REVIEW

FUNDING: No funding was received for the

preparation of this article.
FINANCIAL DISCLOSURES: None of the
authors have a conflict of interest in the
conduct and reporting of this review. Dr.
IsHak has received grants in associated
research areas as follows: NARSAD on quality
of life in major depression and Pfizer on
ziprasidone monotherapy in major
depression.
ADDRESS CORRESPONDENCE TO: Waguih
William IsHak, MD, FAPA, Cedars-Sinai
Medical Center Department of Psychiatry and
Behavioral Neurosciences, David Geffen
School of Medicine at UCLA, 8730 Alden
Drive, Thalians W-157, Los Angeles, CA
90048; Phone: (310) 423-3515; Fax: (310)
423-3947; Email: Waguih.IsHak@cshs.org
KEY WORDS: Adult attention deficit
hyperactivity disorder, quality of life

10

Innovations in CLINICAL NEUROSCIENCE

The Quality of Life of

Adults with Attention
Deficit Hyperactivity
Disorder: A Systematic
Review
by RASHI AGARWAL, MD; MATTHEW GOLDENBERG, DO; ROBERT
PERRY, MD; and WAGUIH WILLIAM ISHAK, MD, FAPA
Dr. Agarwal is a resident at Brookdale University Hospital, Brooklyn, New York; Dr.
Goldenberg is a resident at Banner Good Samaritan Medical Center, Phoenix, Arizona; and Drs.
Perry and IsHak are with Cedars-Sinai Medical Center, David
Geffen School of Medicine at UCLA, Los Angeles, California.
Innov Clin Neurosci. 2012;9(56):1021

ABSTRACT
Objective: Across all medical
specialties, quality of life has become
an important measure of outcomes in
both research and clinical settings.
However, to date, there has not been a
systematic review of the research
relevant to quality of life in
populations with adult attention
deficit hyperactivity disorder. We
approach quality of life in adult
attention deficit hyperactivity disorder
by answering the following questions:
1) What specific metrics are used to
assess quality of life in adult attention
deficit hyperactivity disorder? 2) What
is the impact of adult attention deficit
hyperactivity disorder on quality of
life? 3) What effects do attention
deficit hyperactivity disorder
treatments have on quality of life?
Searches of major electronic
databases were conducted, and
reference lists from the identified
articles were searched for additional
studies, with a focus on studies that
utilized quality of life measures.
Design: Thirty-six relevant studies
are included in our review.
Results: There are multiple unique
measures currently used to measure

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

quality of life in adult attention deficit

hyperactivity disorder, ranging from
general quality of life scales to those
specifically designed for use in
attention deficit hyperactivity
disorder. Attention deficit
hyperactivity disorder was found to
significantly worsen the quality of life
in adults. Treatment with atomoxetine
and mixed amphetamine salts has
shown beneficial effects on quality of
life even in cases without
symptomatology improvement.
Conclusion: Pharmacological
treatment and early diagnosis have a
positive impact on outcomes, longterm prognosis, and quality of life in
adults with attention deficit
hyperactivity disorder. Having multiple
unique measures of quality of life have
limited the direct comparison of
different classes of attention deficit
hyperactivity disorder medication
treatments and future research should
be aimed to address this.

INTRODUCTION
Quality of life (QoL) can be
described as a multidimensional
construct that primarily concerns a
patients personal evaluation of his or

her life with regard to global health,

handicaps or impairments, and daily
living activities. An important
distinction can be made between
health-related QoL and overall QoL.
Health-related QoL comprises disease
and treatment related aspects of the
individual, such as pain, limitations in
motor ability, energy level, or mood.
Overall QoL, however, additionally
encompasses nonmedical aspects of a
persons life, such as satisfaction with
social, educational, and occupational
functioning. We found that QoL
instruments have been developed
with the specific aim of objectively
measuring overall QoL in those
suffering from attention deficit
hyperactivity disorder (ADHD).
These instruments were specifically
designed to assist clinicians in
identifying appropriate treatment
targets, facilitate future research, and
improve the well-being and
functioning of adults with ADHD.1
We will first examine the various
QoL instruments and their validity in
the context of adult ADHD. We will
then review studies that utilize these
specific QoL measures to investigate
the impact of ADHD in adults and the
effects of pharmacotherapy on QoL.

EPIDEMIOLOGY OF ADHD
The Diagnostic and Statistical
Manual of Mental Disorders,
Fourth Edition, Text Revision
(DSM-IV-TR) defines ADHD via
criteria that fall under the broad
categories of inattention,
hyperactivity, and impulsivity. ADHD
has its onset during childhood and
affects approximately 3 to 7 percent
of school age children.2 There is also
evidence that many adults meet the
full criteria for current adult ADHD
despite not having met the full
childhood criteria.3 This alludes to
the difficulty in making a diagnosis of
ADHD, as current criteria require
evidence of symptom onset before
the age of seven years and impact on
activities typically undertaken by
children.4
ADHD is often present with
comorbid disorders, and this can
make an accurate diagnosis even

more difficult. For example, ADHD

often coexists with bipolar disorder
(BPD) (620%), and in these cases
many ADHD symptoms can be
mistakenly attributed to and
overlooked because of BPD.5 Sentissi
et al5 have shown that impairments
in QoL are a key prognostic feature
for predicting the long course of
BPD, and the authors raised the
question as to whether there is a
significant impact of comorbid ADHD
on the QoL of patients with BPD.
Using a sample of participants with
BPD (n=73) they measured QoL
using the 36-item Short Form Health
Survey. It was discovered that there
is, indeed, a significant impairment in
the presence of comorbid ADHD in
BPD patients, especially in
adaptation and social functioning, by
comparison, with BPD patients
without ADHD. In contrast, the
authors failed to detect a significant
impact of substance abuse on those
same functional outcomes. This
impresses the large role ADHD plays
in determining QoL in comorbid
disorders, such as BPD, and the
importance of making an accurate
diagnosis of ADHD.5
ADHD was formerly regarded as a
childhood disorder. However, it is
now known as a developmental
disorder persisting over the lifespan.6
In a revealing retrospective
assessment of 18- to 44-year-olds
with a history of childhood ADHD
(n=3,197), Kessler et al7 reported
that 1 in 3 currently met DSM-IV-TR
criteria for adult ADHD. A recent
study conducted at the Department
of Health Care Policy at Harvard
Medical School (n=345) found that
almost half of the respondents
(45.7%) who had childhood ADHD
continued to meet full DSM-IV-TR
criteria for current adult ADHD.3
Unfortunately, it remains difficult
to predict persistence of ADHD into
adulthood. Kessler et al7 found that
only childhood ADHD severity and
childhood treatment significantly
predicted persistence. Controlling for
severity and excluding treatment,
none of the other variables (e.g.,
sociodemographics, childhood

