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Clinical Management of Attention Deficit Hyperactivity Disorder (ADHD)

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: 15 January 2027 | Viewed by 10722

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Dr. Alessandro Pallucchini

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Department of Psychiatry and Addictions, Section of Addictions, North-Western Tuscany Local Health Unit, Tuscany NHS, Apuan Zone, Via Carriona 245, 54033 Carrara, Italy
Interests: neurodevelopmemntal disorders; addiction disorders; psychopharmacology; psychopathology

Special Issue Information

Dear Colleagues,

This Special Issue highlights the need to further explore the clinical and psychopathological aspects of adult patients with Attention-Deficit/Hyperactivity Disorder (ADHD) undergoing pharmacological treatment with opioid agonists. Currently, there are significant challenges in the pharmacological management and clinical care of these patients within Italian Addiction Services. Moreover, individuals with ADHD who access addiction services are often not properly diagnosed and, as a result, do not receive appropriate pharmacological treatment.

The aim of this work is to improve clinical practice and enhance current knowledge regarding adult ADHD patients receiving specific opioid dependence therapies with racemic methadone, who subsequently transition to levomethadone.

Dr. Alessandro Pallucchini
Guest Editor

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Keywords

ADHD
addiction
neurodevelopmental disorders
levomethadone

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Published Papers (4 papers)

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15 pages, 276 KB

Open AccessArticle

Substance Use in Adolescents with ADHD and Bipolar Spectrum Disorders: The Transdiagnostic Role of Emotional Dysregulation, Impulsivity and Hypersensitivity Traits

by Ilaria Accorinti, Diletta Donatella Acierno, Carmen Gnasso, Francesca Ieri, Gianluca Sesso, Annarita Milone, Pamela Fantozzi, Emanuela Inguaggiato, Francesca Lenzi, Valentina Levantini, Antonio Narzisi, Giulio Perugi, Chiara Pfanner, Greta Tolomei, Elena Valente, Valentina Viglione, Arianna Villafranca, Gabriele Masi, Paola Pias and Stefano Berloffa

J. Clin. Med. 2026, 15(9), 3237; https://doi.org/10.3390/jcm15093237 - 24 Apr 2026

Viewed by 704

Abstract

Background/Objectives: Adolescents with attention-deficit/hyperactivity disorder (ADHD) and bipolar spectrum disorders are at increased risk of substance use; categorical diagnoses may not fully explain individual variability in substance-related outcomes. This study examined substance use severity in clinically complex adolescents, focusing on the role of primary diagnosis and transdiagnostic dimensions (emotional dysregulation, impulsivity, cyclothymic-hypersensitive traits). Methods: In this cross-sectional observational study, 47 adolescents (aged 14–17) with DSM-5 diagnoses of ADHD or bipolar spectrum disorders were recruited from two Italian child and adolescent mental health services. Substance use severity was assessed using the Q-PAD Substance Abuse scale and the ABQ. Emotional dysregulation, impulsivity, affective temperament, and emotional-behavioral problems were assessed through RIPOST-Y, BIS-11, CHT-Q, and YSR. Correlation studies and group comparisons based on the Q-PAD Substance Abuse scale were performed to explore associations between clinical features and substance use. Results: Substance use severity was elevated in the overall sample and was not significantly associated with primary diagnostic category, overall illness severity, or global functioning. Higher Q-PAD Substance Abuse scores were significantly associated with impulsivity, emotional dysregulation, and hypersensitivity traits. Later initiation of lithium treatment was also associated with greater substance use severity. Conclusions: In this sample, substance use severity was more related to dimensional transdiagnostic vulnerabilities than to categorical diagnosis. Although preliminary and exploratory, these findings support early identification and targeted intervention on emotional dysregulation and impulsivity as potentially modifiable risk factors for adolescent substance use. Full article

(This article belongs to the Special Issue Clinical Management of Attention Deficit Hyperactivity Disorder (ADHD))

