Do ADHD Treatments Improve Executive Behavior Beyond Core ADHD Symptoms in Adults? Evidence From Systematic Analysis of Clinical Trials

J Clin Pharmacol. 2023 Jun;63(6):640-653. doi: 10.1002/jcph.2209. Epub 2023 Mar 13.

Abstract

We sought to understand the effect of current treatments for attention deficit hyperactivity disorder (ADHD) on executive functioning deficits, which are often comorbid with ADHD, via a systematic analysis of adult ADHD treatment studies evaluating change in behavioral measures beyond the core symptoms of Diagnostic and Statistical Manual of Mental Disorders ADHD. The standardized mean difference for behavioral measures of executive functioning was determined from controlled trials of adults with ADHD and compared with effects on core ADHD symptoms. Several studies of atomoxetine revealed small to large standardized mean differences. Nonreplicated studies revealed small to medium effects for triple-bead mixed amphetamine salts, lisdexamfetamine, and forms of cognitive behavioral therapy. Proportional effect versus core ADHD symptoms ranged from 0.78 to 1.16 for atomoxetine, and from 0.65 to 1.44 across all the studies. ADHD treatments have effects on executive functioning behavior beyond core ADHD symptoms in adults. Clinicians can measure and treat this morbidity using available clinical tools.

Keywords: ADHD; adult; executive function; treatment.

Publication types

  • Review

MeSH terms

  • Adult
  • Amphetamine / therapeutic use
  • Atomoxetine Hydrochloride / pharmacology
  • Atomoxetine Hydrochloride / therapeutic use
  • Attention Deficit Disorder with Hyperactivity* / drug therapy
  • Central Nervous System Stimulants* / pharmacology
  • Central Nervous System Stimulants* / therapeutic use
  • Executive Function
  • Humans
  • Lisdexamfetamine Dimesylate / therapeutic use

Substances

  • Atomoxetine Hydrochloride
  • Amphetamine
  • Lisdexamfetamine Dimesylate
  • Central Nervous System Stimulants