Improved Executive Function in Adults Diagnosed With Attention-Deficit/ Hyperactivity Disorder as Measured by the Brown Attention-Deficit Disorder Scale Following Treatment With SHP465 Mixed Amphetamine Salts Extended-Release: Post Hoc Analyses From 2 Randomized, Placebo-Controlled Studies

Treating new-onset cognitive complaints after risk-reducing salpingo-oophorectomy: A randomized controlled crossover trial of lisdexamfetamine

OBJECTIVE

To determine whether the psychostimulant lisdexamfetamine improves subjective and objective measures of cognitive functioning among women genetically at-risk for cancer who have undergone risk-reducing salpingo-oophorectomy and report new-onset executive functioning difficulties.

METHODS

69 participants were assigned to a randomized controlled crossover trial with 6-week trials of active medication (lisdexamfetamine) and placebo, separated by a minimum 2-week washout in an intent-to-treat framework (clinical trial registration number: NCT03187353). At trial baseline, midpoint, and endpoint, participants completed a self-report measure of executive functioning (Brown Attention Deficit Disorder Scale). At study baseline and trial endpoint, participants completed sustained attention, attention/working memory, and verbal learning/memory cognitive tasks. Side effects were assessed at 2, 3, 4, and 6 weeks for each trial.

RESULTS

From trial baseline to trial endpoint, lisdexamfetamine - relative to placebo - significantly improved total scores on the self-report Brown Attention Deficit Disorder Scale (and scores on four of five subdomains) as well as attention and working memory performance. Significantly more participants endorsed side effects across the lisdexamfetamine trial versus placebo; however, trial completion rates were similar, indicating that lisdexamfetamine was nonetheless well-tolerated.

CONCLUSIONS

Lisdexamfetamine improved both subjective and objective measures of attention and working memory and could offer women experiencing cognitive difficulties post-risk-reducing salpingo-oophorectomy an alternative therapeutic option.

Systematic Review of Executive Function Stimulation Methods in the ADHD Population

Background/Objectives: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by elevated motor activity, impulsivity, and attention deficit. Approximately 5% of the population suffers from this disorder. Among the key explanations of ADHD, executive functions play an important role in understanding the symptomatology present in this disorder and in determining the main treatment strategies for affected patients. We present a systematic review that seeks to identify the treatment methods developed to support executive functions in individuals with ADHD. Methods: Articles were analyzed in the SCOPUS, PUBMED, and Science Direct databases. Initially, 739 articles were found. After applying inclusion and exclusion criteria, 30 articles remained and were included in the data extraction process. Results: Among the primary treatments identified, 14 studies propose psychological training for executive functions, 9 studies recommend medication, 5 studies suggest digital interventions, and 1 study advocates for sports as beneficial for executive functions. Conclusions: The data are discussed around the need to develop new proposals to enhance the executive functions of individuals with ADHD, thereby improving their performance in educational, personal, social, and family activities impacted by this disorder.

A review of amphetamine extended release once-daily options for the management of attention-deficit hyperactivity disorder

INTRODUCTION

Amphetamine preparations are one of the two categories of stimulant medications approved for the treatment of attention deficit hyperactivity disorder (ADHD). Optimal treatment of ADHD aims to reduce core symptoms for as much of the waking hours as possible, leading to longer-acting delivery formats. In addition, the pediatric population commonly has difficulty swallowing pills and manufacturers have developed a variety of options to facilitate this concern. These include chewable tablets, capsules that may be sprinkled on soft food, liquids and transdermal patches.

AREAS COVERED

This article reviews the once-daily extended-release preparations currently available for amphetamine compounds, their pharmacodynamics, and common adverse effects.

EXPERT OPINION

There is an extensive evidence base supporting use of amphetamine preparations in the treatment of ADHD. Rapid onset of action and a favorable side effect profile make these widely used. The availability of once-daily extended-release chewable tablets, capsules that can be opened and sprinkled, and liquid formulations provides clinicians with multiple options to meet the specific needs of patients with difficulty swallowing whole pills.

A Single-Blind, Placebo Controlled Trial of Triple Beaded Mixed Amphetamine Salts in DSM-5 Adults With ADHD Assessing Effects Throughout the Day

OBJECTIVE

To examine the effects of triple beaded mixed amphetamine salts (TB MAS) on ADHD and executive dysfunction symptoms throughout the day in adults with DSM-5 ADHD.

METHOD

This was a 6 week, single-blind, placebo-lead in trial of TB MAS (12.5-37.5 mg/day); all participants received 2 weeks of single-blind placebo); one individual was a placebo responder and was discontinued. One of these 18 dropped after 1 week on 12.5 mg/day, while all others completed the trial and received 37.5 mg/day TB MAS.

RESULTS

There were significant effects of TB MAS on all clinical measures, including investigator overall symptoms (AISRS); self-report overall (ASRS), time-sensitive ADHD (TASS) scores throughout the day, impairment (CGI) and executive function scores (BRIEF-A). TB MAS was generally well tolerated.

CONCLUSIONS

This study extends prior findings of TB MAS to adults with DSM-5 ADHD; it further re-validates findings of efficacy of TB MAS throughout the day.

A Comparative Study of Prison Inmates With and Without ADHD: Which Neuropsychological and Self-Report Measures are Most Effective in Detecting ADHD Within Correctional Services?

OBJECTIVE

In this study we aimed to investigate the screening and diagnostic properties of various self-report instruments to identify measures which most effectively detect ADHD in a correctional sample.

METHOD

The sample consisted of 193 male high security prisoners in Sweden. We investigated if measures of ADHD symptoms, executive functioning, impulsivity, estimated IQ and working memory could differentiate participants with ADHD from those with ASPD or no diagnosis.

RESULTS

Participants with ADHD obtained significantly higher total scores on all included measures. Although we found that some of the measures were more efficient in differentiating ADHD, mean values were generally elevated in the sample.

CONCLUSION

Results demonstrate the importance of investigating psychometric properties in relevant samples to assure a measurement's usefulness in different contexts, in this case a correctional setting, where the high influence of unspecific behavioral indicators in these measurements might negatively affect their validity.

Do ADHD Treatments Improve Executive Behavior Beyond Core ADHD Symptoms in Adults? Evidence From Systematic Analysis of Clinical Trials

We sought to understand the effect of current treatments for attention deficit hyperactivity disorder (ADHD) on executive functioning deficits, which are often comorbid with ADHD, via a systematic analysis of adult ADHD treatment studies evaluating change in behavioral measures beyond the core symptoms of Diagnostic and Statistical Manual of Mental Disorders ADHD. The standardized mean difference for behavioral measures of executive functioning was determined from controlled trials of adults with ADHD and compared with effects on core ADHD symptoms. Several studies of atomoxetine revealed small to large standardized mean differences. Nonreplicated studies revealed small to medium effects for triple-bead mixed amphetamine salts, lisdexamfetamine, and forms of cognitive behavioral therapy. Proportional effect versus core ADHD symptoms ranged from 0.78 to 1.16 for atomoxetine, and from 0.65 to 1.44 across all the studies. ADHD treatments have effects on executive functioning behavior beyond core ADHD symptoms in adults. Clinicians can measure and treat this morbidity using available clinical tools.