Our objective was to compare the efficacy of
the new wake-promoting drug modafinil to that of dextroamphetamine for the
treatment of attention deficit hyperactivity disorder (ADHD) in adults.
Twenty-two adults who met DSM-IV criteria for ADHD participated in a
randomized, double-blind, placebo-controlled, three-phase crossover study
comparing placebo, modafinil, and dextroamphetamine for the treatment of
ADHD. The twice-daily study medications were titrated to doses of optimum
efficacy over 4-7 days and then held constant during the rest of each 2-week
treatment phase. Measures of improvement included the DSM-IV ADHD Behavior
Checklist for Adults, the Controlled Oral Word Association Test (COWAT,
using the letters C, F, and L version), Stroop, and Digit Span (Wechsler
Adult Intelligence Scale version). For the 21 (96%) completers, the mean
(+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day
+/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD
Checklist (p < 0.001) were significantly improved over the placebo
condition following treatment with both active medications. Performance on
the COWAT (p < 0.05) reached trend levels of significance. Both
medications were generally well tolerated. This preliminary study suggests
that modafinil may be a viable alternative to conventional stimulants for
the treatment of adults with ADHD.