28 pages, 572 KB

Open AccessArticle

Factors Associated with Reduced Clinical Response in Adult ADHD: The Role of Alcohol and Cannabis Use Disorders and Autism Spectrum Disorder

by Manuel Glauco Carbone, Beniamino Tripodi, Irene Matarese, Alessandro Bellini, Roberta Rizzato, Claudia Tagliarini, Filippo Della Rocca, Francesco De Dominicis, Icro Maremmani, Giulio Perugi and Angelo G. I. Maremmani

J. Clin. Med. 2026, 15(7), 2688; https://doi.org/10.3390/jcm15072688 - 2 Apr 2026

Cited by 1 | Viewed by 1458

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) in adulthood is frequently associated with complex psychiatric comorbidity, including high rates of Substance Use Disorders (SUDs), which may influence treatment outcomes. Although pharmacological treatments are effective for core ADHD symptoms, real-world response remains heterogeneous, and the contribution of specific substance-related and neurodevelopmental factors to treatment response is not fully understood. Methods: This retrospective observational study examined a real-world cohort of 67 adults with ADHD treated pharmacologically in a specialized outpatient setting. ADHD was diagnosed according to DSM-5-TR criteria using the Diagnostic Interview for ADHD in Adults (DIVA-5). Autism spectrum disorder (ASD) was recorded based on documented pre-existing specialist diagnoses and confirmed clinically at baseline. Psychiatric comorbidities and substance use disorders, including alcohol and cannabis use disorders, were assessed according to DSM-5-TR criteria. Clinical response was defined using the Clinical Global Impression–Improvement scale (CGI-I; responders = scores 1–3). Exploratory binary logistic regression analyses were used to identify clinical factors associated with treatment response. Given the limited sample size, revised multivariable models were specified parsimoniously on the basis of a priori clinical relevance. Results: At follow-up, 48 of 67 patients (71.6%) met criteria for clinical response. In revised parsimonious multivariable models, alcohol use disorder (OR ≈ 0.08–0.10, p = 0.010–0.026) and cannabis use disorder (OR ≈ 0.20–0.24, p = 0.014–0.028) were consistently associated with reduced odds of clinical response. Autism spectrum disorder showed a descriptive trend toward lower response rates but did not retain statistical significance after adjustment (p ≈ 0.11–0.15). Conclusions: In adults with ADHD treated in routine clinical practice, alcohol and cannabis use disorders were associated with a reduced likelihood of achieving clinically meaningful improvement under routine pharmacological care, whereas autism spectrum disorder showed a trend toward lower response that was not stable enough to support firm conclusions. These findings should be considered exploratory given the retrospective design, limited sample size, and lack of systematic treatment exposure measures. Full article

(This article belongs to the Special Issue Clinical Management of Attention Deficit Hyperactivity Disorder (ADHD))

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15 pages, 703 KB

Open AccessArticle

Levomethadone Selectively Reduces Emotional Impulsivity in ASRS-Positive ADHD–OUD Patients, Independent of Dose Escalation

by Alessandro Pallucchini, Maurizio Varese, Irene Pergentini, Elisa Cerrai, Samuele Gemignani, Elisa Parapetto, Francesco Simonetti, Icro Maremmani and Angelo G. I. Maremmani