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

adversity, traumatic life experiences

and comorbid DSM-IV-TR childadolescent disorders [e.g., anxiety,
mood, impulse-control, and
substance disorders]) significantly
predicted persistence, even though
they were significantly associated
with childhood ADHD. In a separate
study, Kessler et al3 reported adult
persistence was much greater for
inattention than for hyperactivity/
impulsivity. However, the authors fell
short of predicting persistence within
types.
Recently, there has been some
genetics research linking ADHD and
the latrophilin 3 (LPHN3) gene (a
brain-specific member of the LPHN
subfamily of G-protein-coupled
receptors) that is expressed in
ADHD-related regions, such as the
amygdala, caudate nucleus,
cerebellum, and cerebral cortex.
They point at this new neuronal
pathway as a common susceptibility
factor for ADHD through the lifespan
and a possible future source of
diagnosis and treatment.8 To date, no
studies have made a direct link, and
future genetics research is needed.
The diagnosis of ADHD and
predicting persistence into adulthood
continues to be difficult and the
genetics remains unclear; however,
the literature is unanimous in that
ADHD negatively impacts QoL in
adults. In this review, with the goal of
increasing the understanding of the
impact of ADHD on QoL in adults,
we 1) describe the instruments used
to quantify QoL in adult ADHD, 2)
review studies that utilize these
specific QoL scales, and 3) examine
the effects of pharmacological
treatments on QoL.

DESIGN
Literature was systematically
collected using the following
databases: Pubmed, Medline,
PsycInfo, Cochrane Database of
Systematic Reviews, ACP Journal
Club, DARE, CCTR, CMR, HTA,
NHSEED, and EMBASE from 1969 to
2011. We focused on studies that
used QoL measures. Keywords used
for the search were quality of life,

Innovations in CLINICAL NEUROSCIENCE

11

TABLE 1. Studies investigating QoL instruments in adult ADHD

REFERENCE

AIM

MEASURE

STUDY TYPE

MAIN OUTCOMES/CONCLUSIONS

This study
investigates the
validity of the AAQoL.

Brod et al (2006)1

AAQoL

Retrospective cohort
of ADHD adults

989

This study
investigates the
responsiveness of
AAQoL in subjects on
ATX.

AAQoL
SF-36

Landgraf et al (2007)14

This study examined

AIM-A, an adult ADHD
specific Quality of life
measure.

AIM-A

Mick et al (2008)11

This study assessed

the psychometric
properties of the QLES-Q-SF in adults
with ADHD.

Matza et al (2007)12

Hsiung et al (2005)

Huang et al (2006)

Q-LES-Q-SF with
social adjustment
scale

This study assess ed

the reliability and
validity of SF-36 and
WHOQoL, to measure
HRQoL.

Randomized, placebocontrolled trial of ATX

in ADHD adults

Open-label trial of
ADHD adults

Case control,
randomized, placebocontrolled trial of
methylphenidate in
ADHD adults

328
(58.8% men, mean
age=36.9 yrs)

AIM-A correlated strongly with the symptom scale

and also showed discrimination based on symptom
subscale, severity, and medication experience. It
serves as a powerful quality of life measure.

Q-LES-Q-SF showed significantly poorer scores

within ADHD patients, strong internal consistency
(0.88), and correlation with the social adjustment
scale; also revealed improved scores in
methylphenidate responders.
This scale proved to be an accurate QOL measure

SF-36
WHOQoL

HIV patients, selfrated

This study compared

ADHD adults, Taiwan
Taiwan versions of SFthe psychometric
national health
36 and WHOQoL
properties of WHOQoL
interview survey
and SF-36.

Subjects on 8 weeks of ATX showed marked

improvement in both symptoms and quality of life.
AAQoL effect sizes were larger than those of SF-36.
AAQoL change scores were significantly correlated
with change in symptom score (all p<0.001).
Strongly supporting the AAQoL as an outcome
measure for treatment of ADHD in adults and as a
measure of QOL.

317

150 ADHD, 134

normal; 173 adults
were randomized to
placebo or
methylphenidate

29-item AAQoL measured four domains: life

productivity, psychological health, relationships and
life outlook. Internal consistency was adequate
(0.93), construct and known-groups validity was
supported.
Demonstrated the AAQoL as a valid measure of
quality of life for ADHD adults.

224

11,440

national representative
sample in 2001

Both these scales correlated positively with

happiness and self-perceived health status and
negatively with intensity of symptoms.
The two measures weakly correlated with each
other and measured separate constructs.

SF-36 measures health related QoL, WHOQoL

measures global QOL.

ADHD: attention deficit hyperactivity disorder; QOL: quality of life; AAQoL: Adult attention deficit hyperactivity disorder quality of life; SF-36: 36-Item Short Form Health Survey; ATX:
atomoxetine; AIM-A Attention Deficit Hyperactivity Disorder Impact Module Adult Version; HRQoL: Health-related quality of life; Q-LES-Q-SF: Quality of life Enjoyment and Satisfaction
Questionnaire Short Form; WHOQoL: World Health Organization Quality of Life

QOL, ADHD, ADD, attention deficit

hyperactivity disorder, attention
deficit disorder, adult, WHO QOL,
AAQOL, AIM-A, SF-36, QLESQSF,
Euro-5D, and Y-QOL-R. Thirty-six
studies are included in this review,
including 24 that used QoL measures
to quantify the QoL in adults with
ADHD.

