Mental Disorders and Learning Disabilities in Children and Adolescents: Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral condition that affects more than 9% of US children and adolescents and often is seen in family medicine settings. A comprehensive evaluation for ADHD gathers information across time and settings; considers common comorbid or alternative conditions, such as learning disabilities and disorders of mood or anxiety, vision, hearing, and sleep; and includes a thorough physical examination. The need for additional evaluation is determined by the history and physical examination results. Diagnosis requires a sufficient number and duration of symptoms of inattention, or hyperactive/impulsive symptoms, or symptoms in each domain, beginning before age 12 years. Evidence-based management varies depending on patient age and may include psychosocial-behavioral approaches and pharmacotherapy. Behavioral treatment is the first-line recommended therapy for preschool-aged children and has been shown to benefit school-aged children. Stimulant drugs address core ADHD symptoms for a majority of patients but the incidence of adverse effects is greater for preschool-aged children. Alternative second-line drugs are available. Monthly monitoring is advised until the dosage is optimized, then patients should be monitored quarterly for the first year, followed by at least two annual visits. Individuals with ADHD may experience symptoms in adulthood.