, but worldwide.”

Though some cases may be “misdiagnosed,” other experts said.

The NHS in England defines ADHD as “a condition that affects people’s behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse”.

It says that adults with ADHD may find they have problems with: organisation and time management; following instructions; focusing and completing tasks; coping with stress; feeling restless or impatient; impulsiveness and risk taking. And some adults may also have issues with relationships or social interaction.

Stimulants, a group of medicines that stimulate parts of the brain to improve concentration and attention and reduce impulsive and hyperactive behaviour, include methylphenidate (such as Medikinet or Ritalin), lisdexamfetamine (such as Elvanse), and dexamfetamine (such as Amfexa).

Atomoxetine works differently to stimulants as a selective noradrenaline reuptake inhibitor, which increases the amount of noradrenaline in the brain which can aid concentration and help control impulses.

The authors stressed that their paper, the largest “network meta-analysis” of treatment for ADHD in adults, did not examine treatment in children.

A similar research project in children, published in 2017, found that medications were effective, but a combination of medication and “parent training behaviour intervention” was even more effective, they added.

Commenting on the research, Dr Celso Arango from Hospital General Universitario Gregorio Maranon in Spain, said: “The analysis highlights a clear shortage of research on ADHD in adulthood, particularly regarding medium-term (beyond 12 weeks) and long-term treatment outcomes, consequently, the findings are applicable only to short-term treatment.

“The results suggest that pharmacological treatments are more efficacious than psychological or neurostimulatory interventions alone when compared to placebo, especially when assessed by patients themselves.

“However, in terms of acceptability, atomoxetine and guanfacine demonstrated less favourable profiles.

“One significant limitation is that the combined approach of pharmacological treatment plus psychological or other interventions was not assessed.”