Tips

From Other Journals

The Management of Attention-Deficit/Hyperactivity Disorder



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2002 Mar 1;65(5):931-932.

Attention-deficit/hyperactivity disorder (ADHD) presents as inappropriate-for-age hyperactivity, impulsivity, and inattention. ADHD cannot be easily diagnosed by a specific test or biologic marker, and it is unclear if the disorder is a truly pathologic condition or just one end of the behavioral spectrum. ADHD is more frequently diagnosed in children with behavioral difficulties and academic underachievement. Guevara reviewed the prevalence of ADHD using evidence obtained from well-established databases, systematic reviews, and several large-scale, randomized clinical trials.

The pooled prevalence of ADHD is between 6.8 and 10.3 percent, with boys having a three-fold higher rate. Psychiatric comorbidities, including oppositional-defiant disorder, conduct disorder, depressive disorder, and anxiety disorders are common.

The Conners' ADHD Index and symptom scales from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), which are ADHD-specific checklists, have a high sensitivity for identification of children with the disorder. Reviews of the pharmacologic management of ADHD with methylphenidate hydrochloride, dextroamphetamine sulfate, and pemoline show these drugs to be generally effective. Tricyclic antidepressants showed some beneficial effect on behavior patterns, but comparison studies with stimulants have not demonstrated a consistent advantage of one over the other.

Nonpharmacologic treatments that have some beneficial effect on behavior and academic performance are behavioral modification and intensive contingency management therapy. Combining drug therapy with psychosocial therapy shows no clear advantage when compared to drug therapy alone. However, the addition of behavioral therapies to medication may have some benefit, including reduction of anxiety and improvement in social skills.

The author concludes that ADHD is best diagnosed using the DSM-IV diagnostic criteria and the Conners' Parent and Teacher Rating Scales. Other psychiatric comorbidities are common and should be identified and properly managed. The symptoms of ADHD tend to decrease over the long-term but may continue into adolescence and adulthood. The most common treatment is stimulant medication.

Guevara JP. Attention deficit hyperactivity disorder. West J Med September 2001;175:189–92, and Hunt RD, et al. An update on assessment and treatment of complex attention-deficit hyperactivity disorder. Pediatr Ann. March 200130;3:162–72.

editor's note: In a comprehensive review of ADHD, Hunt and associates point out the need to diagnose comorbid conditions such as learning disabilities and affective or conduct disorders. Accurate diagnosis requires obtaining behavioral information from parents and teachers. Pharmacologic treatment may require more than one medication. Psychostimulants remain the most effective treatment for enhancing attention and social skills. Combination treatment may be needed to manage multiple symptoms. Medications should be targeted at specific symptoms and started one at a time. Target symptoms should be monitored, and medications or dosages changed one at a time. Once the patient is stabilized, medication dosages can be lowered or discontinued if indicated. Psychosocial interventions, including conflict resolution, increased social support within the family and community, and modifications to work or home environment may be helpful.—r.s.

 

Copyright © 2002 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article