Acceptability

4. Decreasing drug use

Many people with ADHD also have a substance use disorder. Severe substance use disorder is known as addiction. This is the inability to stop using a drug which is having negative effects on the user’s health and ability to function socially.

What are drugs?

Drugs are substances which change a person’s perception and mood when they are consumed. Taking drugs can lead to accidents, loss of consciousness, or trigger episodes of emotional distress. Habitual drug consumption can lead to addiction.

What is addiction?

Addiction is regular drug use which leads to needing to take increasingly larger doses of the drug. If the user does not consume the drug they begin to feel unwell and are unable to stop taking the drug despite being aware of the negative effect it has on their health and their ability to function socially, whether at work, or with friends and family.
In many cases, reducing consumption and achieving sustained abstinence improves how a person functions at work, at home and with friends. It also prevents related health complications such as overdosing, heart disease, respiratory disease, neurological disease and infections.

18. Acceptability

Medications used to treat ADHD have beneficial effects, but they can also produce adverse or harmful side effects. One way to assess whether the benefits outweigh the adverse side effects is to look at whether the patient continues or stops treatment; this is known as acceptability. In short-term treatments, between 15 and 50% of people with ADHD stop treatment, depending on the type of medication prescribed.

What is meant by “acceptability” to treatment?

Medications used to treat ADHD have beneficial effects, but they can also produce adverse or harmful side effects. One way to assess whether the benefits outweigh the adverse side effects is to look at whether the patient stops the treatment; this is known as acceptability. If a treatment significantly improves a condition and has few adverse effects, the drop-out rate is expected to be low, and acceptability is considered to be good. Conversely, if the treatment has little positive effect and many adverse side effects, the drop-out rate will be very high and acceptability, therefore, poor.

In treatments lasting a few weeks or months, between 20 and 25% of people with ADHD receiving medication discontinue treatment. For some specific medicines this figure can be almost 50%, while for others it can be 15%. This means that acceptability to medication is highly variable and depends on the type of medication prescribed.

17. Stopping treatment because of adverse side effects

All medications used to treat ADHD produce adverse side effects. In some cases, these are tolerated by the patient, but in other cases they are not, and the patient stops the treatment. Stopping treatment due to adverse side effects varies widely between the various medications used to treat ADHD.

What is meant by “treatment withdrawal due to adverse side effects”?

All medications used to treat ADHD produce adverse side effects. In some cases, these are tolerated by the patient, but in other cases they are not, and the patient stops the treatment. Stopping treatment because of adverse side effects gives us a general idea of the frequency of moderate or severe side effects.

In short-term treatments, lasting weeks or a few months, 3% of people with ADHD being treated with medication stop treatment because of adverse side effects. However, with some treatments this proportion can be higher than 10%. This figure is 2 or 3 times higher than that observed among patients not receiving active medication.

16. Fainting

Some medications used to treat ADHD cause fainting, which is a sudden and momentary loss of consciousness and muscle strength that gets better spontaneously. Medications that cause this adverse side effect do so rarely. It is an adverse side effect that can be serious and remits when the patient stops taking the treatment.

How is ADHD treatment related to fainting?

Some medications used to treat ADHD cause fainting. Fainting is a sudden, momentary loss of consciousness and muscle strength that gets better spontaneously. Fainting due to taking medication to treat ADHD is usually caused by a significant drop in blood pressure, preceded by the patient feeling dizzy. People who have low blood pressure or heart rate have a higher chance of fainting. Fainting can be serious if it occurs while a person is driving or performing dangerous activities. If fainting is caused by medication, it usually remits when the treatment is withdrawn.

Fainting affects less than 1 in 100 patients. It is unclear how much more frequent fainting is among people being treated for ADHD compared to those who are not.

15. Vomiting

Some medications used to treat ADHD cause vomiting. The medications that cause this adverse side effect do so often. However, this is usually a mild side effect that remits when the patient stops taking the treatment.

What is the relationship between ADHD treatment and vomiting?

Most medications used to treat ADHD cause vomiting. Studies lasting a few weeks or months have shown that just under 10% of patients may have this adverse side effect. This is slightly less than twice that of ADHD patients not receiving active treatment. However, this adverse effect is usually mild and improves by lowering the dose of treatment and remits when treatment is withdrawn.

