Attention-deficit-hyperactivity disorder (
ADHD) is a common neuropsychiatric disorder that impairs social, academic, and occupational functioning in children, adolescents, and adults. In patients with
ADHD, neurobiologic research has shown a lack of connectivity in key brain regions, inhibitory control deficits, delayed brain maturation, and noradrenergic and dopaminergic dysfunction in multiple brain regions. The prevalence of this disorder in the United States is 6-9% in youth (i.e., children and adolescents) and 3-5% in adults. Prevalence rates for youth are similar worldwide. Children with
ADHD are at greater risk than children without
ADHD for
substance abuse and delinquency whether or not they receive
drug therapy; however, early treatment with psychoeducation as well as
drug therapy and/or behavioral intervention may decrease negative outcomes of
ADHD, including the rate of
conduct disorder and adult
antisocial personality disorder.
Drug therapy is effective for all age groups, even preschoolers, and for late-onset
ADHD in adults. Stimulants, such as
methylphenidate and
amphetamine, are the most effective
therapy and have a good safety profile; although recent concerns of sudden unexplained death, psychiatric adverse effects, and growth effects have prompted the introduction of other
therapies.
Atomoxetine, a nonstimulant, has no abuse potential, causes less
insomnia than stimulants, and poses minimal risk of growth effects. Other
drug options include
clonidine and
guanfacine, but both can cause
bradycardia and sedation.
Polyunsaturated fatty acids (
fish oil),
acetyl-L-carnitine, and
iron supplements (for youth with low
ferritin levels) show promise in improving
ADHD symptoms. As long-term studies show that at least 50% of youth are nonadherent with their
drug therapy as prescribed over a 1-year period, long-acting formulations (administered once/day) may improve adherence. Comorbid conditions are common in patients with
ADHD, but this patient population can be treated effectively with individualized treatment regimens of stimulants,
atomoxetine, or
bupropion, along with close monitoring.