METRICS USED TO ASSESS QOL

IN ADULT ADHD
In our review of the literature, we
found that a number of scales have
been utilized in an attempt to
measure and objectively quantify the
QoL in adult ADHD (Table 1). These
include ADHD Impact Module Adult

12

Innovations in CLINICAL NEUROSCIENCE

Version (AIM-A), Adult ADHD

Quality of Life (AAQoL), World
Health Organization Quality of Life
(WHO QOL), Quality of Life
Enjoyment and Satisfaction
Questionnaire Short Form (QLESQSF), and 36-item Short Form Health
Survey (SF-36). An inquiry into the
accuracy and usefulness of these
scales is warranted given that each of
these scales proposes to accurately
measure a construct that, by
definition, is abstract and complex,
and treatment outcomes are based
on their ability to successfully and
objectively measure changes in QoL.
In this spirit, we have outlined the
literature investigating specific scales

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

designed to assess QoL from a

generic perspective, like the WHO
QoL and SF-36, to those more
specifically engineered for use in
adult ADHD, such as the AAQOL and
AIM-A.
WHO QOL Brief Version (WHO
QOL-BREF) and SF-36. WHO
QOL-BREF and SF-36 are examples
of generic instruments of measure
for QoL. WHO QOL-BREF, the most
recent 26-item version of the widely
utilized 100-item WHO QOL-100
assessment, is composed of four
domains: physical, psychological,
social, and environmental.
WHO QOL-BREF and SF-36 were
evaluated for reliability and validity

in a study of patients with human

immunodeficiency virus (HIV)
(N=224). The scales showed high
internal consistency (0.750.86 for
WHOQOL-BREF and 0.720.93 for
SF-36). Both also had positive
correlation with happiness/selfperceived health status measures
and displayed negative correlation
with the number/intensity of
symptoms. Subjects with fewer
symptoms scored higher on all
domains of WHOQOL-BREF, and the
SF-36 scores also revealed an
analogous relation between number
of symptoms and QoL. Good
correlation was seen between the
physical (r=0.48) and mental
(r=0.600.75) domains of both these
scales. WHOQOL-BREF showed less
floor and ceiling effect as compared
to SF-36.9 The above results present
clear and convincing evidence that
these two scales, while not
specifically designed for patients
with ADHD, are valid and reliable
measures of QoL.
A study utilizing the Taiwan
version of these scales collected data
from a national representative
sample in the 2001 Taiwan National
Health Interview Survey (N=11,440)
(which included Taiwan versions of
the SF-36 and WHO QOL-BREF).10
They used standardized effect size to
compare known-group validity for
health-related variables and selfreported overall QoL. They found the
SF-36 and WHO QOL-BREF
appeared to measure different
constructs: the SF-36 measures
health-related QoL, while the WHO
QOL-BREF measures global QoL.
The researchers concluded that
clinicians and future research should
carefully define research questions
related to patient-reported outcomes
before selecting amongst QoL
measurement scales.10
In the section of this article
entitled, Mixed Amphetamine Salts,
we discuss a specific example of how
the use of different QoL scales
effected the conclusions that were
drawn from treatment outcomes in
two separate studies.
QLESQ-SF. Mick et al11

conducted a study that investigated

the validity of the psychometric
properties of another generic
measure of QoL, the QLESQ-SF. One
hundred and fifty adults with ADHD
and 134 adults without ADHD from a
case-control study and 173 adults
randomized to placebo or
methylphenidate (MTP) were
assessed with both the QLESQ-SF
and the Social Adjustment Scale
(SAS). Response to change was
estimated by comparing change in
QLESQ-SF scores in responders and
nonresponders to treatment with
methylphenidate. Results from this
study demonstrated that adults with
ADHD have significantly less life
enjoyment and satisfaction compared
to the non-ADHD participants
(76.510.9) vs. (59.217.3)
(P<0.001). Responders to MTP
treatment showed QLESQ-SF
improvement compared to
nonresponders (76.112.0 vs.
67.914.5, p<0.001). Also, QLESQSF displayed good internal
consistency (0.88) and was highly
correlated (0.72) with the SAS.11
These results support the validity of
the QLESQ-SF as a measure of QoL
in adults with ADHD. In addition, as
previously reported, responders on
methylphenidate showed significant
improvement on QLESQ-SF, which
supports this scales utility as an
accurate measure for treatment
outcomes.
AAQOL. The Adult ADHD Quality
of Life (AAQoL) is an adult ADHD
specific QoL scale that was designed
to quantify the QoL consequences of
adult ADHD. It is composed of 29
items and was developed to
specifically assess health-related QoL
by focusing on four domains: life
productivity, psychological health,
relationships, and life outlook.
A retrospective chart review using
AAQoL (n=989) found good internal
consistency (0.93 overall) in addition
to its strong support of construct and
known groups validity. Using a
priori statistical analysis plan, the
study concluded that the AAQoL
appears to be a valid measure of QoL
for adults with ADHD and can be

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

considered for incorporation into

future studies.1
While studies utilizing AAQoL to
examine the effects of ADHD
medications on QoL will be discussed
later in this article, Matza et al12
specifically addressed the
responsiveness of AAQoL as a
treatment measure of adults with
ADHD started on atomoxetine (ATX).
In this randomized, placebocontrolled trial, subjects (n=328)
completed the AAQoL and other
comparable scales (Conners Adult
ADHD Rating Scale [CAARS], SF-36
and Endicott Work Productivity Scale
[EWPS]) at Baseline and Week 8. In
addition, clinicians rated symptom
severity and improvement.
Responsiveness was examined
through effect sizes and association
with change of the measures listed
previously. They found all AAQoL
domains reflected significant
improvement from Baseline to Week 8
(P< 0.0001) and these results were
significantly correlated with changes
in the other scales (all P<0.001). Also,
they reported the changes in AAQoL
scores significantly discriminated
among patients with various levels of
symptom improvement, and the
AAQoL effect sizes (-0.67 to -1.11)
were larger than the effect sizes for
the SF-36 (0.15 to -0.39). They
concluded that the AAQoL is
responsive to change in symptoms of
ADHD, demonstrates good test-retest
reliability, and appears to be a useful
outcome measure for treatment of
ADHD in adults.12
Collectively, these studies conclude
that the AAQoL yields results that are
consistent with other scales of QoL
and is a successful measure of QoL
changes in clinical trials. Moreover,
because AAQoL was designed
specifically for adults with ADHD, it
yields larger effect sizes than more
generic measures of QoL (such as the
SF-36). Larger effect sizes can aid
both patients and clinicians in
discriminating between treatment
modalities and their outcomes.
AIM-A. Once research studies
proved that condition-specific QoL
measures are definitively better than

