Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) are associated with a variety of practical and clinical challenges. In a recent Psychiatric Times[TM] Viewpoints custom video program, available at PsychiatricTimes.com, Timothy Wilens, MD, a child and adolescent psychiatrist at Massachusetts General Hospital in Boston, Massachusetts, led a discussion regarding the multidisciplinary management of ADHD, the diagnostic and treatment obstacles during the coronavirus disease 19 (COVID-19) pandemic, and the effect of medication abuse. This article recaps the key clinical pearls and takeaways from the conversation.
Diagnosis Is Key
ADHD is the most common presenting neurobehavioral disorder that pediatricians and child psychiatrists will see in their course of practice and is second only to asthma when ranked among all chronic pediatric illnesses, Wilens explained as he opened the discussion. The prevalence of ADHD among children is between 6% to 9%, regardless of country of origin.
Diagnosis can be made as young as age 4. Behavioral interventions are the first-line treatment option. When deemed appropriate and necessary, stimulant medications are the first-line choice for pharmacotherapy, according to the 2019 American Academy of Pediatrics guidelines for the care of ADHD.
A key challenge associated with ADHD is making an accurate diagnosis, Robert L. Findling, MD, MBA said, noting that a countless number of things may make a child appear inattentive or fidgety.
"[Diagnosis] can only be done by a careful assessment, both cross-sectionally and over time, [and] pediatricians are particularly well-equipped to do such a thing because [they] have the benefit of watching children grow up," Findling explained. He added that comorbidities, such as oppositional defiant disorder, anxiety, depression, and bipolarity, are the rule and not the exception in the setting of ADHD. These can complicate the clinical picture and, when left undiagnosed or untreated, can mask the benefits from ADHD medication. "You have to know the whole child," he said. "There are many things ... that will not respond to ADHD treatment."
Approximately 70% to 75% of kids with ADHD have a comorbid medical or psychiatric disorder or coexisting psychosocial or environmental problems, Harlan R....