Skip to Main Content

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Untreated or ineffectively treated childhood attention deficit/hyperactivity disorder (ADHD) can lead to poor school performance, poor socialization, and increased risk for traffic accidents, psychiatric comorbidities, unemployment, and incarceration during adolescence and adulthood.

  • Image not available. ADHD is 40% to 90% genetic in origin, and it is associated with decreased brain volume, a delay in cortical thickening, and dysregulation of the “default mode network,” a brain system that regulates attention, prioritization of information, memory, and impulse control.

  • Image not available. Symptoms of inattention or hyperactivity and impulsivity or all three must be present during childhood and cause functional impairment in two different settings for 6 months to meet diagnostic criteria for ADHD.

  • Image not available. Prior to initiating pharmacotherapy, overall physical and mental health and psychiatric comorbidities must be assessed, and goals of treatment must be set.

  • Image not available. Preschoolers, school-age children, adolescents, and adults with ADHD all can benefit from nonpharmacologic interventions that include a healthy diet, education on ADHD, and potentially effective cognitive and behavioral treatments.

  • Image not available. The psychostimulants, methylphenidate, dexmethylphenidate, lisdexamfetamine or amphetamine salts, are the most effective pharmacologic treatment options for all ages with a rapid therapeutic effect, typically within 1 or 2 hours of an effective dose.

  • Image not available. α2-Adrenergic agonists such as extended-release preparations of guanfacine and clonidine are less effective than stimulants as monotherapy and are used as adjuncts to stimulants in youth to improve symptom control, particularly for oppositional behaviors and insomnia.

  • Image not available. When ADHD coexists with other neuropsychiatric conditions, such as anxiety disorders, major depression, autism spectrum disorder (ASD) or Tourette’s disorder, it is optimal to treat the most functionally impairing disorder first (whether it is ADHD or the co-occurring condition) and then treat the second disorder.

  • Image not available. When ADHD coexists with bipolar disorder, it is necessary to first stabilize the mood with lithium, an anticonvulsant, or an atypical antipsychotic before adding an ADHD-specific medication such as a psychostimulant.

  • Image not available. Atomoxetine is a good option to manage ADHD symptoms in adolescents and adults with substance use disorders. It has a delayed onset of effect (2-4 weeks), but it has no abuse potential.

Once considered primarily a childhood disorder, attention deficit/hyperactivity disorder (ADHD) is now known to persist into adolescence for 75% and into adulthood for approximately 50% of individuals.1,2,3 The American Academy of Pediatrics (AAP) considers ADHD a chronic condition that requires ongoing management.1,2 Functionally impairing inattention, impulsivity, and hyperactivity in the ADHD brain have been correlated with neuroanatomical and functional brain changes.4,5 It is unusual for an individual to display signs of the disorder in all settings or even in the same setting at all times; however, there is a persistent pattern of symptoms that persists for 6 months or more.4,6 Co-occurring anxiety, mood disorders, learning disabilities, medical conditions, and substance abuse must be considered in assessment and treatment. Behavioral interventions and medications are effective for all ages, but there are special considerations for treatment plan development and ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.