Predictive Factors for More Than 3 Years’ Duration of Central Stimulant Treatment in Adult Attention-Deficit/Hyperactivity Disorder

Abstract

There is effective short-term central stimulant (CS) treatment of attention-deficit/hyperactivity disorder (ADHD) symptoms in adult ADHD, and despite this, many patients discontinue the treatment too early. The present study examines the duration of CS treatment in a Norwegian cohort of adult ADHD to identify predictors for long treatment duration (≥ 3 years). The data were based on the medical records of a sample of 117 of all 119 adult ADHD patients diagnosed over a period of 8 years in a specific catchment area and treated with CS. A logistic regression model was applied to identify possible predictors for long treatment duration. The sample was severely impaired in terms of comorbidity, educational achievement, and employment. The median duration of CS treatment was 33.0 months. Use of extended-release formulations of methylphenidate predicted long treatment duration positively (odds ratio, 4.420 [95% CI, 1.875-10.419]), whereas baseline antisocial personality disorder predicted long treatment duration negatively (odds ratio, 0.210 [0.085-0.518]). This study showed that it is possible to treat severely impaired and highly comorbid adult ADHD patients with CS over years. The finding that extended-release formulations of methylphenidate predict long treatment duration supports previous research, and it is important to show this association in naturalistic samples such as in the present study. Comorbid antisocial personality disorder was a negative predictor of long CS treatment duration. Univariate analyses also indicate that comorbid substance use disorder is related to shorter duration of CS treatment.

Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD): An open-label prospective study of time in treatment, dose, side-effects and comorbidity

“…Retrospective studies have found comorbidity related to less adherence to medication (Lensing et al, 2013;Torgersen et al, 2012), corresponding with our findings of less comorbidity among those adherent to treatment.…”

“…However, we found no gender differences in the global GAF-measures or for mental distress, and adherence at endpoint did not differ between the sexes, similar to reports by a 3 years retrospective study (Torgersen et al, 2012). Improvement on medication was found despite presence of comorbid psychiatric disorders.…”

Long‐Term Pharmacotherapy of Adults With Attention Deficit Hyperactivity Disorder: A Literature Review and Clinical Study

“…Cmorbid anxiety and bipolar disorders were associated with less effectiveness adjusted for age, gender and dosage. Retrospective studies have found comorbidity related to less adherence to medication , and this corresponds with our findings with less comorbidity among those adherent to treatment. Medication dosages were in line with other medication studies in adults with ADHD .…”

Personality Disorder in Adult Attention-Deficit/Hyperactivity Disorder

“…Adler and Nierenberg (2010) noted that attrition approaches 65% in long-term ADHD studies, but did not address the reasons this occurs. Torgersen et al (2012) reported that adults with ADHD and antisocial personality had elevated dropout rates, whereas Lensing et al (2013) felt that treatment noncompliance in ADHD adults is associated with comorbidity. Victor et al (2009) found as well that comorbidity was associated with attrition.…”