Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent disorder that has an onset in early childhood, but persists frequently into adolescence and adulthood. Outcome studies suggest continued deleterious effects in adolescence and adulthood with continued academic impairment, and increased risk for the development of antisocial behaviors, substance abuse, and psychopathology. Recent findings indicate that ADHD is highly familial and that discrete subtypes may be identified based on patterns of comorbidity, particularly with conduct, mood, and anxiety disorders. These subtypes may have differing risk factors, clinical course, and pharmacological responses. Treatment needs to be multimodal and may include individual therapy, family counseling and parental guidance, cognitive and behavior therapy, remedial educational interventions, and pharmacotherapy. The mainstay of pharmacotherapy has been the stimulant medications, but alternative interventions including tricyclic antidepressants are available. Patients and families should be educated regarding the nature of this disorder, the available interventions, and the need for long-term support and follow-up.