14. Seizures

Some medications used to treat ADHD cause seizures. A seizure is a sudden loss of consciousness accompanied by muscle jerks or spasms. The medications that cause this adverse side effect do so very rarely. This is a serious side effect, although it usually improves when the patient stops taking the treatment.

How is ADHD treatment related to seizures?

Some medications used to treat ADHD cause seizures. A seizure is a sudden loss of consciousness accompanied by muscle jerks or spasms. This is a serious adverse side effect that can sometimes be fatal.

This very rare adverse side effect is thought to affect less than 1 in 10,000 patients taking ADHD medication. It is more common in people who are predisposed to seizures such as epileptics or people with a brain injury. In most cases, seizures do not recur once the patient stops taking the treatment causing them.

13. Tics

Some medications used to treat ADHD cause tics. These are sudden, repeated, involuntary muscle movements, usually in the face or neck. Medications that cause this adverse side effect do so very often. However, this side effect is usually mild and remits when the patient stops taking the treatment.

How is ADHD treatment related to tics?

Some medications used to treat ADHD cause tics. Tics are sudden, repeated, involuntary movements of a small group of muscles, and usually occur in the face or neck. If a patient already has a tic before starting treatment with medication, the medication can increase the frequency and severity of the tic. In short-term studies, 2-3% of patients are found to have this adverse side effect, although it is unclear to what degree this is higher in patients not receiving active treatment. Despite being an annoying side effect, it is usually mild and improves by decreasing the treatment dose and remits when treatment is withdrawn.

12. Dry mouth

Some medications used to treat ADHD cause dry mouth. The medications that cause this adverse side effect do so very often. However, this side effect is usually mild and remits when the patient stops taking the treatment.

How is ADHD treatment related to dry mouth?

Many of the medications used to treat ADHD reduce saliva production and cause dry mouth. Dry mouth can lead to problems with speech and swallowing. Short term studies show that around 1 in 6 patients have this adverse side effect. The frequency is 4 to 5 times higher in ADHD patients who do not receive active treatment. However, this side effect usually improves by lowering the treatment dose and remits when treatment is withdrawn.

11. Dizziness

Some medications used to treat ADHD cause dizziness, which is the feeling of loss of stability. The medications that cause this adverse side effect do so frequently. However, this side effect is usually mild and remits when the patient stops taking the treatment.

How is ADHD treatment related to dizziness?

Dizziness is a feeling of loss of stability and is often accompanied by a cold sweat and the sensation that objects in your surroundings are moving.

Most medications used to treat ADHD cause dizziness. Studies lasting a few weeks or months show that just under 10% of patients are affected by dizziness. This is twice as likely in ADHD patients who do not receive active treatment. However, this side effect usually improves when the treatment dose is reduced, and remits when treatment is withdrawn.

10. Drowsiness

Some medicines used to treat ADHD cause drowsiness, which is the feeling of being sleepy. Medications that cause this adverse side effect very often do so. However, this side effect is usually mild and remits when the patient stops taking the treatment.

What is the relationship between ADHD treatment and drowsiness?

Drowsiness is a strong desire to sleep that leads to a state halfway between being awake and asleep. It disrupts how a person functions during daytime because they feel very tired and have difficulty concentrating. Drowsiness can be dangerous when performing tasks that require constant concentration, such as driving a vehicle.

Some medications used to treat ADHD cause drowsiness. Studies lasting a few weeks or months have shown that almost half of patients can experience this adverse side effect, and this is 3 to 4 times more likely in people with ADHD who do not receive active treatment. However, this side effect usually improves when the treatment dose is reduced, and remits when treatment is withdrawn.

Insomnia

Some medications used to treat ADHD may cause insomnia, which is difficulty falling or staying asleep. Medications that cause this adverse side effect very often do so. However, this side effect is usually mild and remits when the patient stops taking the treatment.

How is ADHD treatment related to insomnia?

