I Just Received the Diagnosis of ADHD! Should I Tell Them at Work?
by Wilma Fellman, M.Ed., LPC

You just got your performance review at work…and it wasn’t “sterling.” You also were recently diagnosed with ADHD. Would it be a good idea to share this new information with your employer and/or co-workers? While this is a very personal decision that you have to make…the answer is very complicated and twofold:

On one hand, it might be the right decision to explain your challenges, in order to receive reasonable accommodations similar to any other type of disability-situation. The result might be that for the first time, your employer and co-workers understand your struggles, and no longer consider you lazy or unqualified. They may be willing to help you to re-think your workspace, making day-to-day tasks easier to accomplish in a marketable time frame. They may also be willing to help you receive support services through an Employee Assistance Program, which might provide the counseling/coaching you need to develop workable systems for efficiency and productivity.

On the other hand, sometimes employers and co-workers don’t understand the real workings of ADHD, and might make assumptions about you that may not be true. They may believe that people with ADHD are not bright and capable, or that you suddenly need to be watched very carefully for mess-ups. Such skeptical surveillance might result in more stress, documentation needed for writing you up, and dismissal.

It might be best then, to discuss the pros and cons with a qualified service provider…a career counselor, coach or therapist, in order to weigh what might be gained from such disclosure against the potential backfires that could occur.

Wilma Fellman has been a Career Counselor, for over 24 years, specializing in individuals with AD/HD, LD, and other challenges. She is the Founder/Coordinator of a Michigan organization for professionals who specialize in AD/HD. She is the author of: The Other me: Poetic Thoughts on ADD for Adults, Kids and Parents, and contributing author of Understanding Women with AD/HD. The Second Edition of her career development book, Finding A Career That Works For You, contains a Special Foreword by Richard Nelson Bolles, author of What Color is Your Parachute? Wilma is a Past President of Michigan Career Development Association, served on the ADD Association (ADDA) Board for 8 years, and is developing training for other career counselors, coaches, etc.

Last week, Shire released the following new ADHD data about VYVANSE, DAYTRANA and guanfacine extended release at the American Psychiatric Association (APA) annual meeting in San Diego. Following are the highlights:

VYVANSE (lisdexamfetamine dimesylate) - the first prodrug stimulant treatment for ADHD - recently received FDA approval and is scheduled for a June 2007 launch. Twelve-month treatment with VYVANSE yielded a greater than 60 percent improvement in ADHD symptom control in children, based on a phase III extension trial. Once-daily dosing of VYVANSE provided predictable and reliable delivery of its active ingredient, d-amphetamine, as demonstrated by data documenting its low variability from patient to patient in the time to maximum drug concentration, between 4.5 and 6 hours. In comparison, during the same phase II trial, patients taking MAS XR achieved maximum d-amphetamine concentration between 3 to 12 hours.

DAYTRANA (methylphenidate transdermal system) - the first and only ADHD patch medication - offers a flexible wear time, up to nine hours, which enables physicians to individualize duration of effect. Both boys and girls, aged 6 to 12 years, achieved significant efficacy in reducing their ADHD symptoms using DAYTRANA in a phase III study.

Guanfacine extended release (GXR) - the first selective alpha-2a-adrenoreceptor agonist in development as an ADHD nonstimulant medication Treatment with GXR yielded significant control of core ADHD symptoms in children, based on four, long- and short-term phase III studies, including a 24-month study. GXR is a nonstimulant, is not a controlled substance and does not appear to have a mechanism for potential abuse or dependence.

D-Amphetamine Prodrug New Clinical Research
by Richard L. Rubin, MD

Lisdexamfetamine, under the brand name Vyvanse, is expected available in pharmacies during June. The FDA has approved this medicine for ADHD in children 6-12. Additional information to guide practitioners was presented at the May 2007 American Psychiatric Association Annual Meeting. Prior new research presentations explained how this compound released d-amphetamine after a gastric enzyme cleaved off an attached lysine molecule, a natural amino acid. The Lisdexamfetamine (LDX) compound is called a prodrug because it has no effects itself. Therefore alone, it reduces abuse potential by the IV or nasal routes. The gastric enzyme process provides gradual, extended release of the active drug, d-amphetamine. Research announced in 2006 showed that LDX doses of 30, 50, and 70 mg taken once daily were equivalent in ADHD core symptom benefit to Mixed Amphetamine Salts XR (Adderall XR) at the commonly used 10, 20, and 30 mg doses. The short-term study LDX side effects were also similar to MAS-XR.

Practitioners are asking how this new d-amphetamine formulation improves patient care, beyond reduced appeal to severe stimulant abusers. Prior research also showed some improved safety margin in overdose, because the rate of freeing the d-amphetamine is limited. Since LDX is approved now only for children, results of these attributes for adolescents and adults in practice are still pending further studies. One 2007 APA New Research Poster compared LDX and MAS-XR blood levels in a small group of children, and found that LDX amounts varied less that the MAS-XR. This suggests that the prodrug cleavage mechanism may provide a more consistent dose than current extended release delivery systems. A second research poster showed how the medicine absorption is rapid when dissolved in water or taken whole without food, and delayed an hour with a meal. A third study compared the ADHD response of Caucasian and Non-Caucasian children in the initial 4 week long trial, finding the degree of symptom improvement and side effects were similar. Lastly, the outcome of 12 months' continuous treatment after initial response was presented. The initial benefits were maintained over the year with 80% much or very much improved at endpoint. Side effects occurred at rates familiar in use of long-acting stimulants. The most common were decreased appetite, headache, insomnia, and decreased weight, and all had declining incidence over time.

In general, LDX is a more familiar than different medicine for practitioners. D-amphetamine has been used for over 60 years, and this appears to be the best long-acting form yet. It remains to be seen if d-amphetamine alone is similar or different in treating the more complex community populations outside controlled studies than mixed amphetamine salts. Cost will be a factor, compared to other long-acting alternatives. And despite less severe abuse potential, misuse and diversion are still likely. The FDA continued Class II controls on LDX, same as prior amphetamines.

Dr. Rubin practices Child and Adult Psychiatry, directs The Clinical Study Center in Burlington Vermont, and serves as Clinical Associate Professor at the University of Vermont College of Medicine.

Reprinted with permission of Journal of Attention Disorders, this column contains abstracts of recent research studies provided by Sam Goldstein, Ph.D., University of Utah Medical School and editor of the Journal of Attention Disorders.

Clancy, T.A., Rucklidge, J.J., & Owen, D. (2006). Road crossing safety in virtual reality: A comparison of adolescents with and without ADHD. Journal of Clinical Child and Adolescent Psychology, 35, 203-215.

These authors investigated the potential accident proneness of adolescents with ADHD in a hazardous road crossing environment. An immersive virtual reality traffic gap-choice task was used to determine whether those with ADHD show more unsafe road crossing behaviors than controls. In a population of participants, 13 to 17 years of age, those with ADHD had a lower margin of safety, walked slower, under-utilized the available gap in oncoming traffic, showed greater variability in road crossing behavior and evidenced twice as many collisions as compared to controls. No gender differences were observed. The authors suggest that virtual reality may help identify and educate those at higher risk of being involved in dangerous traffic situations.