Adults with attention-deficit/hyperactivity disorder (ADHD) are more frequently presenting for diagnosis and treatment. Medication is considered to be appropriate among available treatments for ADHD; however, the evidence supporting the use of pharmacotherapeutics for adults with ADHD remains less established. In this article, the effectiveness and dosing parameters of the various agents investigated for adult ADHD are reviewed. In adults with ADHD, short-term improvements in symptomatology have been documented through the use of stimulants and antidepressants. Studies suggest that methylphenidate and amphetamine maintained an immediate onset of action, whereas the ADHD response to the nonstimulants appeared to be delayed. At a group level, there appears to be some, albeit not entirely consistent, dose-dependent responses to amphetamine and methylphenidate. Generally speaking, variability in diagnostic criteria, dosing parameters and response rates between the various studies was considerable, and most studies were of a relatively short duration. The aggregate literature shows that the stimulants and catecholaminergic nonstimulants investigated had a clinically significant beneficial effect on treating ADHD in adults.

The link between Attention-deficit/Hyperactivity Disorder (ADHD) and substance use disorders (SUD) continues to be an area of great interest. In this report we discuss more recent work exploring the developmental relationship between ADHD and SUD and associated concurrent disorders. Recent work highlights the role of treatment of ADHD in children on subsequent cigarette smoking and SUD in adolescence and adulthood. Recent diagnostic issues examining ADHD in SUD populations are highlighted. Recent studies in patients with ADHD and SUD suggest that SUD treatment needs to be sequenced initially with ADHD treatment quickly thereafter.

Although psychotherapy is generally efficacious, a substantial number of patients fail to improve meaningfully, whereas still others deteriorate. Moreover, psychotherapists have difficulty forecasting which patients are at risk for nonresponse or deterioration, especially when relying predominantly on their judgment. These limitations have implications for the ethical practice of psychotherapy, and they call for remediation strategies. One such strategy involves the use of routine outcomes monitoring (ROM), or the regular collection of core patient progress information that can be fed back to the clinician and patient in real time. ROM-informed analytics outperform clinical judgment in predicting patients who are on or off track for treatment success, which can help psychotherapists plan and responsively adjust their interventions. Additionally, research demonstrates that ROM-generated feedback improves treatment outcomes for the average case who receives versus does not receive it. ROM data can also uncover between-therapist differences in general efficacy, as well as scientifically highlight clinicians' own relative strengths and weaknesses in treating different mental health problems. In light of such evidence, we submit that the research on ROM has matured to the point that it should occupy a central role in discussions of, and guidelines about, the ethical practice of psychotherapy. In this vein, we discuss ROM at patient, psychotherapist, and mental health care systems levels; namely, for each of these stakeholders, we review the extant empirical support before turning to possible ethical implications. Finally, we offer concluding thoughts on the expanding relevance of ROM for helping psychologists fulfill their ethical practice obligations. Clinical Impact StatementQuestion: After surveying relevant research, we discuss the growing role of routine outcomes monitoring (ROM) for helping psychotherapists and mental health care systems fulfill their ethical practice obligations, including maximizing patient benefit and minimizing harm. Findings: There is expanding evidence that ROM-generated information has the potential to improve treatment outcomes at the patient level (e.g., by identifying patients at risk of nonresponse or harm and informing clinician responsiveness to this signal), psychotherapist level (e.g., by helping to establish clinicians' objective strengths and weaknesses that could inform their selective practice and personalized training foci), and mental health care systems level (e.g., by referring patients to empirically good-fitting clinicians within a care network). Meaning: Research on ROM suggests that it should be considered in any discussion about the ethical practice of evidence-based psychotherapy. Next Steps: It will be important for clinical and research efforts to concentrate on increasing ROM implementation to fulfill ethical demands at the patient, psychotherapist, and systems levels.