Mixed Amphetamine Salts Extended Release for the Treatment of ADHD in Adolescents: Current Evidence

Ongoing research on attention-deficit/hyperactivity disorder (ADHD) has yielded important new information that has impacted the clinical recognition and management of this disorder. ADHD has long been considered one of the most common psychiatric disorders initially diagnosed and treated in childhood. Contrary to the once widely held assumption that symptoms spontaneously resolved or abated, clinically significant symptoms for most patients persist into adolescence and adulthood. While hyperactivity appears to decrease with age, impaired attention and impulsivity persist into adolescence and are linked to clinically significant functional impairments in academic, social, and family settings. Like their younger counterparts, adolescents with ADHD exhibit higher rates of comorbid psychiatric illness and concomitant mental health service use. Among the most common comorbid psychiatric disorders seen in adolescents with ADHD are major depression, anxiety disorders, conduct disorder, and oppositional defiant disorder (ODD). In young adults, a direct correlation has been revealed between ongoing ADHD symptom severity and lower levels of academic achievement, greater risk of illicit drug use, and drug-related crime. These findings highlight the potential importance of adequate ADHD symptom management in adolescence in predicting long-term outcomes; as a result, a lifespan approach toward ADHD is beginning to be adopted by many clinicians, and anti-ADHD medication (including psychostimulants) is being recommended for the management of ADHD in all age groups. However, most clinical research involving psychostimulants has been conducted in school-age children <12 years of age, and knowledge concerning the use of medications in adolescents with ADHD is limited. Questions about dosing, safety, level of efficacy to be expected, and optimal duration of treatment in adolescents with ADHD must be addressed. Clinical choice of therapy is also complicated by the fact that the anti-ADHD armamentarium continues to evolve, and now includes long-acting formulations of methylphenidate, mixed amphetamine salts, and nonstimulants.