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Attention deficit hyperactivity disorder

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Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

  • •Management of attention deficit hyperactivity disorder (ADHD) encompasses two general domains: pharmacologic therapies and nonpharmacologic therapies, including educational, cognitive-behavioral, and other psychological and psychiatric approaches.

  • •Within the past year there have been two seminal developments in treatment. The first is that the Evidence-based Practice Center at McMaster University, under contract with the Agency for Health Care Policy and Research, produced an evidence based report on the treatment of ADHD. The topic was proposed to the AHCPR by the American Academy of Pediatrics and American Psychiatric Association, who served as partners to the center. The second is the completion of the Multisite Multimodal Treatment Study of Children with Attention-Deficit/ Hyperactivity Disorder (MTA) study by the National Institutes of Mental Health [1, Class I], a 14-month double-blind placebo trial of medication and behavioral therapy in ADHD. In general, the result of the evidence-based review and the MTA study is that stimulants are the most effective agents for the treatment of ADHD. Results from the MTA study indicate that methylphenidate (MPH) and MPH combined with behavioral therapy are superior to behavioral therapy alone and that all three are superior to community therapy. The evidence-based review indicates that each of the stimulants is superior to placebo and the stimulants (regular and sustained-release MPH as well as d and l isomers of the stimulants) are comparable.

  • •As for other agents, tricyclic antidepressants, specifically desipramine, are superior to placebo. Only a few studies compared stimulants directly with tricyclic antidepressants, and these were technically inadequate, leading to the conclusion that more rigorous studies are required. Only five studies were found that examined nonpharmacologic treatment, and all contained major limitations in methodology. Despite the limitations, all showed that stimulants were more effective than the nonpharmacologic therapies, consonant with the results of the MTA study. There was lack of evidence to support the superiority of combination multimodal treatment over stimulant therapy alone, again consonant with the MTA study. Both the evidence-based review and the MTA study examined ADHD in middle childhood.

  • •Finally, most studies are relatively short-term, including the MTA study (at 14 months). Some evidence suggests that MPH reduces behavioral disturbance as long as it is taken.

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References

  1. MTA Cooperative Group: 14-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder. A multimodal treatment study of children with ADHD. Arch Gen Psychiatry 1999, 56:1073–1086.

    Article  Google Scholar 

  2. Wolraich ML, Hannah JN, Pinnock TY, et al.: Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in country-wide samples. J Am Acad Child Adolesc Psychiatry 1996, 35:319–324.

    Article  PubMed  CAS  Google Scholar 

  3. Shaywitz SE, Schnell C, Shaywitz BA, Towle VR: Yale Children’s Inventory (YCI): an instrument to assess children with attentional deficits and learning disabilities. Scale development and psychometric properties. J Abnorm Child Psychol 1986, 14:347–364.

    Article  PubMed  CAS  Google Scholar 

  4. Shaywitz SE, Shaywitz BA: Evaluation and treatment of children with attention deficit disorders. Pediatr Rev 1984, 6:99–109.

    Google Scholar 

  5. Agronin ME, Holahan JM, Shaywitz SE, Shaywitz BA: The Multi-grade Inventory for Teachers (MIT): scale development, reliability, and validity of an instrument to assess children with attentional deficits and learning disabilities. In Attention Deficit Disorder Comes of Age: Toward the Twenty-first Century. Edited by Shaywitz SE, Shaywitz BA. Austin, TX: Pro-Ed; 1992:89–116.

    Google Scholar 

  6. Holahan J, Shaywitz B, Chhabra V, et al.: Developmental trends in teacher perceptions of student cognitive and behavioral status as measured by the Multi-grade Inventory for teachers: evidence from a longitudinal study. In Developmental Variations in Language and Learning. Edited by Molfese DM, Kirk U. Mahway, NJ: Lawrence Erlbaum; 2001.

    Google Scholar 

  7. Seidman LJ, Biederman J, Faraone SV, et al.: A pilot study of neuropsychological function in girls with ADHD. J Am Acad Child Adolesc Psychiatry 1997, 36:366–373.

    Article  PubMed  CAS  Google Scholar 

  8. Garfinkel BD, Brown W, Klee SH, et al.: Neuroendocrine and cognitive responses to amphetamine in adolescents with a history of attention deficit disorder. J Am Acad Child Psychiatry 1986, 25:503–508.

    Article  PubMed  CAS  Google Scholar 

  9. Varley CK: Effects of methylphenidate in adolescents with attention deficit disorder. J Am Acad Child Psychiatry 1983, 22:351–354.

    PubMed  CAS  Google Scholar 

  10. Klorman R, Coons HW, Borgstedt AD: Effects of methylphenidate on adolescents with a childhood history of attention deficit disorder: I. Clinical findings. J Am Acad Child Adolesc Psychiatry 1987, 26:363–367.

