Attention Deficit-Hyperactivity Disorder in Children and Adolescents

ADHD is characterized by inattention, hyperactivity, impulsivity, or a combination of these symptoms, which compromise functioning. Management includes medications (shown to improve core symptoms but not necessarily functional outcomes) and behavioral therapies. ForewordThis Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.StageA 9-year-old boy who received a diagnosis of attention deficit-hyperactivity disorder (ADHD) at 7 years of age is brought to your office by his parents for a follow-up visit. He had had behavioral problems since preschool, including excessive fidgeting and difficulty following directions and taking turns with peers. Parent and teacher rat ings of behavior confirmed elevated levels of inattention, hyperactivity, and impulsivity that were associated with poor grades, disruptions of classroom activities, and poor peer relationships. He was treated with sustained-release methylphenidate. Although parent and teacher rating scales after treatment showed reduced symptoms, he still makes many careless ... Attention Deficit-Hyperactivity Disorder in Children and Adolescents Attention deficit-hyperactivity disorder (ADHD), the most prevalent neurobehavioral disorder in children, is associated with adverse long-term functional outcomes. Diagnostic evaluation relies on the use of validated parent and teacher rating scales that assess the child's behavior in everyday situations in various environments. Adolescents provide self-report as part of the diagnostic evaluation. Coexisting conditions and problems, especially learning disorders, anxiety and depression (internalizing disorders), and oppositional behaviors and conduct disturbance (externalizing disorders), must be considered in the evaluation and management of ADHD. Treatment should address a child's areas of functional disability rather than focus exclusively on ADHD core symptoms. Management plans developed with the child and family members, including parents, should specify measurable target objectives that relate to broader functional outcomes and are monitored in the evaluation of treatment effectiveness. Stimulant medications reduce the symptoms of ADHD without necessarily improving corresponding functional limitations. Behavior management is not as effective as medication in reducing core symptoms, but it improves functioning, which is important for subgroups of children with ADHD, and it increases parental satisfaction.