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Update on attention-deficit/hyperactivity disorder

Campbell Daley, Katie

Current Opinion in Pediatrics: April 2004 - Volume 16 - Issue 2 - p 217-226
Office pediatrics

Purpose of review Attention-deficit/hyperactivity disorder (ADHD) is present in 3% to 10% of children in the United States. Children with ADHD can have academic impairments, social dysfunction, and poor self-esteem. There is also a higher risk of both cigarette smoking and substance abuse. Given this, the importance of treatment for ADHD needs to be underscored. This article will briefly review the diagnosis, etiology, and treatment of ADHD, with particular focus on nonstimulant medication and alternative treatment modalities.

Recent findings Recent evidence suggests that the overall rate of medication treatment for ADHD has been increasing, with over 2 million children being treated with stimulants in 1997. With this increase, controversy has arisen over the possible association of stimulants with growth suppression. In addition, estimates indicate that as many as 30% of children with ADHD either do not respond to stimulant treatment or cannot tolerate the treatment secondary to side effects. This has lead to the consideration of treatment with both nonstimulant medications as well as alternative therapies, including diet, iron supplementation, herbal medications, and neurofeedback. Considering the various treatment options now available for ADHD, along with the complexity of the condition, clinical practice guidelines are emerging for the treatment of ADHD and will be discussed.

Summary ADHD continues to be a serious health problem. Adequate treatment is needed to avoid academic impairments, social dysfunction, and poor self-esteem. This treatment includes consideration of stimulant medication, nonstimulant medication, as well as alternative therapies. The child with ADHD is likely better served with a mutimodal treatment plan, including medication, parent/school counseling, and behavioral therapy. Implementing an evidenced based algorithm for the treatment of ADHD may prove to be most effective.

Department of Medicine, Children’s Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Katie Campbell Daley, MD, Department of Medicine, Children’s Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA

Tel: 617 541 6400; fax: 617 541 6434; e-mail: katie_daley@vmed.org

© 2004 Lippincott Williams & Wilkins, Inc.