Low-Dose Amphetamine Salts and Adult Attention-Deficit/Hyperactivity Disorder

Background: Effective treatments forattention-deficit/hyperactivity disorder (ADHD) in adults arestill being defined. Pediatric studies have suggested that amixed amphetamine salt product (Adderall) is safe and effectivein the treatment of childhood forms of ADHD. Presently, there areno reports in the scientific literature concerning the safety andefficacy of Adderall in adults with ADHD, which is the focus ofthis study.

Method: Twenty-four outpatients (mean age = 33.3years) with DSM-IV ADHD were administered Adderall in anopen-label fashion, starting at 5 mg p.o. b.i.d., with titrationaccording to clinical response, across a 16-week period.Relatives or spouses of each patient completed serial checklists(including the Copeland Symptom Checklist and the BrownAttention-Deficit Disorder Scales). Prospectively collected datawere analyzed retrospectively.

Results: Thirteen patients (54%) responded in apositive manner to Adderall, based on Clinical GlobalImpressions-Improvement scale scores. The mean end dose forresponders was 10.77 mg/day (0.14 mg/kg/day). An intent-to-treatanalysis revealed a decrease in the mean Copeland score from99.05 to 63.3 (p < .001), while the mean Brown score droppedfrom 76.75 to 50.85 (p < .0001). Nine patients (38%) were poorresponders or nonresponders to Adderall. Acute anxiety symptomsoccurred in 4 of 7 patients with a comorbid anxiety diagnosis.

Conclusion: Adderall may be an effective agentfor the treatment of adult forms of ADHD, with positive responsesoccurring at relatively low doses, at least for some individuals.However, Adderall may precipitate anxiety in vulnerableindividuals. Further study is required.