Innovations in CLINICAL NEUROSCIENCE

13

generic measures, research was

conducted for the purpose of
developing additional scales
engineered specifically for QoL in
adult ADHD.
One such measure that was
developed and evaluated in an open
label trial (n=317) was AIM-A. This
measure of QoL utilizes multi-item
scales to assess both global QoL and
ADHD-specific QoL in six domains.
AIM-A has shown 80- to 100-percent
scaling success with good internal
consistency (alpha coefficients
0.83). It was found to discriminate
based upon symptom severity,
subtype, and medication experience
(p0.01) and was also sensitive to
change (P<0.001). It also correlated
nicely with the ADHD rating scale
(0.4940.200).14 These results
strongly suggest that AIM-A is a
valuable tool for objectively
determining QoL in adults with
ADHD. A limitation, however, is that
there are no studies comparing AIMA to the other QoL scales discussed
previously. Additionally, AIM-A has
been assessed in only a limited
number of clinical trials measuring
treatment outcomes. We hope future
research will address these
shortcomings in order to better
assess the specific advantages and
strengths of each scale in direct
comparison to the others.
Minimal clinically important
difference. QoL instruments gained
the attention of researchers and
clinicians as they continued to prove
themselves as worthy measures of
QoL and treatment outcomes. Once
their value was established, QoL
instruments were, for the first time,
featured as primary outcomes in
many randomized trials.15 One of the
challenges facing investigators using
such measures is determining the
significance of any observed
differences and communicating that
significance to clinicians and patients
who will be applying the trial results.
Jaeschke et al15 proposed elucidating
the significance of changes in scores
of QoL instruments by comparing
them to global ratings of change.
Using this approach they established

14

Innovations in CLINICAL NEUROSCIENCE

a plausible range within which the

minimal clinically important
difference (MCID) falls, which helps
guide interpretations of
questionnaire scores.15
They cite, for example, three
studies in which instruments
(measuring dyspnea, fatigue, and
emotional function in patients with
chronic heart and lung disease) were
applied using the MCID, which was
represented by a mean change in
score of approximately 0.5 per item
(when responses were presented on
a 7-point Likert scale). This affords
subjective changes in scores to be
given objective labels, such as
moderate or large change in the
domains of interest. This has been
useful in both interpreting
questionnaire scores and in the
planning of new trials.

ADHDS IMPACT ON QOL

To date, a surprisingly limited
number of studies have utilized these
QoL measures to investigate the
specific effects of ADHD on QoL in
adults. A review of available studies
(Table 2) shows that the ADHD
population suffers greater anxiety,
depression, and increased daytime
sleepiness than the non-ADHD
population.16 There appears to be a
consensus that patients with adult
ADHD have lower QoL than nonADHD patients. For example, a study
using WHO QOL-BREF found
respondents with ADHD to have
lower QoL (all P0.05), and patients
with ADHD showed a below-average
level of overall mental health (a
component of QoL) on self-ratings
measured by SF-36.2,16 While
decreased QoL scores in the adult
ADHD population reflect an inferior
sense of subjective well-being, they
do not explain what leads to or
causes adults with ADHD to feel this
way. Understanding the negative
impact of ADHD on QoL is
important; however, if identified,
these factors can serve as treatment
targets and outcome measures.
In an effort to identify specific
factors that decreased QoL,
Gudjonsson et al17 aimed to directly

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

associate ADHD symptoms with a

negative satisfaction with life (as
measured by the Satisfaction with
Life Scale). As they hypothesized,
they found both ADHD symptoms
and associated problems to be
significantly related to poorer
satisfaction with life. They also found
that predictors for dissatisfaction
with life appear to differ between
men and women with ADHD. They
reported that the best predictor for
decreased scores was poor social
functioning in men and poor
emotional control in women.17 These
specific predictors of negative
satisfaction and decreased QoL are
the first step in understanding how
ADHD negatively affects QoL and in
developing targeted treatments and
outcome measures.
A study conducted by Rimmerman
et al18 also observed that differences
in QoL predictors exist between men
and women. They found the main
predictors to be monthly income for
men and level of attention deficit
symptoms for women. These
studies17.18 add to the understanding
that differences in QoL exist between
sexes and that treatment approaches
should be tailored accordingly.
Further research might uncover the
positive effects of other modifiable
environmental factors and their
differing effects on men and women.
A separate study conducted by
Rimmerman et al19 involving Israeli
adults with borderline IQ (7079)
and ADHD led to a greater
understanding of some of these
modifiable determinants and
variables. The authors measured this
subsets QoL via the QoL
questionnaire by Schalock and
Keith37 and found that high scores
are associated with having had
inclusive education, limited medical
disabilities, lower scores on the
Brown ADHD Symptom Scale, high
monthly income, participation in
leisure activities, and having a
personal friend. The authors
reported the two most significant
predictors of QoL as being ADHD
symptomatology score and monthly
income.19 These results identify

additional factors that can be

addressed by clinicians seeking to
improve their patients QoL, and
while this study was conducted in
adults with borderline IQ, the factors
they identified are universal. As
those subjects with lower
symptomatology scores had higher
QoL scores, their results also
indirectly confirm that treatment of
the symptoms of ADHD plays a
direct role in increasing QoL. There
needs to be more research targeting
specifically how ADHD affects QoL in
adults. The studies that have been
published and are examined in this
review show that there are
differences between how ADHD
affects the sexes and that there are
modifiable factors that can be
targeted in treatments and should be
in the future in order to increase
positive outcomes.

TREATMENT AFFECTS ON QOL IN

ADHD
In order to accurately measure
pharmacological treatment impacts
and compare outcomes, QoL
measures have been increasingly
used in both clinical settings and
research. Table 3 contains a
summary of the studies on the effect
of treatment on QoL.
After finding that symptoms of
ADHD and QoL improve
simultaneously, Weiss et al20 went so
far as to conclude that satisfaction
with medications is a direct measure
that predicts QoL benefits. This
highlights the important role that
effective medication plays in shaping
the QoL in adults with ADHD.
To this end, we review studies
carried out with ADHD
pharmacological treatments that
utilized the previously discussed QoL
scales as measures.
Nonstimulant medications.
Atomoxetine (ATX). ATX, a
norepinephrine reuptake inhibitor,
was approved in November 2002 for
the treatment of ADHD in children,
adolescents, and adults. It is
manufactured, marketed, and sold in
the United States under the brand
name Strattera. Generic

