Attention-deficit/hyperactivity disorder: a diagnosis for the '90s

Over the past few years, the lay and medical press increasingly have focused on attention-deficit/hyperactivity disorder (ADHD) as a widespread and common disorder of school-age children and adults. ADHD's cause remains unknown, but current research supports a neurobiological foundation. An ADHD diagnosis should focus on the three main components of the disorder: impulsivity, hyperactivity, and inattention. There are no specific tests, but the diagnosis is based on history, interview, physical examination, and developmental and psychological evaluation. Management should include a balanced treatment plan of pharmacologic methods combined with behavioral/psychological therapy and environmental manipulation. Current drug therapy supports the careful and closely monitored use of stimulants like methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert). Additionally, patients and their families are encouraged to seek individual, group, family, and marital therapy. Special adaptations for schools, homes, and workplaces are now also available. The NP's role in ADHD treatment is that of evaluator, coordinator, and monitoring clinician. Treatment goals are established with the patient and family; the NP assists in the completion of these goals through teaching, monitoring, and referring to community services when appropriate. While this multimodal treatment and management is complex, it supports the ADHD patient and his family.