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Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood and often persists into adulthood. ADHD is a neurophysiologic disorder defined in behavioral terms and associated with significant morbidity in the realms of social and academic success, and self-esteem. ADHD is often associated with comorbid psychiatric disorders and learning disabilities, which further impede the successful development of these persons. It is essential that family physicians be knowledgeable about the presentation and diagnosis of ADHD. Stimulant medications continue to be the mainstay of treatment, although many other medications (such as antidepressants and alpha blockers) are helpful adjuvants to therapy. Current recommendations for treatment include an individualized, multimodal approach involving parents, teachers, counselors and the school system. Treatment follow-up includes monitoring response to medications in various settings, as well as side effects. With time and interest, the family physician can develop the skills needed to treat this disorder. (Am Fam Physician 2001;64:1355-62.)
Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood, present in approximately 5 percent of the population.1 This disorder can affect a child's education, development, peer functioning and self-esteem. Treating patients with ADHD can be rewarding, with long-term benefits for the patient, the family and the physician-family relationship. Family physicians should be able to diagnose and treat the majority of patients who present with ADHD.2
Competency in the diagnosis and treatment of patients with ADHD requires an understanding of the spectrum of this condition, its comorbidities and various treatment approaches. A key component of treatment requires that the physician be aware of community and national resources for children with ADHD and their parents, including the school system, support groups and referral resources for complicated cases.
Diagnosing ADHD
The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria3 serve as a standardized framework for the diagnosis of ADHD and recognize three subtypes of the condition: inattentive, hyperactive and combined.
The American Academy of Pediatrics recently published recommendations for the diagnosis of ADHD in school-age children (Table 1).4 These recommendations can be modified slightly to diagnose adult patients (Table 2).4-9 Standardized behavior checklists (Table 3)10 can be useful in gathering information before making the diagnosis and in choosing an appropriate treatment. These scales may be completed by pediatric patients and...