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Economic burden of attention-deficit/hyperactivity disorder among children and adolescents in the United States: a societal perspective

Schein, Jeff; Adler, Lenard A; Childress, Ann; Cloutier, Martin; Gagnon-Sanschagrin, Patrick; Davidson, Mikhaïl; Kinkead, Frédéric; Guerin, Annie; Lefebvre, Patrick
OBJECTIVE/UNASSIGNED:To provide a comprehensive evaluation of the economic burden associated with attention-deficit/hyperactivity disorder (ADHD) among children and adolescents from a US societal perspective. MATERIALS AND METHODS/UNASSIGNED:Direct healthcare costs of children (5-11 years) and adolescents (12-17 years) with ADHD were obtained using claims data from the IBM MarketScan Research Databases (01/01/2017-12/31/2018). Direct non-healthcare and indirect costs were estimated based on literature and government publications. Each cost component was estimated using a prevalence-based approach, with per-patient costs extrapolated to the national level. RESULTS/UNASSIGNED:The total annual societal excess costs associated with ADHD were estimated at $19.4 billion among children ($6,799 per child) and $13.8 billion among adolescents ($8,349 per adolescent). Education costs contributed to approximately half of the total excess costs in both populations ($11.6 billion [59.9%] in children; $6.7 billion [48.8%] in adolescents). Other major contributors to the overall burden were direct healthcare costs ($5.0 billion [25.9%] in children; $4.0 billion [29.0%] in adolescents) and caregiving costs ($2.7 billion [14.1%] in children; $1.6 billion [11.5%] in adolescents). LIMITATIONS/UNASSIGNED:Cost estimates were calculated based on available literature and/or governmental publications due to the absence of a single data source for all costs associated with ADHD. Thus, the quality of cost estimates is limited by the accuracy of available data as well as the study populations and methodologies used by different studies. CONCLUSION/UNASSIGNED:ADHD in children and adolescents is associated with a substantial economic burden that is largely driven by education costs, followed by direct healthcare costs and caregiver costs. Improved intervention strategies and policies may reduce the clinical and economic burden of ADHD in these populations.
PMID: 35068300
ISSN: 1941-837x
CID: 5154282

Economic burden of attention-deficit/hyperactivity disorder among adults in the United States: a societal perspective

Schein, Jeff; Adler, Lenard A; Childress, Ann; Gagnon-Sanschagrin, Patrick; Davidson, Mikhaïl; Kinkead, Frédéric; Cloutier, Martin; Guérin, Annie; Lefebvre, Patrick
PMID: 34806909
ISSN: 2376-1032
CID: 5063342

The Validity of the World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in Adolescence

Somma, Antonella; Adler, Lenard A; Gialdi, Giulia; Arteconi, Martina; Cotilli, Elisabetta; Fossati, Andrea
PMID: 34166067
ISSN: 1557-8992
CID: 5060842

Neurobiological Basis of Reinforcement-Based Decision-Making in Adults With ADHD Treated With Lisdexamfetamine Dimesylate

Ivanov, I; Newcorn, J H; Krone, B; Li, X; Duhoux, S; White, S F; Schulz, K P; Bédard, A C V; Pedraza, J; Adler, L A; Blair, R J
PMID: 34355611
ISSN: 1557-1246
CID: 5004282

A Placebo-Controlled Trial of Lisdexamfetamine in the Treatment of Comorbid Sluggish Cognitive Tempo and Adult ADHD

Adler, Lenard A; Leon, Terry L; Sardoff, Taylor M; Krone, Beth; Faraone, Stephen V; Silverstein, Michael J; Newcorn, Jeffrey H
PMID: 34232582
ISSN: 1555-2101
CID: 5043582

Dasotraline in adults with attention deficit hyperactivity disorder: a placebo-controlled, fixed-dose trial

Adler, Lenard A; Goldman, Robert; Hopkins, Seth C; Koblan, Kenneth S; Kent, Justine; Hsu, Jay; Loebel, Antony
In a previous study, dasotraline demonstrated efficacy at a dose of 8 mg/day in adults with attention deficit hyperactivity disorder (ADHD). The aim of the current study was to evaluate the efficacy and safety of dasotraline in doses of 4 and 6 mg/day. Adults meeting Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria for ADHD were randomized to 8 weeks of double-blind, once-daily, fixed-dose treatment with dasotraline 4 mg/day, 6 mg/day, or placebo. The primary efficacy endpoint was changed in the ADHD Rating Scale, Version IV (ADHD RS-IV) total score. Secondary efficacy endpoints included the Clinical Global Impression, Severity (CGI-S) Scale. Least squares mean reduction at week 8 in the ADHD RS-IV HV total score was not significantly greater (vs. placebo) in the dasotraline 4 mg/day group (-15.0 vs. -13.9; n.s.; or in the dasotraline 6 mg/day group (-16.5 vs. -13.9; P = 0.074; Hochberg correction). Treatment with dasotraline 6 mg/day was significant at week 8 (uncorrected) on the ADHD RS-IV total score (P = 0.037) and the CGI-S score (P = 0.011). Treatment with the 4 mg/day dose of dasotraline was NS. Treatment with dasotraline was generally well tolerated. The results provide additional evidence that supports the potential efficacy of dasotraline, in doses of 6 mg/day, in adults with ADHD.
PMID: 33724251
ISSN: 1473-5857
CID: 4858252

