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Am Fam Physician. 2023;107(3):292-296

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Case Scenario

An eight-year-old boy presents to your office for his annual well-child examination. His grandmother is his legal guardian and is concerned because he has difficulty finishing his homework and gets distracted easily by noises at home. His second-grade teacher informed the grandmother that the patient performs significantly below grade-level expectations. His medical history is notable for prematurity (28 weeks of gestation) and grade 2 intraventricular hemorrhages. His grandmother asks you to prescribe a chewable long-acting stimulant such as the one his cousin takes to improve his school performance. You provide Vanderbilt assessment forms (https://www.nichq.org/sites/default/files/resource-file/NICHQ-Vanderbilt-Assessment-Scales.pdf) for the patient’s grandmother and teachers to complete.

Clinical Commentary

EPIDEMIOLOGY

Rates of attention-deficit/hyperactivity disorder (ADHD) have increased over the past several decades (Figure 1).1 A nationwide, population-based, cross-sectional survey found that ADHD rates increased by 67%, from 6.1% in 1997 to 1998 (when the survey first included questions on ADHD) to 10.2% in 2015 to 2016.2 Similar increases have been observed in other Westernized countries.3,4 During this period, there was a concordant increase in the use of stimulants.1,5 In contrast to the increase in ADHD diagnoses, the frequency and severity of ADHD symptoms have stayed relatively constant.3,6 It is unknown if the increase in ADHD diagnoses and the use of stimulants represent changing neurobiology, improved detection, expanding definitions of disease, the impact of pharmaceutical marketing,7 or other factors.

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Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Lown Right Care published in AFP is available at https://www.aafp.org/afp/rightcare.

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