formulations of ATX are sold in other

countries.
The effects of ATX on QoL in
adults with ADHD was assessed in a
series of studies by Adler et al2,21,23,25
using SF-36 and AAQoL as measures
of QoL. These studies found that
ATX reduced symptomatology and
also improved QoL of adult ADHD
patients. Similarly, in a previously
mentioned study, Adler et al2 found
significant improvement on selfratings measured by SF-36 after six
weeks of ATX treatment in adults
with ADHD (P<0 .001), which
correlated with improvement on the
symptom scale (P<0 .001). Similar
results were obtained when the
AAQoL was applied to ATX-treated
participants in a randomized, doubleblind, placebo-controlled, six-month
trial (n=501). They found ATX was
statistically superior to placebo at
both the 10-week and six-month time
points.21 Both studies2,21 concluded
that ATX treatment not only
ameliorates ADHD symptoms, but
also improves perceived QoL in
adults with ADHD.
An interesting distinction, with
regard to treatment with ATX, was
raised in a review of 13 relevant
studies. In their review, Matza et al22
point out that ATX treatment was
associated with greater benefits than
placebo on multiple domains, such as
behavior, mental health, self esteem
and social/family functioning.
Subsequently, the authors concluded
that there was compelling evidence
that treatment of ADHD has broad
positive impacts beyond pure
symptom improvement. The authorse
seemd to be speaking of QoL without
mentioning it by name, as these data
sets predated much of the research
and instruments used to measure
QoL in adult ADHD.22
Drawing a distinction between
improvements in QoL and
symptomatology is an important
takeaway for both patients and
clinicians in regards to ADHD
treatment and evaluation of
treatment outcomes. This topic was
addressed in a six-month, doubleblind trial with ATX and placebo

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

(n=410) in adults with DSM-IV-TRdefined ADHD. In this study, Adler et

al23 found ATX-treated patients
showed significantly greater
improvement in QoL than placebotreated patients on the AAQoL, after
controlling for baseline severity of
ADHD. Conversely, at six months,
both groups had non-significantly
different improvements on the EWPS
total scores, a direct measure of
symptom improvement. The authors
concluded that while
symptomatology may fail to improve,
ATX-treated patients can still show
significant improvement in diseasespecific QoL measures.23
An open label study of 725 adults
with ADHD found changes in
attention to be a stronger mediator
of ADHD-specific QoL outcomes than
the more obvious changes in
disruptive symptoms.20 This
impresses the importance of using
QoL scales, and not solely
symptomatology improvement, to
assess and compare the effectiveness
of treatment outcomes.
As mentioned previously, patients
with ADHD have been found to have
higher rates of anxiety than the nonADHD population. We found several
studies that utilized QoL measures in
regard to ATX treatment and its use
in adult ADHD populations with
comorbid anxiety disorders.24,25 One
such study reported that the most
problematic impairments in adults
with ADHD are in the domain of
work, followed by interpersonal
(both being associated with ADHD
severity); and that these
impairments manifested with distress
defined by anxiety and depressive
symptoms.24 ATX has been shown to
decrease anxiety symptoms in a
randomized, double-blind, placebocontrolled study (as measured by
STAI- trait inventory) in adults with
ADHD and comorbid social anxiety
disorder (n=442).25 The authors
reported significant improvement of
AAWoL scores at every time point.
This study not only confirmed
improvements in QoL of adults with
ADHD treated with ATX, but also
reported improvements of comorbid

Innovations in CLINICAL NEUROSCIENCE

15

TABLE 2. Studies of the impact of ADHD on QoL

REFERENCE

AIM

Examined the
relationship between
ADHD, depression/
anxiety, and quality of
life

Chao et al (2008)16

MEASURE

STUDY

WHOQoL-BREF, BDI,
BAI

Draftees in Taiwanese
army

SWLS

Grenwald-Mayes
(2002)38

Examine the
relationship between
current QOL, family of
origin dynamics, and
ADHD in college
students

Schalock and Keith

QOL questionnaire

Undergrad college
students, both ADHD
and non-ADHD

Sentissi et al (2008)

Study the impact of

ADHD and substance
abuse on QOL within a
population of patients
diagnosed with bipolar
disorder

SF-36 (for well-being),

SAS-SR (for social
adaptation), and Brief
Psychiatric Rating
scale.

BPD-I and BPD-II

within the outpatient
population

Rimmerman et al
(2007)19

Study the QOL of

ADHD subjects with
borderline IQ

Rimmerman et al
(2005)18

Study the QOL of men

and women with
ADHD and borderline
IQ

Boonstra et al (2007)30

To investigate
parameters of sleep,
activity, and circadian
rhythm and the effects
of MPH on these
variables in adults with
ADHD

Kooij et al (2001)31

Monitor the effect of

stimulants on
nocturnal motor
activity and sleep
quality in ADHD adults

Adler et al (2009)32

MAIN OUTCOMES/CONCLUSIONS

Ascertain whether
ADHD symptoms are
negatively related to
subjective well-being.

Gudjonsson et al
(2009)17

929 adult subjects

(328 met criteria for
ADHD)

University students in
Iceland

369

Schalock and Keith

QOL questionnaire

37 ADHD and 59 nonADHD subjects

73

Young Israeli adults

with ADHD

ADHD adults

Actigraphy

Placebo-controlled
trial; adults with ADHD
compared to those
without ADHD

39 normal controls
and 33 adults with
ADHD for baseline
comparisons; 31
adults with ADHD in
medication trial

Actigraphy

Open-label trial; adults

with ADHD and normal
adults

8 ADHD diagnosed
adults and 8 matched
normal controls

127

420 ADHD adults; 62

received placebo,
119 received LDX
Placebo-controlled
30mg, 117 received
trial; adults with ADHD
LDX 50mg, 122
received LDX 70mg
(all dosed daily)

ADHD negatively correlated with the ADHD symptom

scale. ADHD also correlated negatively with the
anxiety scale scores.
ADHD is associated with poor QoL.

ADHD students had lower QOL compared to

controls.
Family of origin dynamics effected ADHD subjects
more significantly than their non-ADHD counterparts.

30% met ADHD criteria and 22% had substance

abuse.
Comorbidity of ADHD with BPD reduced the level of
social functioning, adaptation, and quality of life.
Substance abuse lacked an apparent effect.

Two main predictors of overall QOL are ADHD

symptomatology and monthly income. For young
adults, inclusive education and high monthly income
were main predictors while for older adults, low level
of medical disability and low ADHD symptom scores
were predictive.

