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MANAGEMENT OF STIMULANT MEDICATIONS IN CHILDREN WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

1999; Elsevier BV; Volume: 46; Issue: 5 Linguagem: Inglês

10.1016/s0031-3955(05)70165-6

1557-8240

Andrew Adesman, Andrew M. Morgan,

Child and Adolescent Psychosocial and Emotional Development

In the United States, considerable media attention has been given to the growing number of youth diagnosed with attention-deficit/hyperactivity disorder (ADHD) and treated with psychotropic medications.27 Ironically, at a time when methodologically rigorous research consistently supports the primacy of stimulant therapy as the most effective treatment for ADHD, there is increased interest in the expanding universe of nonpharmacologic interventions available. Many alternative therapies for ADHD are proffered in magazine advertisements, by support groups, and through the Internet. These alternative approaches supplement the array of psychosocial interventions that have been provided traditionally by mental health professionals. Pediatricians who care for children with ADHD must be familiar with the range of treatment options and the data supporting the benefits of each. The efficacy of stimulant medications long has been recognized clinically and is well documented in research.1, 6, 9 Two recent well-controlled, multi-site, double-blind, prospective treatment studies suggest that pharmacotherapy is the most effective form of treatment for ADHD in children and adolescents.31 These studies suggest that treatment with stimulant therapy, when done properly, is more effective than psychosocial interventions such as behavior modification, social skills training, and educational tutoring. These studies also found that the addition of psychosocial interventions did not yield any significant benefits on a range of behavioral, emotional, psychosocial, and academic measures. Thus, although there is increasing public concern about pharmacotherapy for ADHD, stimulant medications continue to play a major role in the treatment of children with ADHD. Primary care pediatricians are on the “front line” with respect to the diagnosis of ADHD and the formulation of an initial treatment plan for these children. For this reason, they need to explain to parents why stimulant therapy may be the most appropriate therapy for a particular child, and they should be skilled in the clinical management of ADHD using these medications. Unfortunately, not all pediatricians are comfortable with managing stimulant medication. Whereas some pediatricians have considerable experience with the art and science of treating youth with ADHD, others refer all patients to consultants for medication management. In the current managed care environment, primary care pediatricians must feel comfortable initiating and monitoring treatment of ADHD with stimulants. The purpose of this article is to provide clinicians with “everything they need to know but were afraid to ask” about stimulant therapy for children and adolescents with ADHD.