Attention Deficit and Hyperactivity Disorder: Controversies of Diagnosis and Safety of Pharmacological and Nonpharmacological Treatment

Attention-Deficit and Hyperactivity Disorder (ADHD) is a condition that presents with a variety of behavioral and social problems. The objective of this review was to examine the evidence concerning the controversies surrounding the diagnosis of ADHD and the safety of pharmacological and nonpharmacological treatment. A MEDLINE search was conducted using MeSH terms ADHD, children, treatments or behavioral therapy. The search was limited to January 1990 to present, randomized clinical trials, retrospective studies and English. Fifty-seven articles were selected for review. Controversies exist regarding the diagnosis: variations exist by gender, across countries and by method of diagnosis. These issues are currently unresolved. The interventions with the most data concerning their safety and efficacy in children were stimulant medications. Children with ADHD who took stimulant medications showed the greatest improvement in behavior when compared to other interventions such as behavior therapy or family counseling. Limitations of behavior therapy included that it is often a difficult process to continue on an ongoing basis and only a portion of the therapy stimulated the child's natural reward system. However, a combination of both stimulant medication and behavior therapy demonstrated synergistic efficacy. Care must be taken to insure that issues of gender and race, as well as the adverse effects of treatment options, are adequately taken into account by the treating clinician.