In a regular education environment, main QOL

predictors for men are monthly income, while for
women, its ADHD symptom level. For those in
special education, there are no predictors for women
while for men, QOL is affected by the quality of
contact with their mothers.
Actigraphic sleep estimates showed that ADHD
subjects took longer to fall asleep, suffered lower
sleep efficiency, displayed shorter within-night
periods of uninterrupted sleep, and exhibited
continuously elevated daytime activity levels. MPH
reduced total sleep time but improved sleep quality
by consolidating sleep.

127

Schalock and Keith

QOL questionnaire

To evaluate the impact

Pittsburgh Sleep
of LDX on sleep quality
Quality Index (PSQI)
in adults with ADHD

35.3% identified as having adult ADHD. ADHD adults

had more severe depression, anxiety, and daytime
sleepiness and had poorer QOL than controls (all
p<0.05).
ADHD should be included in the differential diagnosis
for decreased QoL.

Sleep problems are inherent in adults with ADHD and

treatment with MPH improves the quality of sleep.

ADHD patients had poorer sleep quality and showed

significantly higher nocturnal motor activity at baseline
compared with controls. Three weeks of treatment with
MPH improved sleep quality and reduced activity level
and movements.

PSQI demonstrated poor sleep quality within this entire

ADHD sample. For most subjects, LDX was not
associated with overall worsening of sleep quality. LDX
significantly improved daytime functioning in adults with
ADHD.

ADHD: attention deficity hyperactivity disorder; QOL: quality of life; WHOQoL-BREF: World Health Organization Quality of Life Brief Version; BDI: Beck Depression Inventory; BAI: Beck
Anxiety Inventory; SWLF: Satisfaction with Life Scale; SF-36: 36-Item Short Form Health Survey; SAS-SR: Social Adjustment Scale Self Report; BPD: bipolar disorder; LDX:
lisdexamfetamine dimesylate; MPH: methylphenidate

16

Innovations in CLINICAL NEUROSCIENCE

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

anxiety symptoms. Accordingly, the

authors concluded that ATX
treatment of ADHD is beneficial and
improves the QoL in patients with
comorbid anxiety symptomatology.25
Unfortunately, the study of how
treatment of ADHD can improve the
symptoms of other comorbid
disorders associated with ADHD is
an important data set that has yet to
be fully investigated and should be
the focus of future research. As in
this case, understanding that ATX
has beneficial effects on comorbid
anxiety symptomatology can help
prevent over prescribing of
additional classes of medication and
can improve outcomes.
Stimulant medications. Mixed
amphetamine salts (MAS). MAS are
another commonly prescribed class
of ADHD medications. This class has
been sold in the United States under
the brand name Adderall since
1996, and generic formulations are
presently available in the United
States. MAS formulations are
collectively thought to act by
increasing norepinephrine and
dopamine.
Studies done by Spencer et al26
and Spencer et al27 monitored the
effects of MAS on both
symptomatology and QoL in the
treatment of adult ADHD. AIM-A was
utilized in both studies as a QoL
measure, and the authors reported
significant improvement on all six
ADHD-specific AIM-A subscales. A
seven-week, double-blind, placebocontrolled trial of MAS (N=274)
found statistically significant
improvements in global QoL (for
AIM-A Question 1, P=0.0001 and for
AIM-A Question 4, P=0.0006).26 A
separate randomized, double-blind,
multicenter, placebo-controlled study
(N=272) with MAS treatment not
only found improvements in both
global and ADHD-specific QoL, but
also found improvements in executive
functioning (EF) (as measured by
BADDS) (P<0.0001).27 The authors
concluded that EF deficits play a
large role in adults with ADHD,
including having possible correlations
to changes in QoL.27

Kessler et al3 highlighted the

importance of EF. The authors noted
that although currently necessary for
a diagnosis of ADHD, inattention is
not specific to ADHD because it is
strongly associated with other mental
disorders. Kessler et al3 reason that
EF deficits, in comparison, are more
specific and, consequently, stronger
predictors of adult ADHD, despite not
being in the DSM-IV-TR. Supporting
this hypothesis, there have been
improvements in EF correlated with
improvement in QoL, as assessed in
two independent clinical trials in
which participants received MAS for
the treatment of ADHD.28
All of these studies3,2628 reported
that MAS was significantly more
effective than placebo in treating
adult ADHD and that adverse effects
were consistent with amphetamine
treatment. The extended duration of
action (up to 16 hours), significant
improvements in EF, and both global
and disease-specific QoL
improvements make MAS an
important treatment of adult ADHD.
This also underscores that EF
improvement is an area where MAS is
superior to ATX in the treatment of
adult ADHD. Kessler et al3 suggests
that the number of EF symptoms
should be increased in the upcoming
fifth edition of the DSM and the 11th
edition of the International
Classifications of Diseases (ICD),
and that EFs effects on QoL in the
adult ADHD population should be the
focus of future research.
Goodman et al,29 who performed a
10-week analysis in a QoL,
Effectiveness, Safety, and Tolerability
(QU.E.S.T) trial, reported another
area where MAS were found to be
superior to ATX. This was an ongoing,
open-label, multicenter investigation
of once-daily MAS extended release
(XR) in adults (n=725). After 10
weeks of treatment (on final visit
mean dose 37.2mg/day), patients
showed significant improvement in
QoL on SF-36. ADHD symptom score
also decreased for both
hyperactive/impulsive and inattentive
subtypes (P<0.0001), and 74.4
percent of subjects were rated as

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

much/very much improved. In

addition to improvement on vitality,
social, emotional, and physical
functioning, they found there was
significant improvement in both
mental and physical health (all
P<0.0001).29 This is in contrast to
ATX results, which did not show
specific physical improvement.
There are two possible
explanations for the specific physicalhealth improvements reported with
MAS, and this highlights the
differences among the QoL
instruments and the conclusions that
can be drawn from them (as
mentioned in the first section on the
specific QoL scales). First, the SF-36
specifically targets physical health as
one of its domains, whereas the
AAQoL does not. The ATX trials used
both surveys to collect data, while the
MAS study by Goodman et al29 used
only the SR-36 as the authors
specifically targeted physical health as
one of their measures of QoL. Second,
there was more discontinuation due
to adverse events for ATX versus
MAS, which was comparable to
placebo (17.2% ATX vs. 6.9% MAS vs.
5.6% placebo).25,29 Therefore, one
could surmise that the increased
adverse effects of ATX contributed to
a less noticeable improvement in
physical health.
To limit such ambiguities, Huang at
al10 suggested researchers should
carefully define their research
questions and goals before selecting a
QoL instrument. Moreover, as we
discuss previously, having multiple
measures of QoL has limited the
direct comparison of different classes
of ADHD medication treatments and
in this case allowed claims of
superiority that may or may not be
accurate. Therefore, future direct
comparative clinical trials are needed
to fully assess the QoL improvements
of the different classes of ADHD
medications.

