A clinical trial found improved self-reported quality of life with lisdexamfetamine in adults with ADHD and significant executive-function difficulties. Those reports add information about daily experience, while remaining different from objectively measured task performance.
Adler and colleagues examined quality-of-life outcomes from a ten-week randomized placebo-controlled trial. The study randomized 161 adults with ADHD who met a specified threshold for executive-function deficits. Lisdexamfetamine doses ranged from 30 to 70 mg daily.
The primary trial measure was a self-reported executive-function scale. Quality of life was assessed using the Adult ADHD Impact Module, while clinician-completed symptom scales supplied additional information.
Lisdexamfetamine significantly improved the Impact Module’s multi-item domains relative to placebo, including performance and daily functioning, symptom interference, relationships and general well-being. The size of the reported difference varied by domain.
Another quality-of-life instrument was added while the trial was underway. Analyses involving participants with results on both instruments were post hoc. Those observations should not be presented as if every measure had been prespecified and available for the full original sample.
People’s reports of functioning and well-being are meaningful clinical outcomes. However, a favorable rating does not directly establish better accuracy, fewer errors or safer driving. Those require measures designed for the corresponding question.
The trial’s blinding and placebo comparison strengthen treatment inference compared with an uncontrolled satisfaction survey. They do not eliminate all reporting influences or establish objective improvement on unmeasured activities.
Participants with important psychiatric comorbidity or cardiovascular disease were excluded, and everyone had to meet the executive-deficit threshold. Generalization to the broader population, including people without ADHD, is therefore limited.
The paper supports a clinical benefit in reported quality of life under its protocol. It does not permit an expert to infer daily competence from a positive amphetamine specimen or to treat a self-report score as an impairment cutoff.
Related reading: Lisdexamfetamine and a simulated workplace task.