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Attention deficit/hyperactivity disorder: complexities and controversies

Schonwald, Alisona; Lechner, Erinb

Current Opinion in Pediatrics: April 2006 - Volume 18 - Issue 2 - p 189-195
doi: 10.1097/01.mop.0000193302.70882.70
Office pediatrics

Purpose of review Attention deficit/hyperactivity disorder continues to be a prevalent childhood behavioral disorder, with significant clinical and media interest. Providers must be current with research findings that impact the evolving understanding of this complex entity. This article summarizes recent progress in our view of attention deficit/hyperactivity disorder, with emphasis on controversies around diagnosis and treatment, and future management directions.

Recent findings Literature about attention deficit/hyperactivity disorder in 2005 further enhanced our understanding of the genetic contribution to the expression of attention deficit/hyperactivity disorder, with exploration of sophisticated genetic models and their dynamic interaction with exposures and experiences. Previous literature focuses on conventional treatment; new developments in pharmacological/alternative options add to treatment choices, but have brought well publicized controversies. Furthermore, optimal management continues to gain evidence-based support.

Summary Attention deficit/hyperactivity disorder is a subject of great interest to families, providers, researchers, and public forums. Scientific investigation supports a primary genetic contribution, but the relationship of molecular bases and environmental exposures appears intricate and complex. With increased awareness of this disorder, diagnostic dilemmas and medication side effects are more widely understood, topics particularly important to clinicians. Stimulant treatment remains the mainstay of intervention, but new delivery forms and nonstimulant options are potential therapies as well.

aChildren's Hospital, Boston, Massachusetts, USA

bUniversity of Vermont College of Medicine, Burlington, Vermont, USA

Correspondence to A. Schonwald MD, Children's Hospital, Boston, 300 Longwood Avenue, Fegan 10, Boston, MA 02115, USA. Tel: +1 617 355 4125; fax: +1 617730 0252; E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.