Current drug therapy recommendations for the treatment of attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattentiveness and/or hyperactivity-impulsivity which are not appropriate to the child's age. This disorder usually manifests by age 3 and affects up to 5% of school-age children. Although the aetiology is unknown, ADHD appears to have a strong genetic component and to involve dysregulation of the CNS dopaminergic system. Psychostimulants are the mainstay of therapy. The majority of patients will respond to an adequate trial of one of the 3 available stimulants, methylphenidate, dexamphetamine or pemoline. Use of the tricyclic antidepressants as second-line agents is supported by substantial literature. Third-line agents include amfebutamone (bupropion) and clonidine. Other modalities have been studied, but sufficient research is not available to recommend their use over the abovementioned treatments. Assessment of response is best achieved by objective rating scales which allow for input from various environments.