THE IMPACT OF ADHD

TREATMENT ON SLEEP QUALITY
We found three studies that
directly investigated the impact of
pharmacological interventions for

Innovations in CLINICAL NEUROSCIENCE

17

TABLE 3. Studies of the impact of treatment on QoL of adults with ADHD

REFERENCE

AIM

Adler et al (2006)2

Measure the effect

of newly
introduced ATX in
the treatment of
adult ADHD

MEASURE

STUDY

TREATMENT
DURATION/DOSES

218

40mg twice daily

or 80mg daily for
6 weeks

SF-36

Adult ADHD
patients

Adler et al (2009)

To evaluate the
efficacy of ATX on
ADHD symptoms
and quality of life

AAQoL

Adult ADHD
patients;
randomized,
double-blind,
placebo-controlled

206; 94
randomized to ATX Once-daily dose of
and 112 to
ATX for 6 months
placebo

Adler et al (2008)23

To measure the
effect of ATX on
QOL and work
productivity

AAQoL
EWPS

Adult ADHD
subjects;
randomized,
placebo-controlled

Once-daily
410; 271
morning dose of
randomized to ATX
ATX was given at
and 139 to
4080mg/day for
placebo
6 months

Adler and
Liebowitz (2009)25

Evaluate the effect

of ATX on ADHD
and comorbid
social/anxiety
disorder

AAQoL
STAI

Adults with ADHD

and social/anxiety
disorder;
randomized,
double-blind,
placebo-controlled

442; 224
40100mg/day of
randomized to ATX
ATX over a 14and 218 to
week period
placebo

Matza et al
(2006)22

To evaluate the
effect of ATX on
ADHD symptoms
and QOL

Review included
studies with both
generic and
specific healthrelated QOL
instruments

Not applicable
review article

Not applicable
review article

Not applicable
review article

Spencer et al
200826

To assess the
effect of treatment
with MAS on the
QOL of ADHD
adults.

AIM-A

Adults with ADHD;

randomized,
double-blind,
placebo-controlled

274; 137
randomized to
triple bead MAS
and 137 to
placebo)

12.5 to 75mg/day
of triple-bead MAS
for 7 weeks

Spencer et al
(2008)27

To evaluate the
efficacy and safety
of triple-bead
MAS-XR in
patients with
ADHD

AIM-A (for QOL)

Adults with ADHD;

multicenter,
randomized,
double-blind,
placebo-controlled

272; subjects
randomized to
triple bead MAS
XR or placebo

Starting dose was

set at 12.5mg/day.
Once daily dosage
was given for 7
weeks.

Goodman et al
(2005)29

To evaluate safety
and efficacy of
MAS XR in adults
with ADHD

QuEST SF-36

Adult ADHD
patients;
multicenter, openlabel

Goksoyer et al
(2007)39

To evaluate
whether treatment
of children with
ADHD with
stimulants reduces
the burden of adult
ADHD

Index of Burden
which included
Functioning and
QOL questionnaire
as one of 5
components

Adult ADHD
subjects;
91 (Norway)
retrospective study

21

702

MAIN OUTCOMES

Treatment with ATX ameliorated the ADHD

symptoms (as measured by CAARS) and also
showed improvement on the mental health subscale
of SF-36.

A once-daily morning dose of ATX over a 6-month

period significantly improved QoL and adequately
controlled symptoms maintaining its efficacy in the
evening.

QoL significantly improved for subjects on ATX

compared to controls. However, there was little
difference in improvement between groups on
measures of work productivity.

The ATX-treated patients showed significant

improvement in QoL and ADHD symptoms, as well
as reduced anxiety.

ATX-treated subjects showed greater benefits than

controls on both generic and specific QoL
instruments.
On comparing results between children and adults,
some functional improvement was seen in adults, and
results were less consistent than seen in children.

1060mg/day of
MAS XR given for
10 weeks

Unspecified doses
of stimulants

Significant improvement was seen on all domains of

AIM-A. Also, global QOL improved in patients on
triple-bead MAS.
Study showed positive effect of this drug on QOL of
ADHD patients.

After 7 weeks of MAS-XR treatment, improvement

was seen on all AIM-A domains. Also, subjects
showed improvement in ADHD symptoms as well as
executive functioning. These effects were seen for an
extended duration, i.e., up to 16 hours.

The results of this 10-week trial revealed significant

improvement from baseline symptoms via the
ADHD-RS-IV.
SF-36 showed significant increases in QOL (e.g.,
general health; physical and mental health; and
vitality, social, emotional, and physical functioning).

This study strongly suggests that stimulant use in

childhood increases social and psychological
functioning in adults.

ADHD: attention deficit hyperactivity disorder; QOL: quality of life; STAI: State Trait Anxiety Inventory; CAARS: Conners Adult Attention Deficit Hyperactivity Disorder Rating Scale; ATX:
atomoxetine; SF-36: 36-Item Short Form Health Survey; EWPS: Endicott Work Productivity Scale; MAS: mixed amphetamine salts; QuEST: quality of life effectiveness, safety, and
tolerability; HRQoL: health-related quality of life; AIM-A: Attention Deficit Hyperactivity Disorder Impact Module Adult Version; MAS-XR: mixed amphetamine salts extended release,
ADHD-RSIV: Attention Deficit Hyperactivity Disorder Rating Scale IV.

