Disorders of attention and vigilance

Attention deficit hyperactivity disorder has gone through multiple name and criterion changes over the last 10 years. It is still viewed as the most common neurobehavioral disorder in the pediatric age group. Diagnostic criteria, as outlined by the DSM III-R, have, as primary diagnostic features of ADHD, inattention, impulsivity, and hyperactivity. There are no diagnostic tests that will absolutely confirm this disorder. Many questionnaires have been devised to help organize and systematize the evaluation. Vision and hearing screening, physical examination, and the neurologic examination are important to exclude other causes for hyperactivity and impulsivity. There are no routine laboratory or specialized tests that are useful in the diagnosis of ADHD. When psychologic testing is deemed necessary, specific areas to study would include discrepancies in the performance and verbal IQ (possibly indicating further testing needed to rule out learning disabilities) and difficulties in the coding portion of the examination, which might point to attentional difficulties. Educational testing can further complete an evaluation when needed. Management of children with ADHD involves multimodal treatment, including educational, behavioral, and possibly pharmacologic intervention. Pharmacotherapy can be a useful adjunct in treating these children. The psycho-stimulants continue to be the first-line medication in treatment, although investigators have studied other drugs. Once the diagnosis has been made and a child has been placed on the multimodal treatment, he should be carefully followed. This disorder does not disappear at the time of puberty, as once was thought, but instead continues to cause problems through adolescence.