Insomnia is difficulty getting to sleep or staying asleep and can manifest itself as difficulty falling asleep (initial insomnia), waking up frequently during the night, or waking up very early in the morning, earlier than expected (terminal insomnia). Insomnia disrupts how a person functions during the daytime and often causes tiredness and difficulty concentrating.

Some medications used to treat ADHD cause insomnia, especially early insomnia. Studies carried out over a few weeks or months have shown that up to 40% of patients may have this adverse side effect, and that the frequency is 2-3 times higher in ADHD patients than those not receiving active treatment. However, this side effect usually improves when the treatment dose is reduced, and remits when treatment is withdrawn.

8. Loss of appetite

Some medications used to treat ADHD can often cause a loss of appetite. However, this is a mild side effect that remits when the patient stops taking the treatment.

What is the relationship between ADHD treatment and loss of appetite?

Some medications used to treat ADHD can often cause a loss of appetite. If the loss of appetite is sustained over time, this may lead to weight loss and slower physical growth.

Short studies lasting a few weeks or months have shown that up to half of ADHD patients may experience this adverse side effect. The frequency of this happening is 4 to 5 times higher than in patients not receiving active treatment. However, this side effect usually improves when the treatment dose is reduced, and remits when treatment is withdrawn.

7. Quality of life

People with ADHD have a worse quality of life than people without the disorder, mainly because ADHD has a negative impact on social, family, educational, work and emotional functioning.

What is quality of life?

Quality of life refers to a person’s satisfaction with their physical, mental, emotional and social functioning. Quality of life is a subjective perception and influenced by a person’s cultural context, values, expectations and concerns.

People with ADHD have a worse quality of life than people who do not have the disorder. This is probably due to the chronicity of symptoms of inattention, hyperactivity and impulsivity, and the negative impact ADHD has on their health and social functioning.

Quality of life is evaluated using questionnaires in which the person rates a series of aspects of their life. Areas of life most negatively impacted by ADHD are related to social, family, educational, work and emotional functioning.

6. Academic performance enhancement

People with ADHD tend to obtain poorer academic results due to difficulties they face managing time and organising and planning academic tasks, and the fact that they are easily distracted. We do not have quality studies which indicate whether medication for treating ADHD improves the academic performance of patients with the disorder.

How is ADHD related to academic performance?

Numerous studies, the majority conducted in the United States, have found that people with ADHD are more likely to exhibit problem behaviour in class, have poorer reading and maths test scores, perform less well academically, have a shorter period of schooling and higher dropout rates than those without ADHD. This poor academic performance partly explains why people with ADHD have lower paying jobs, and therefore lower socioeconomic status.

These poorer academic results are probably due to the fact that people with ADHD have difficulty organizing and managing time, and planning academic tasks, and are easily distracted.

As the majority of studies have been conducted in the United States, it is difficult to extrapolate the results to countries with other education systems.

5. Accident prevention

People with ADHD are more likely to suffer serious physical injuries than people without ADHD. This is mainly due to accidents, particularly road traffic accidents.

How is ADHD related to having accidents?

Numerous studies have found that people with ADHD are more likely to get injured than those without ADHD. These injuries may be due to falls, traffic accidents, burns or poisoning, and can vary in severity. It has been observed that between 5 and 6% of people without ADHD, at some point in their lives, have had a serious injury requiring hospital care. This figure, however, is 65% higher among people with ADHD. This increased risk of physical injury is most likely because people with ADHD have attention problems, are easily distracted, and take drugs more often than people without ADHD.
The most frequent and severe physical injuries people with ADHD have are the result of accidents, particularly road traffic accidents. It has been observed that people with ADHD are 20-30% more likely to have a traffic accident than people without ADHD. For people with ADHD who also have a substance or drug use disorder, oppositional defiant disorder, or a conduct disorder, this risk is even higher. This means people with ADHD also have a higher mortality rate as a result of the higher number of accidents. Research shows that 2-3 people in 10,000 without ADHD die each year. This figure rises to almost 6 among people with ADHD, accidents being the main cause of death.

3. Preventing drug or substance use disorder

People with ADHD have a higher risk of developing a substance or drug use disorder than those without ADHD. Overall, children with ADHD are 2 to 3 times more likely to develop drug use disorder in adolescence or adulthood.

What is drug use disorder?

