Objective

Describe the signs of ADHD in adults in the US, discuss the negative side effects of therapy, and evaluate the consequences on productivity at work and quality of life (QoL).

Methods

Adults in the US taking ADHD medication participated in an online survey to provide data about symptoms of ADHD and unfavourable side effects of therapy. From July 26, 2021, to July 30, 2021, participants were drawn from the panel of a reputable market research company, Dynata, and if they satisfied the study's eligibility requirements and agreed to take part in the survey, they were added to the study. Linear regression analyses were used to determine correlations between important outcomes (QoL, employment, and job impairment) and symptoms.

Results

95.2% of the 585 participants reported having at least one undesirable side effect related to their therapy or ADHD during the previous month (average = 5.8 symptoms). There was a strong correlation found between the quantity of symptoms and lower quality of life, lower likelihood of employment, and higher work/activity impairment. 50.4% and 44.7%, respectively, of the subgroups with emotional impulsivity/mood lability and insomnia/other sleep disorders said that their symptoms had "a lot" or "extremely" negative effects on their general well-being.

Conclusions

Adverse side effects connected to therapy or symptoms related to ADHD are prevalent and significantly impair quality of life, making it less likely for patients to find work. Adults with ADHD may have better quality of life and productivity at work if ADHD/treatment-related unfavourable side effects are better managed and there are more palatable treatment options available.

Introduction

An estimated 4.4% of adults in the United States (US) suffer from attention-deficit/hyperactivity disorder (ADHD), a persistent neurodevelopmental disease marked by symptoms of hyperactivity and/or inattention that interfere with functioning.

 The majority of people with ADHD usually receive pharmaceutical intervention using stimulants as their first line of treatment, as this has been demonstrated to be successful in lowering the fundamental symptoms of ADHD.

 psychotherapy and non-stimulants are further therapeutic alternatives

The use of pharmaceuticals to treat ADHD is linked to unfavourable side effects.

 In the longest-running clinical trial of methylphenidate for adult ADHD to date (10), patients with sleep-related issues (such as insomnia [8.8 vs. 4.8%], restlessness [10.2 vs. 2.9%], loss of appetite [22.4 vs. 3.8%], dry mouth (14.6 vs. 4.8%), weight loss (6.3 vs. 1.9%), and emotional dysregulation (such as irritability [6.8. vs. 5.3%], depressed mood [19.0 vs. 12.9%]) were more likely to receive methylphenidate than patients receiving a placebo (N = 209). Clinically significant physiological unfavourable side effects, such as insomnia, were more common in children with ADHD who continued taking stimulant medication as opposed to those who stopped using it, according to another clinical investigation.

 Furthermore, it might be difficult to determine if these negative side effects are due to the treatment or not because many of them can be linked to the disease itself. These ADHD-related unpleasant side effects may have a significant impact on patients' well-being, regardless of the underlying reason.

Previous research has examined the possible effects of these ADHD/treatment-related adverse side effects in children and adolescents (e.g., impact on overall functional impairment, school grades, and health service utilisation) 14–18, but it is less clear how they may affect adult patients' quality of life and productivity at work.

Notably, it has been demonstrated that unfavourable side effects associated with ADHD and therapy may impact patients' perseverance and adherence to it20, which are critical factors influencing treatment results. To better understand the burden and potential consequences associated with these adverse side effects and to improve the clinical management of this population, more information regarding the impact of ADHD and treatment-related adverse side effects on the day-to-day functioning of adults with ADHD is thus required. Using an online survey, the current study sought to characterise ADHD symptoms and treatment-related adverse side effects experienced by adults with ADHD receiving pharmaceutical treatment in the US. It also evaluated the effects of these outcomes on participants' quality of life and productivity at work using validated scales.

Methods

Study design and data source

From July 26, 2021, to July 30, 2021, an online survey was used to gather de-identified, individual-level data from persons with ADHD who were receiving treatment in the US. Participants were chosen from Dynata's panel, a reputable market research company. All US panel participants who reported having ADHD received an invitation with the survey URL. There were four sections on the survey questionnaire: (1) A screening and informed consent form was used to determine the eligibility and willingness of the respondent to participate in the study. (2) The core section contained questions about individual characteristics and general outcomes. (3) A section specific to sleep disturbances was used to collect information from people who reported experiencing symptoms of insomnia and other sleep disturbances in the previous month. (4) A section specific to emotional impulsivity and mood lability was used to collect information from people who reported experiencing symptoms of emotional impulsivity and mood lability in the previous month. Before any data was collected, three qualified participants participated in semi-structured virtual interviews as part of a pilot testing process to check the survey's content, make sure the participants understood it, and make any necessary revisions to the questions. The Institutional Review Board for the Western Copernicus Group accepted this study under the exemption category.

Study population

Adult US residents who were diagnosed with ADHD and receiving pharmaceutical medication that was approved by the US Food and Drug Administration (FDA) for the treatment of ADHD symptoms at the time of the study were eligible to take part in it. Patients on several drugs and those with treatment-resistant ADHD (e.g., chronic patients) were not excluded from the study in order to obtain a patient group that could more accurately represent patients with ADHD treated in the real world. It must have been reasonably easy for participants to read and comprehend English.

Study measures and outcomes

Data on the demographics, clinical conditions, and treatment characteristics of the participants (e.g., current and previous treatments, frequency and reasons for skipping or missing a dose of current pharmacological treatment) were gathered. Additionally, information on experiences with treatment-related adverse side effects and symptoms associated with ADHD in the past month was gathered. Treatment-related adverse side effects were defined as unwanted symptoms experienced by patients while on treatment, which could be associated with the ADHD disease state or the ADHD treatment received; adverse side effects were identified from the FDA labels of various ADHD medications. Finally, data on the participants was gathered.

Statistical analyses

The data gathered was presented in a descriptive manner for both the entire sample and for subgroups of participants who reported specific symptoms of ADHD or unfavourable side effects from the medication (such as emotional impulsivity and mood swings, sleeplessness, and other sleep disruptions). For continuous data, frequency counts and percentages were recorded; for categorical variables, means, medians, and standard deviations were.

After correcting for participant characteristics (i.e., gender, age, and education level), linear regression analyses with stepwise variable selection were performed to determine the connection between symptoms associated with ADHD/treatment-related unpleasant side effects and key outcomes of interest. In particular, a logistic regression model was used to estimate a binary response variable (employment), while ordinary least square regression models were employed to estimate continuous response variables (such as the AAQoL score or the WPAI-SHP activity impairment score).