ADHD

The keys to optimal use of psychostimulant and nonstimulant medications for attention deficit hyperactivity disorder are careful screening of patients, appropriate dosage regulation, and-most of all-close monitoring of both positive and adverse outcomes.

It's long been suggested by research that adolescents who have ADHD are more likely—nearly four times so—to be involved in a motor vehicle accident than unaffected drivers in the same age group. Furthermore, young adults with ADHD have a significantly higher rate of traffic violations and license suspensions than patients without ADHD.

Attention deficit hyperactivity disorder (ADHD) is very common. In the United States, between 6% and 10% of children and adolescents are affected, as are 4% of adults.1 Children in other countries also have ADHD, although rates of comorbid disorders may vary from those found in the United States.2

There are many exciting new studies of the biologic basis of ADHD that use neuroimaging and genetic testing. However, none of these methods can reliably diagnose this complex disorder. Someday, these technologies will be used to help subtype ADHD and improve treatment matching.

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed bio-behavioral disorder of childhood. It occurs in 6% to 9% of children--about the same prevalence as childhood asthma. It is also one of the most controversial diagnoses in children; parents are often perplexed about whether ADHD is underdiagnosed or overdiagnosed, or undertreated or overtreated. A good deal of this confusion stems from the fact that there are no laboratory tests, imaging studies, or psychological testing profiles that can be used to make the diagnosis.

Two excellent review atricles on attention deficit hypertention disorder (ADHD) follow. The first, by Michael Reiff MD, of the university of Minesota, presents an overview of the assessment and diagnosis of ADHD with clear, straightforward recommendations for the primary care practictioner illustrated with clinical vignettes. The format lends itself to a quick read, but the details are included if you want to drill down.

Infants and toddlers will put just about anything into their mouths. Each year in this country, between 100,000 and 200,000 incidents of foreign-body ingestions are reported to poison control centers.1,2 The large majority of ingestions are accidental. (In adolescents, ingestions are usually intentional.)

New research reported at the annual meeting of the American Psychiatric Association in Toronto in May shows that Shire Pharmaceutical Group's methylphenidate transdermal system (Daytrana) appears a safe and well-tolerated alternative to OROS methylphenidate, and is equally efficacious.

The second of a four-part series on nutritional interventionsexamines evidence of a salicylate-elimination diet for ADHD.

A new study on potential interactions between genetic and environmental factors in ADHD suggests that current limits on lead exposure are too high. Lead exposure below the current limits allowed by Environmental Protection Agency regulations produced measurable impairment of executive functions, especially in boys, who have a specific variation in the DRD4 dopamine receptor gene.

A 9-year-old girl presents with multiple hyperpigmented lesions, some of which have been present since birth (Figure 1). The lesions have increased in size and number. There is no history of seizures. Her 40-year-old mother has multiple skin nodules (Figure 2).

ASSESSMENT

The longest and most complex study of methylphenidate (Ritalin) in preschool children shows that it can be safe and effective for some children in that age group who have attention deficit hyperactive disorder (ADHD), according to the study's lead author.

The US Food and Drug Administration (FDA) recently approved Adderall XR (an extended-release formulation of mixed salts of amphetamine) as a once-daily treatment for attention deficit hyperactivity disorder in adolescents 13 to 17 years old. That action bridges an "indication gap" between earlier approval of the product for patients 6 to 12 years old and for older (18 years) adolescents and adults.

Q Parents of a 4 1/2-year-old boy in my practice are concerned because he takes too many risks. They report that he always seems to be doing something dangerous, which often results in injury.

At pediatricians' disposal today are numerous formulations of approved medications for ADHD--traditional psychostimulants and newer agents. We also have developed an appreciation of the value of a multipronged approach to this chronic disorder.

Step-by-step evaluation of an adolescent girl who may have ADHD highlights the strengths and limitations of the AAP diagnostic guidelines and offers insight into how to augment them.

Diagnosing and treating a child?s ADHD is often not enough. Most patients have coexisting developmental or psychiatric disorders that must be addressed.

Pediatric Puzzler: Weakness (thyrotoxic periodic paralysis)

The prognosis for teenagers with ADHD is better than ever, thanks to more effective therapies and greater understanding of how the disorder manifests itself in adolescence.