J. Clin. Med. 2026, 15(1), 89; https://doi.org/10.3390/jcm15010089 - 23 Dec 2025

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Abstract

Background: Emotional dysregulation and impulsivity represent key risk factors for adverse trajectories in adults with ADHD and are frequently observed among patients with opioid use disorder (OUD). Levomethadone, the R-enantiomer of methadone, provides more stable dopaminergic modulation than the racemic formulation and may improve emotional control. The primary objective was to examine emotional, clinical, and substance use changes after the switch to levomethadone and to determine whether these trajectories differed according to ADHD screening status. This study evaluated emotional, clinical, and behavioral outcomes—including substance use—after transitioning from racemic methadone to levomethadone maintenance therapy, focusing on the moderating role of ADHD symptoms and dose escalation. Methods: Eighty-three OUD patients in methadone maintenance were assessed at baseline, T1 (mean = 2.13 months, SD = 0.65), and T2 (mean = 6.20 months, SD = 0.91). Emotional dysregulation (RIPOST), clinical severity (Clinical Global Impression), and days of substance use were analyzed using Linear Mixed Models (participants with ≥1 valid follow-up). ADHD symptoms (Adult ADHD Self-Report Scale DSM-5) were evaluated with Wilcoxon signed-rank tests. Dose escalation (↑levomethadone) was defined as ≥1 increase during follow-up and was only included in the mixed models. Substance use analyses were restricted to baseline active users. Results: Emotional impulsivity significantly decreased over time only in participants screening positive for ADHD symptoms (ASRS ≥ 14), independent of dose escalation. Emotional instability also declined but across the full cohort. CGI scores improved in all participants. Substance use patterns showed a modest overall improvement, with reductions most evident for sedatives and alcohol. The findings indicate a specific effect of levomethadone on affective regulation and clinical stabilization, particularly in individuals with impulsivity traits. Conclusions: Levomethadone maintenance appears to improve emotional regulation and global functioning beyond dose-related effects, supporting its potential value in complex OUD patients with clinically relevant ADHD symptomatology. Combined treatment with levomethadone and methylphenidate may further enhance executive control and craving regulation in this population. Full article

(This article belongs to the Special Issue Clinical Management of Attention Deficit Hyperactivity Disorder (ADHD))

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22 pages, 1502 KB

Open AccessSystematic Review

Effectiveness of Pharmacological Treatments for Adult ADHD on Psychiatric Comorbidity: A Systematic Review

by Beniamino Tripodi, Manuel Glauco Carbone, Irene Matarese, Roberta Rizzato, Filippo Della Rocca, Francesco De Dominicis and Camilla Callegari

J. Clin. Med. 2025, 14(24), 8848; https://doi.org/10.3390/jcm14248848 - 14 Dec 2025

Cited by 2 | Viewed by 6333

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is frequently accompanied by psychiatric comorbidities that worsen outcomes and complicate treatment. Pharmacological management is central in care, yet its impact on co-occurring disorders remains uncertain. This systematic review evaluated the effectiveness of commonly prescribed medications for adult ADHD (methylphenidate, atomoxetine, bupropion, and lisdexamfetamine) on comorbid mood, anxiety, personality, and substance use disorders. Tricyclic antidepressants were also included in the search strategy; however, no eligible adult studies assessing imipramine or desipramine in patients with ADHD and psychiatric comorbidity were identified. Methods: A systematic search of the literature was conducted to identify studies examining these medications in adults with ADHD and at least one psychiatric comorbidity. Eligible studies reported clinical outcomes for both ADHD symptoms and the co-occurring disorder. Data were extracted and narratively synthesized, with particular attention paid to treatment effects and sources of heterogeneity. Results: Across the included studies, pharmacological treatments consistently improved core ADHD symptomatology. Their effects on psychiatric comorbidity were more variable. Some evidence suggested beneficial outcomes for selected anxiety disorder subtypes and for features of Cluster B personality disorders, possibly related to reductions in emotional dysregulation and impulsivity. Findings regarding substance use disorders were mixed: several studies reported reduced craving or substance use, but long-term stabilization was inconsistent. Marked heterogeneity in study design, populations, and outcome measures limited comparability. Conclusions: Current pharmacological treatments for adult ADHD show reliable efficacy for core symptoms but inconsistent benefits across comorbid psychiatric conditions. While targeted improvements may occur in specific domains, the evidence base is insufficient to define optimal long-term strategies for adults with ADHD and complex comorbidity. Rigorous, longitudinal studies are needed to clarify medication effects on distinct comorbid profiles and to inform integrated treatment planning. Full article

(This article belongs to the Special Issue Clinical Management of Attention Deficit Hyperactivity Disorder (ADHD))

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