I recently went to a lecture on ADHD.   There are different ADHD subtypes: combined (hyperactivity with impulsivity), predominantly inattentive, predominantly hyperactive without impulsivity.  The ADHD with hyperactivity is most likely diagnosed because of the child’s attention-getting (conduct disorder) behavior.  Stimulants make everyone improve their ability to concentrate.  3-7% of school children affected in US. Males have ADHD more common than females.

Other things to think of… Does the child have a seizure disorder, chronic ear infections, sleep apnea, narcolepsy, metabolic abnormality (like hyperthyroidism), toxic exposures (like lead poisoning or fetal alcohol syndrome)?  These are issues that can look like ADHD, but are not.  Your physician also needs to rule out learning or language disorder, autism spectrum disorder or sleep disorder.  The child may also have anxiety, depression or other mood disorders, psychotic disorders or substance use disorders (huffing or chugging Benadryl).  Tics are very common and the treatment for ADHD may make the tics worse.

ADHD disease course.  1/3 resolve spontaneously.  As ADHD patients age, the symptoms may seem to decrease even if they continue to have ADHD.  Must treat the co-morbidity.  Treat the parents.  The parents will often bring the patient to the doctor when they are fed-up.

MTA (Multimodal treatment of ADHD) Study of 1999.  This NIH-sponsored study showed medication (stimulants) are effective.  Behavioral treatments are not as effective as medication for core ADHD symptoms.  Increased physician contact improves outcomes.  More frequent and higher dosing may lead to less ADHD symptoms.  2-year follow up showed benefit with medication over behavioral therapy.  Stimulants are not found to help at 3-year or 8-year follow up compared to behavioral therapy.  For kids at 4-5 years of age, have parents work on parenting and scheduling.  Then try methylphenidate.  If there’s no benefit, your physician may start dextroamphetamine.  The side effects from medicine: insomnia and decreased eating.  There is a concern for decreasing growth velocity (the child may have an adult height 2 inches shorter than without stimulants).   When adolescents take stimulants, think of the potential for abuse and diversion.  The patient will need to see the physician monthly to confirm that the medication has helped and that side effects are kept to a minimum.