Substance or drug use disorder is a psychiatric disorder that occurs when drug use causes significant problems in a person’s life. These problems can be health related, or social problems such as failure to meet responsibilities at work, home or school. Substance use disorder can be mild, moderate, or severe. Severe substance use disorder is commonly known as addiction. This refers to regular drug use which leads to needing to take increasingly larger doses of the drug. When the person does not consume the drug they feel unwell and are unable to stop taking it despite being aware of its negative effects.

How is ADHD related to drug use disorder?

Numerous studies find that children with ADHD are more likely to develop a substance use disorder. In general, children with ADHD are 2 to 3 times more likely to develop a drug use disorder in adolescence or adulthood than children without ADHD. However, this varies depending on the type of drug taken.
Tobacco: approximately 30-40% of adults smoke or have smoked. However, the probability of smoking is almost three times higher among those with ADHD.
Alcohol: just under 10% of adults have or have had an alcohol use disorder at some time in their lives. However, the risk of developing an alcohol use disorder is twice as high among those with ADHD.
Drugs other than tobacco and alcohol: around 6% of adults in the United States have or have had a cannabis or marijuana use disorder. However, the risk is 50% higher for people with ADHD. Regarding cocaine, just over 2% of adults have, or have had, cocaine use disorder. However, the risk is twice as high among those with ADHD.

2. Improved clinical global impression

The clinical global impression is a subjective measure of symptom severity and the efficacy of the treatment given to you by your doctor, based on his/her experience.

What is the clinical global impression?

The clinical global impression is a subjective measure of symptom severity and the efficacy of the treatment given to you by your doctor based on their experience. A doctor assesses symptom severity on a scale ranging from “the person normal, not at all ill “to “the person is among the most extremely ill patients.” The doctor also evaluates how much a patient improves from treatment using a scale ranging from “the patient has improved considerably” to “the patient has got considerably worse”.

1. Symptoms of ADHD

People with ADHD have symptoms of inattention and/or hyperactivity and impulsivity. Some patients show both types of symptoms, while others have only one type. ADHD symptoms include making careless mistakes, having difficulty sustaining attention, having difficulty completing tasks or obligations, being easily distracted, having trouble organizing and planning, losing objects, being constantly on the go and running, walking or climbing in places where it is not considered appropriate to do so. They often feel restless, talk excessively, are unable to wait and interrupt others. The more severe the symptoms, the more they interfere with the person’s ability to function day-to-day.

What are symptoms?

Illnesses or disorders show symptoms. In the case of ADHD, these symptoms hinder the person’s development and ability to function fully. ADHD symptoms are grouped into two categories: those associated with inattention and hyperactivity, and those associated with impulsivity. Some patients have both groups of symptoms; others only a subgroup.

What are the symptoms of ADHD?

Someone with ADHD may show some or all of the following signs and symptoms:

lacking attention to detail
making careless mistakes at school or work
having difficulty maintaining attention while doing an activity such as playing, reading, or listening to a conversation
unable to listen when spoken to
having difficulty following instructions, and completing tasks or obligations.
having difficulty completing tasks once started as they are easily distracted
having trouble:

-organizing tasks that require a sequence of actions

-keeping objects and belongings in order

-keeping work organised

-completing tasks on time

avoiding doing tasks that require sustained mental effort
loss of objects needed to do homework or other activities such as school supplies, wallet, keys, glasses, or mobile phone.
being easily distracted by thoughts or stimuli not related to the activity in hand
forgetting to do everyday tasks such as keeping appointments or returning calls

Someone with ADHD may show the following symptoms of hyperactivity and impulsivity:

being unable to sit still
getting up and walking around at times and in places they are expected to remain seated, such as in the classroom or office
running, walking or climbing in inappropriate places
often feeling restless
being constantly on the move, wandering around or acting as if “driven by a motor “
talking excessively
giving answers before questions have been completed or being unable to wait their turn in the conversation
unable to wait their turn
interrupting others or intruding in their conversations, games, or activities

These symptoms can be measured using scales administered by patients, parents, teachers or clinicians.

The more severe the symptoms are, the more the patient’s daily life will be affected by them.

For patients