    Article  PubMed  CAS  Google Scholar 

  11. Klorman R, Brumaghim JT, Fitzpatrick PA, Borgstedt AD: Methylphenidate speeds evaluation process of attention deficit disorder adolescents during a continuous performance test. J Abnorm Child Psychol 1991, 19:263–283.

    Article  PubMed  CAS  Google Scholar 

  12. Greenhill LL, Abikoff HB, Arnold E, et al.: Medication treatment strategies in the MTA study: relevance to clinicians and researchers. J Am Acad Adolesc Psychiatry 1996, 34:1304–1313.

    Article  Google Scholar 

  13. Biederman J, Baldessarini RJ, Wright V, et al.: A doubleblind placebo controlled study of desipramine in the treatment of ADD: I. Efficacy. J Am Acad Child Adolesc Psychiatry 1989, 28:777–784.

    Article  PubMed  CAS  Google Scholar 

  14. Spencer T, Biederman J, Wilens T, et al.: Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle. J Am Acad Child Adolesc Psychiatry 1996, 35:409–432.

    Article  PubMed  CAS  Google Scholar 

  15. Riddle MA, Nelson, JC, Kleinman CS, et al.: Sudden death in children receiving norpramin: a review of three reported cases and commentary. J Am Acad Child Adolesc Psychiatry 1991, 30:104–108.

    Article  PubMed  CAS  Google Scholar 

  16. Cantwell DP, Swanson J, Connor DF: Case study: adverse response to clonidine. J Am Acad Child Adolesc Psychiatry 1997, 36:539–544.

    Article  PubMed  CAS  Google Scholar 

  17. Chappell PB, Riddle MA, Scahill L, et al.: Guanfacine treatment of comorbid attention-deficit hyperactivity disorder and Tourette’s syndrome: preliminary clinical experience. J Am Acad Child Adolesc Psychiatry 1997, 36:1140–1146.

    Article  Google Scholar 

  18. Atkins MS, Pelham WE: School-based assessment of attention deficit-hyperactivity disorder. In Attention Deficit Disorder Comes of Age: Toward the Twenty-first Century. Edited by Shaywitz SE, Shaywitz BA. Austin, TX: Pro-Ed; 1992:69–88.

    Google Scholar 

  19. Barkley RA: The assessment of attention in children. In Frames of Reference for the Assessment of Learning Disabilities: New Views on Measurement Issues. Edited by Lyon GR. Baltimore: Paul H. Brookes; 1994:69–102.

    Google Scholar 

  20. Shaywitz SE, Shaywitz BA, Schnell C, Towle VR: Concurrent and predictive validity of the Yale University Children’s Inventory: an instrument to assess children with attentional deficits and learning disabilities. Pediatrics 1988, 81:562–571.

    PubMed  CAS  Google Scholar 

  21. Firestone P: Factors associated with children’s adherence to stimulant medication. Am J Orthopsychiatry 1982, 52:447–457.

    Article  PubMed  CAS  Google Scholar 

  22. Kendall PC, Braswell L: Cognitive-behavior Therapy for Impulsive Children. New York: Guilford Press; 1985.

    Google Scholar 

  23. Hinshaw SP, Henker B, Whalen CK: Cognitivebehavioral and pharmacologic interventions in hyperactive boys: comparative and combined effects. J Consult Clin Psychol 1984, 52:739–749.

    Article  PubMed  CAS  Google Scholar 

  24. Pelham WE, Murphy HA: Attention deficit and conduct disorders. In Pharmacological and Behavioral Treatment: An Integrative Approach. Edited by Hersen M. New York: John Wiley & Son; 1986:108–148.

    Google Scholar 

  25. Schell RM, Pelham WE, Bender ME, et al.: The concurrent assessment of behavioral and psychostimulant interventions: a controlled case study. Behav Assess 1986, 8:373–384.

    Google Scholar 

  26. McDermott SP: Cognitive Therapy of Adults with Attention Deficit/Hyperactivity Disorder in ADHD and Comorbidities in Children, Adolescents, and Adults. Washington, DC: American Psychiatric Press; 2000.

    Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Yale University School of Medicine, P.O. Box 3333, 06520-8064, New Haven, CT, USA

    Bennett A. Shaywitz MD, Jack M. Fletcher PhD & Sally E. Shaywitz MD

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  1. Bennett A. Shaywitz MD
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  2. Jack M. Fletcher PhD
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  3. Sally E. Shaywitz MD
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Shaywitz, B.A., Fletcher, J.M. & Shaywitz, S.E. Attention deficit hyperactivity disorder. Curr Treat Options Neurol 3, 229–235 (2001). https://doi.org/10.1007/s11940-001-0004-y

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