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.