Low-dose amphetamine salts and adult attention-deficit/hyperactivity disorder

Background: Effective treatments for attention-deficit/hyperactivity disord er (ADHD) in adults are still being defined. Pediatric studies have suggest ed that a mixed amphetamine salt product (Adderall) is safe and effective i n the treatment of childhood forms of ADHD. Presently, there are no reports in the scientific literature concerning the safety and efficacy of Adderal l in adults with ADHD, which is the focus of this study. Method: Twenty-four outpatients (mean age = 33.3 years) with DSM-IV ADHD we re administered Adderall in an open-label fashion, starting at 5 mg p.o. b. i.d., with titration according to clinical response, across a 16-week perio d. Relatives or spouses of each patient completed serial checklists (includ ing the Copeland Symptom Checklist and the Brown Attention-Deficit Disorder Scales). Prospectively collected data were analyzed retrospectively. Results: Thirteen patients (54%) responded in a positive manner to Adderall , based on Clinical Global Impressions-Improvement scale scores. The mean e nd dose for responders was 10.77 mg/day (0.14 mg/kg/day). An intent-to-trea t analysis revealed a decrease in the mean Copeland score from 99.05 to 63. 3 (p < .001), while the mean Brown score dropped from 76.75 to 50.85 (p < . 0001). Nine patients (38%) were poor responders or nonresponders to Adderal l, Acute anxiety symptoms occurred in 4 of 7 patients with a comorbid anxie ty diagnosis. Conclusion: Adderall may be an effective agent for the treatment of adult f orms of ADHD, with positive responses occurring at relatively low doses, at least for some individuals. However, Adderall may precipitate anxiety in v ulnerable individuals. Further study is required.