2026 ECNP Congress

PS03-3158

Attention-deficit/hyperactivity disorder pharmacotherapy in adults: prevalence, clinical profiles, and predictors of treatment modality

Chiara Bucca — M. Olivola, M.C. Angeletti, B.M. Dell'Osso, P. Landi · University of Milan, Department of Biomedical and Clinical Sciences, Milan, Italy

2026 ECNP Congress

Background

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition affecting nearly 3% of adults [1]. It is characterized by significant impairment in daily, social, and occupational functioning [2]. Furthermore, it is associated with high rates of psychiatric comorbidity, most commonly anxiety disorders (34%), mood disorders (22%), and substance use disorders (11%), which are important to identify in order to optimise treatment choices [3]. From a treatment perspective, first-line management typically involves pharmacotherapy with stimulants; however, non-pharmacological interventions, including psychotherapy, are also recommended, particularly for patients with comorbid conditions [3,4]. Despite increasing clinical recognition of ADHD in adults, real-world data on pharmacotherapy patterns and their clinical correlates remain limited.

Aims

This study aimed to characterise the prevalence of ADHD pharmacological treatment and to identify predictors of treatment modality (pharmacotherapy alone versus combined pharmacotherapy and psychotherapy) in a clinical sample of adults with ADHD.

Methods

A cross-sectional study was conducted in a specialised adult ADHD outpatient clinic. A total of 229 adults were assessed, of whom 87 (38%) had previously received pharmacological treatment. Sociodemographic and clinical variables, including ADHD severity and subtype, were assessed using the Diagnostic Interview for ADHD in Adults (DIVA 2.0). Psychometric evaluation included retrospective childhood ADHD symptoms (Wender Utah Rating Scale, WURS), emotional dysregulation (Difficulties in Emotion Regulation Scale, DERS), impulsivity (Barratt Impulsiveness Scale, BIS-11), depressive symptoms (Zung Self-Rating Depression Scale, Zung), state and trait anxiety (State-Trait Anxiety Inventory, STAI-Y1/Y2), problematic internet use (Internet Addiction Test, IAT), camouflaging behaviours (Camouflaging Autistic Traits Questionnaire, CAT-Q), and quality of life (Adult ADHD Quality of Life Scale, AAQoL). Group differences between treatment modalities were analysed using chi-square tests for categorical variables and independent-samples t-tests for continuous variables. A logistic regression model was applied to identify predictors of treatment modality (pharmacotherapy alone vs. combined pharmacotherapy and psychotherapy).

Results

Among the treated subsample (n = 87), 80.5% presented at least one psychiatric comorbidity, most commonly anxiety and mood disorders. Patients receiving combined treatment showed significantly higher state anxiety (STAI-Y1: t(60.11) = −2.36, p = .022, d = −0.58), while no significant differences were observed in other domains (DERS, BIS-11, Zung, STAI-Y2, IAT, CAT-Q) (all p > .15). In logistic regression, the overall model did not reach statistical significance (χ²(4) = 8.68, p = .070; Nagelkerke R² = .162). Age was the only significant predictor (OR = 1.13, 95% CI [1.02–1.26], p = .024), indicating that older patients were more likely to receive combined treatment.

Conclusions

In this clinical sample of adults with ADHD, pharmacotherapy was reported by 38% of patients, with high rates of psychiatric comorbidity. Combined treatment was associated with higher state anxiety and older age, but not with broader psychopathological severity. These findings suggest that treatment modality may be influenced more by specific symptom domains and demographic factors than by overall clinical severity, highlighting the need for targeted and individualized treatment strategies.

References

  1. Ayano, G., Tsegay, L., Gizachew, Y., Necho, M. et al. (2023). Prevalence of attention deficit hyperactivity disorder in adults: Umbrella review of evidence generated across the globe. Psychiatry research, 328, 115449.
  2. Kosheleff, A. R., Mason, O., Jain, R. et al. (2023). Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment. Journal of attention disorders, 27(7), 669–697.
  3. Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I. et al.(2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European psychiatry : the journal of the Association of European Psychiatrists, 56, 14–34.
  4. National Institute for Health and Care Excellence (NICE), 2018. Attention deficit hyperactivity disorder: diagnosis and management, NG87. NICE, London. Available from: https://www.nice.org.uk/guidance/ng87.[Accessed: 04 May 2026]