Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Abstract

Objective.-To deal with public and professional concern regarding possible overprescription of attention-deficit/hyperactivity disorder (ADHD) medications, particularly methylphenidate, by reviewing issues related to the diagnosis, optimal treatment, and actual care of ADHD patients and of evidence of patient misuse of ADHD medications.Data Sources.-Literature review using a National Library of Medicine database search for 1975 through March 1997 on the terms attention deficit disorder with hyperactivity, methylphenidate, stimulants, and stimulant abuse and dependence. Relevant documents from the Drug Enforcement Administration were also reviewed.Study Selection.-All English-language studies dealing with children of elementary school through high school age were included.Data Extraction.-All searched articles were selected and were made available to coauthors for review. Additional articles known to coauthors were added to the initial list, and a consensus was developed among the coauthors regarding the articles most pertinent to the issues requested in the resolution calling for this report. Relevant information from these articles was included in the report.Data Synthesis.-Diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness. The criteria of what constitutes ADHD in children have broadened, and there is a growing appreciation of the persistence of ADHD into adolescence and adulthood. As a result, more children (especially girls), adolescents, and adults are being diagnosed and treated with stimulant medication, and children are being treated for longer periods of time. Epidemiologic studies using standardized diagnostic criteria suggest that 3% to 6% of the school-aged population (elementary through high school) may suffer from ADHD, although the percentage of US youth being treated for ADHD is at most at the lower end of this prevalence range. Pharmacotherapy, particularly use of stimulants, has been extensively studied and generally provides significant short-term symptomatic and academic improvement. There is little evidence that stimulant abuse or diversion is currently a major problem, particularly among those with ADHD, although recent trends suggest that this could increase with the expanding production and use of stimulants.Conclusions.-Although some children are being diagnosed as having ADHD with insufficient evaluation and in some cases stimulant medication is prescribed when treatment alternatives exist, there is little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate by physicians.

ADHD: a critical update for educational professionals

“…When DSM-IV was published in 1994 (American Psychiatric Association, 1994) the prevalence of ADHD was an estimated 3% (Goldman, Genel, Bezman, & Slanetz, 1998). Since then, the percentage of children with a parent-reported ADHD diagnosis increased substantially, from 7.8% in 2003 to 9.5% in 2007 to 11.0% in 2011.…”

Evaluation of the Reinforcing Effects of Monoamine Reuptake Inhibitors Under a Concurrent Schedule of Food and I.V. Drug Delivery in Rhesus Monkeys

“…Attention-deficit-hyperactivity disorder (ADHD) is the most common neurobehavioral disorder among children, with an estimated prevalence of 3-7% in school-aged populations (Goldman et al, 1998;Swanson et al, 1998;American Psychiatric Association, 2000). ADHD is characterized by persistent and developmentally inappropriate levels of inattention, distractibility, impulsivity, and motor activity (American Psychiatric Association, 2000).…”

“…ADHD also is associated with impairment in academic, occupational, emotional, and social functioning . The disorder may continue into adulthood and be accompanied by considerable comorbidity (Biederman et al, 1991;Goldman et al, 1998;Swanson et al, 1998;Marks et al, 2001).…”

“…In particular, nearly 90% of patients with ADHD show clinically significant reductions in symptoms following treatment with psychostimulant drugs such as methylphenidate and d-amphetamine (Goldman et al, 1998;Elia et al, 1999). Although not approved for the treatment of ADHD, tricyclic antidepressant drugs such as imipramine and desipramine are used as second-line therapies for ADHD owing to their overall lesser efficacy and adverse side effects.…”

“…Although not approved for the treatment of ADHD, tricyclic antidepressant drugs such as imipramine and desipramine are used as second-line therapies for ADHD owing to their overall lesser efficacy and adverse side effects. They are typically prescribed only when psychostimulant drugs are ineffective or produce intolerable adverse effects (Goldman et al, 1998;Elia et al, 1999). A marked increase in new diagnoses of ADHD has led to a dramatic increase in the prescription of psychostimulant drugs particularly in the US (Goldman et al, 1998).…”