Key concepts

To meet present attention-deficit hyperactive disorder (ADHD) diagnostic criteria, patients need to display hyperactivity, impulsivity, and/or inattentiveness before 7 years of age.

The exact cause of ADHD is unknown, but dysfunction in neurotransmitters norepinephrine and dopamine has been implicated as a key component.

ADHD is rarely encountered without comorbid conditions.

'O' Treatment goals for ADHD are to improve behavior, increase attention/response inhibition, and minimize side effects associated with pharmacotherapy.

Pharmacotherapy is superior to behavioral therapy in the treatment of ADHD, but both should be emphasized in order to maximize outcomes.

Stimulants are first-line agents for the treatment of ADHD. If the initial trial of a stimulant fails, then a trial of an alternative stimulant should be tried. On failure of the second stimulant, it is rational to attempt a third trial with a different stimulant formulation or select a nonstimulant agent such as bupropion, atomoxetine, or imipramine.

Attention-deficit hyperactivity disorder (ADHD) is the most common mental disorder

that occurs in the pediatric population. This disorder must begin in childhood before 7 years of age and may continue into adulthood. ADHD is characterized by a core triad of symptoms: hyperactivity, impulsivity, and inattention. It can have a severe impact on a patient's ability to function in both academic and social environments. The exact cause of ADHD is unknown, but twin studies strongly suggest a genetic eti-

ology. Early diagnosis and appropriate treatment are essential to compensate for areas of deficit.

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