The Unique Signs and Struggles of Adult ADHD


On the heels of the FDA approval of viloxazine extended-release capsules for adult ADHD, a neuropsychiatrist discusses the state of care and diagnosis among older patients.

Last week, the US Food and Drug Administration (FDA) approved viloxazine extended-release capsules (Qelbree) for treatment of adult patients with ADHD—broadening the non-stimulant therapy’s indication to include all patients aged ≥6 years old.

Aside from providing younger patients with ADHD a streamlined method of prescribed care through adulthood, the approval granted to viloxazine was significant for the already-existing adult ADHD population. In fact, it had been decades since such a candidate had been approved for adults.

In an interview with HCPLive regarding viloxazine and adult ADHD, Theresa R. Cerulli, MD, a neuropsychiatrist with Beth Israel Deaconess Medical Center, reviewed the recent history of FDA-approved non-stimulant therapies for adults with ADHD. It was a brief review.

“In the last 20 years we’ve only got 1 agent that’s been FDA approved that is a non-stimulant, Cerulli said. “The word “lacking” is a fitting one. Mostly for adult ADHD, it’s been stimulants, which are controlled substances and certainly have their challenges with the abuse potential. When it came to non-stimulant treatment, there was no choice involved.”

In discussing the state of adult ADHD management and prescribing strategy, Cerulli discussed the unique challenges and manifestations of the disorder in older patients. Similarly to children, 3 core features constitute the clinical diagnosis of ADHD in an adult: inattention, hyperactivity and impulsivity.

“But when you think about how that manifests in a child versus an adult, it does look different,” Cerulli said. “The observable things we watch for in kids versus adults might present in ways that you hadn’t anticipated.”

For example, she explained, a child will have visible characteristics of hyperactivity and impulsivity—such as running around the classroom against their teacher’s instructions. Among adult patients, hyperactivity and impulsivity appears more subdued: they may simply be more animated, or physically restless.

“It’s not that their hyperactive or impulsive symptoms disappear, they just start to be a little less noticeable—you have to look for them a little bit more in the adult,” Cerulli said.

Cerulli also discussed the burdens of stigma and undiagnosed conditions among afflicted adults; she noted it’s generally hard for older patients to observe the signs and symptoms of ADHD.

“On any given day, we all struggle with attention, we all struggle with organization at times,” she said. “They’re not thinking of it in terms of a disorder, they’re thinking of it more as a negative reflection of their self, and they develop some anxiety or depression.“

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