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  • Novel Treatments for a Common Neurodevelopmental Disorder
    October marks the arrival of Attention-Deficit/Hyperactivity Disorder (ADHD) Awareness month, an occasion and opportunity to spread recognition and education in healthcare communities and the patient populations with which they engage. Remarkably, the condition has been quickly growing as a conversation topic on social media platforms, as individuals share their own experiences leading to a diagnosis. As a result, healthcare providers may notice an uptick in patient questions regarding the condition.

    Although ADHD always begins during childhood, cases can be overlooked until later in life. It is estimated that approximately 5% of adults and nearly 11% of children have ADHD. The figures are often debated, with concerns of over- or misdiagnosis. The overall trends do seem to show a fairly rapid increase in cases in recent decades. The increase could be due to the growing awareness in society as more individuals learn about and seek medical care for psychiatric illnesses.

    The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5), contained updated criteria to help providers diagnose ADHD. The guidelines consider ADHD a developmental disorder associated with a continuous pattern of inattention, hyperactivity, or impulsivity. The categories of ADHD include “mostly impulsive-hyperactive,” where individuals exhibit symptoms of both impulsivity and hyperactivity; “mostly inattentive,” where individuals have trouble paying attention and are easily distracted; and “combined,” which is the most common type and includes a combination of impulsivity, hyperactivity, and inattentiveness.

    Genetic, chemical, communication, and structural differences in the brain have been confirmed through research, showing certain neurotransmission abnormalities. The connections and communications that occur within the brain of an individual who has ADHD perform differently than in a ‘neurotypical’ individual. The causes and extent of the differences are continuing to be discerned. So far, there is no laboratory test that a patient may undergo to obtain a diagnosis. To confirm a diagnosis, psychological tests that assess processes such as reasoning and spatial skills, executive functions, and memory would need to be completed.

    The predominant approach to ADHD treatment is a combination of medication and therapy. Pharmacotherapies commonly used for treating ADHD are stimulants, which for individuals with ADHD, actually have a calming effect that works to aid in focus. Medications such as Vyvanse (lisdexamfetamine dimesylate), Adderall (amphetamine aspartate monohydrate/amphetamine sulfate/dextroamphetamine saccharate/dextroamphetamine sulfate), and Ritalin (methylphenidate HCl) are all effective for helping normalize brain activity. Certain health risks are present when prescribing stimulant medications, so regular assessment and evaluation of patients should be conducted to monitor or identify any cardiac or psychiatric issues.

    If stimulants are not well-tolerated, there are non-stimulant medication options that are useful alternatives. Among these are centrally acting alpha agonists such as Intuniv (guanfacine) and selective norepinephrine reuptake inhibitors such as Strattera (atomoxetine) and the newest approval, Qelbree (viloxazine HCl). Qelbree was first approved in April 2021 for treatment of ADHD in patients aged 6 to 17 years. In September 2021, the FDA received a supplemental new drug application for Qelbree to treat ADHD in adult patients. The ongoing research and availability of new treatment options give more opportunities for prescribers to find the most effective treatment plan and get the right prescription to the right patient at the right time.

    Non-drug therapies are also now available, having been recently approved for prescription-only use by the FDA. The Monarch external Trigeminal Nerve Stimulation (eTNS) System was approved for use in patients aged 7 to 12 years and not currently taking prescription ADHD medication. The system includes an external device with a skin patch that delivers an electric pulse to the trigeminal nerve through the forehead. The treatment is delivered while the patient sleeps to modulate activity in targeted brain regions. Another first-of-its-kind device that recently received approval is the EndeavorRx, a game-based device used by patients aged 8 to 12 years who have mostly inattentive or combined-type ADHD. The digital device guides users through “a video game experience which leverages art, music, storytelling, and reward cycles to keep patients engaged.”

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