18

Innovations in CLINICAL NEUROSCIENCE

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

ADHD on the sleep quality in

adults.3032 These studies
unfortunately did not utilize QoL
instrument scales; however,
actinographic studies have shown
that ADHD had many effects on
patients sleep.30,31 Those subjects
with ADHD took longer to fall asleep
and had lower sleep efficiency
(shorter within-night periods of
uninterrupted sleep).30 These
findings were consistent with
subjective complaints. Similar results
were reported in another study
where subjects with ADHD showed
increased nocturnal motor activity
and also had reduced self-perceived
quality of sleep.31
The effect of stimulant
methylphenidate (MTP) on sleep
quality was assessed in a doubleblind, placebo controlled study that
showed that stimulants reduced total
sleep duration by leading to a later
bedtime and later sleep onset.30
However, nocturnal awakenings
decreased and sleep efficiency
increased (a measure of sleep
quality), indicating more
consolidated sleep. A second study
also reported the beneficial effects of
reduced activity level (p=0.10) and
movement index (p=0.07) and
improved sleep quality (p=0.05).31
However, in contrast the authors did
not find effects on sleep latency,
number of awakenings, or total time
in bed. A possible explanation for
this disparity is the small sample size
(n=8) used in the second study.31
The amphetamine pro-drug
lisdexamfetamine (LDX) was utilized
in a similar study examining its
impact on sleep in ADHD
treatment.32 In the Adler et al study,32
the authors found the mean baseline
Pittsburg Sleep Quality Index (PSQI)
global score was 5.8 for LDX and 6.3
for placebo (P=0.19), indicating poor
overall sleep quality of subjects with
ADHD in both the treatment group
and the control group. Out of seven
sleep components used to assess
sleep quality, LDX was found to have
an impact only on daytime
functioning without any significant
changes found in sleep quality,

latency, duration and habitual sleep

efficiency, sleep disturbances or use
of sleep medications. The authors
concluded that LDX improves
daytime functioning in ADHD
patients, while not disrupting sleep
quality.32
Taken as a whole, these studies3032
conclude that sleep problems are
inherent in adults with ADHD and
that ADHD medication improves the
quality of sleep. However, further
research is required to determine the
direct effect improved sleep quality
has on overall QoL.

EMERGING NONSTIMULANT
PHARMACOLOGICAL
TREATMENTS
The stimulant drugs commonly
used for the treatment of ADHD
have clinically significant side effects,
such as insomnia, dry mouth,
decreased appetite, and headache, in
almost 1 in 5 patients.29 Researchers
are continuously investigating new
classes of drugs that are more
efficacious and have fewer side
effects. Current nonstimulant
medications include ATX, the only
United States Food and Drug
Administration (FDA)-approved,
nonstimulant drug for adults with
ADHD, which has a positive effect on
QoL. Guanfancine (Intuniv) and
clonidine XR (Kapvay), both alpha2A adrenergic receptor agonists,
were FDA-approved in the past three
years for ADHD in children ages 6 to
17 years old, and has not been
adequately studied in terms of its
effect on QoL in adults. Three other
nonstimulant formulations are
undergoing clinical trials, as follows:
Long-acting clonidine hydrochloride
(Clonicel) is in Phase III clinical
trials with no QoL data yet.
Pozanicline (ABT-089), a neuronal
nicotinic receptor partial agonist,
might prove to be promising, as
research has shown this drug to
significantly improve QoL (as
measured using AAQoL), improve
the core symptoms of ADHD, and
also reduce the overall work
impairment in the adult ADHD
population. And finally, sofinicline

[VOLUME 9, NUMBER 56, MAYJUNE 2012]

(ABT-894), another nonstimulant

agent, is in clinical trials for ADHD
and no QoL data are yet available.

DISCUSSION
While traditional treatment
evaluation and outcome measures
focused only on symptomatology,
QoL scales expand our ability to
monitor and quantify formerly
subjective perceptions of physical,
psychological, and social functioning.
Self-esteem, body image, leisure,
spirituality, safety and security,
sexual relations, social supports, and
home environment are clear
examples of life aspects evaluated
during outcome assessments of
ADHD interventions with QoL
instruments.33 The utilization of QoL
scales permits objective evaluation of
clinical samples of ADHD adults in a
more holistic sense by delving into
the lesser-studied and more often
neglected aspects of patients lives.
This is important because there have
been reports of significant
improvements in QoL and positive
treatment outcomes in cases without
significant symptomatology
improvement.7,15 Since ADHD is a
multifaceted and far-reaching
disease, it is important to measure
clinical course and treatment
outcomes with similarly global
assessments.
First-line treatment for ADHD is
pharmacotherapy with stimulant
drugs, such as MAS. While these
medications have established efficacy
in treating ADHD, they also have
high abuse potential. They are
currently categorized as United
States Drug Enforcement Authority
(DEA) schedule II controlled
substances, which places MAS
alongside pharmaceuticals notorious
for their abuse potential, such as
morphine, cocaine, and
methamphetamine. While stimulant
abuse is beyond the scope of this
article, it was reported that patients
with chemical dependency and
ADHD had increased addiction
severity and pathology compared to
those with chemical dependency
alone.34 The potential for abuse of

Innovations in CLINICAL NEUROSCIENCE

19

stimulant medications may likely

influence the choices that clinicians
and/or patients make regarding
whether to commence therapy with
the aforementioned stimulants.
Therefore, there is a clear need for
the utilization of nonstimulant
pharmaceuticals.
With this in mind, it is important
to consider that early treatment of
ADHD is critical. As previously
discussed, not only does early
treatment simultaneously decrease
symptomatology and improve QoL,
but early treatment also plays a large
role in adult ADHD course and
prognosis, as was shown in a
retrospective study of adult ADHD
patients utilizing the Index of
Burden to compare groups.35 The
index was constructed of five
variables (alcohol abuse, substance
abuse, criminality, global severity
index of SCL-90, and the Functioning
and Quality of Life questionnaire).
Results from this study alert us to
the clinically relevant notion that the
treatment of ADHD during childhood
results in higher social and
psychological functioning in adults
and helps reduce the burden of
untreated ADHD in adulthood.35
A different method of calculating
the burden of illness was developed
for depression incorporating
symptom severity, functioning, and
quality of life in one measure named
the Individual Burden of Illness
Index (IBI-D).36 This innovative
approach, if it would to be developed
for ADHD, may add significant value
to outcome measurement of
treatment interventions by
incorporating QoL.
In summary, this review
contributes to the adult ADHD
literature by examining the various
QoL measurement scales, ADHDs
effect on QoL in adults, and the
impact of specific pharmacological
interventions on QoL. Going forward
we hope that when the public,
patients with ADHD, and clinicians
who treat these patients consider the
risks and benefits of prescribing a
medication or therapy for ADHD
treatment, improving QoL will now

20

Innovations in CLINICAL NEUROSCIENCE

be among their treatment outcome

considerations. QoL research on
adults with ADHD has presented a
new paradigm for the evaluation of
ADHD medications, showing that
they do not solely alleviate symptoms
and functional impairments
associated with ADHD, but perhaps,
more importantly, benefit the way in
which an adult patient with ADHD
experiences and rates his or her
quality of life in general.

8.

9.

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