Adult ADHD Prescriptions Surpass Pediatric Use

An increasing number of adults receiving prescription stimulant medications challenge the notion that ADHD is a children’s condition and create new obstacles for pharmacists attempting to manage symptoms.

Data compiled by lisdexamfetamine dimesylate (Vyvanse) maker Shire Plc show that adults accounted for 53% of the 63 million ADHD drug prescriptions filled last year—officially overtaking the amount of children receiving them. By comparison, adults comprised only 39% of ADHD prescriptions in 2007.

Several factors may be at play in this uptick. For instance, Christopher Thomas, PharmD, BCPP, BCPS, president-elect of the College of Psychiatric and Neurologic Pharmacists, told Pharmacy Times that “many of those millennials diagnosed with ADHD in the 90s are now adults, and ADHD does not automatically resolve itself when the child turns 18. Therefore, many of the cases of adult ADHD were identified when the child was young, but have now grown up.”

Additionally, specific clinical criteria to diagnose adult ADHD were not established until 2013, when the condition was defined in the DSM-5 released that year, Dr. Thomas said.

To meet these criteria, patients aged older than 17 years must have 5 symptoms of inattention or hyperactivity.

According to the Mayo Clinic, adult ADHD symptoms may include:

· Low frustration tolerance

· Unstable relationships

· Difficulty completing tasks

· Hot temper

· Impulsivity

In light of the increase in adult ADHD diagnoses, pharmacists can play a critical role in managing proper treatment regimens.

“First, the pharmacist can help identify any medication use patterns that may be contributing to the patient’s symptoms,” Dr. Thomas explained. “For instance, overuse of OTC antihistamines can certainly cause impairment in concentration and memory, which may mimic symptoms of inattention in ADHD.”

Pharmacists must also recognize that ADHD impairment may present differently in adults than in children.

“In children, hyperactivity and inattention are clearly delineated and can easily be observed in different settings. As an adult, the impairment might be the inability to focus or stay organized, such as paying bills or not completing tasks at work,” Dr. Thomas explained. “Of course, the impairment will catch up with these individuals, but may be less obvious initially to the patient and to the health care provider.”

Finally, pharmacists can “assist the health care team in identifying any potential substance use disorders, which can (not only) help identify underlying symptoms the patient may be experiencing, but also help drive the choice of medication for ADHD in those individuals, if treated,” Dr. Thomas concluded.