Screening for Adult ADHD

Anbarasan, Deepti; Kitchin, Michael; Adler, Lenard A
PURPOSE OF REVIEW/OBJECTIVE:This review paper aims to update readers on the importance of screening for attention-deficit/hyperactivity disorder (ADHD) in adults and to provide a primer on how best to screen and diagnose this condition in an efficient and reliable manner. RECENT FINDINGS/RESULTS:The ASRS Screening Scale was updated in 2017 to reflect the changes made to identify ADHD based on the DSM-5 criteria and to reflect our understanding that adult ADHD is characterized by executive functioning deficits that are not explicitly reflected in the DSM-5 criteria. The use of the ASRS Screening Scale improves the clinician's ability to rapidly identify adult patients who require a comprehensive evaluation to diagnose ADHD and/or other comorbid psychiatric conditions. The scale has been validated for use in both the general population and in the ADHD specialty treatment population, which supports its use by both general clinicians and mental health clinicians. Identification of adult ADHD is critical due to the profound personal, familial, and societal costs associated with this condition.
PMID: 33095375
ISSN: 1535-1645
CID: 4642602

Post hoc Responder and Remission Analyses from Two Studies of SHP465 Mixed Amphetamine Salts Extended-Release Among Adults with Attention-Deficit/Hyperactivity Disorder

Adler, Lenard A; Robertson, Brigitte; Chen, Jie; Sarkis, Elias
PMID: 32423239
ISSN: 1557-8992
CID: 4446662

Executive Functioning Outcomes Over 6 Months of Atomoxetine for Adults With ADHD: Relationship to Maintenance of Response and Relapse Over the Subsequent 6 Months After Treatment

Adler, Lenard A; Solanto, Mary; Escobar, Rodrigo; Lipsius, Sarah; Upadhyaya, Himanshu
OBJECTIVE: This study examines the relationship between maintenance of improved executive functioning (EF) in adults with ADHD with long-term symptom improvement with atomoxetine. METHOD: Data were collected from a yearlong, double-blind, placebo-controlled clinical study on adult patients with ADHD receiving atomoxetine (80-100 mg/day) for 24 weeks. Patients were then randomized to continue atomoxetine or placebo for 6 months. Executive functioning was rated with Behavior Rating Inventory of Executive Function-Adult Version: Self-Report (BRIEF-A: Self-Report), and the T-scores were determined. RESULTS: Postrandomization T-scores for atomoxetine patients were significantly better than those of placebo patients (3 and 6 months postrandomization). Patients with greater improvements in EF were more likely to show worsening of EF and to relapse after atomoxetine discontinuation. The maintenance of improved EF was significantly associated with improved ADHD symptoms (Conners' Adult ADHD Rating Scale-Investigator Rated: Screening Version [CAARS-Inv:SV] with adult prompts). CONCLUSION: Treatment with atomoxetine improved EF during the treatment phases. Improved EF was maintained up to 6 months after discontinuation of atomoxetine.
PMID: 27521574
ISSN: 1557-1246
CID: 2219202

A Long-Term, Open-Label, Safety Study of Triple-Bead Mixed Amphetamine Salts (SHP465) in Adults With ADHD

Adler, Lenard A; Frick, Glen; Yan, Brian
Objective: The aim of this study was to evaluate the long-term safety of triple-bead mixed amphetamine salts (MAS) in adults with ADHD. Method: Adults meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) ADHD criteria and satisfying study criteria from one of two antecedent studies were enrolled in this 52-week (dose titration, 4 weeks; dose maintenance, 11 months) open-label extension. The protocol included 12.5- to 75-mg triple-bead MAS but was amended to a maximum of 50-mg triple-bead MAS. Safety evaluations included treatment-emergent adverse events (TEAEs) and vital signs. Clinical outcome measures included ADHD Rating Scale-IV (ADHD-RS-IV) total score changes. Results: Of 505 enrolled participants, 266 completed the study; the M ± SD daily dose during the study was 48.0 ± 15.96 mg. The most frequent TEAEs were insomnia (initial insomnia, insomnia, early morning awakening, middle insomnia; 38.2%), headache (25.7%), and dry mouth (20.2%). Study discontinuations were more frequent with higher doses of triple-bead MAS (37.5-75 mg) than with lower doses (12.5 and 25 mg). Blood pressure and pulse increases were observed at end-of-study. Mean ADHD-RS-IV total score decreases from antecedent study and open-label baselines at end-of-study were -23.3 ± 11.44 and -7.9 ± 13.19, respectively. Conclusion: Triple-bead MAS exhibited a long-term safety profile comparable with previous reports and demonstrated evidence of continued symptom control for up to 12 months.
PMID: 28412886
ISSN: 1557-1246
CID: 4874992