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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain accepted criteria necessary for the diagnosis of attention-deficit hyperactivity disorder (ADHD).

  2. Recommend a therapeutic plan, including initial doses, dosage forms, and monitoring parameters, for a patient with ADHD.

  3. Differentiate among the available pharmacotherapy used for ADHD with respect to pharmacology and pharmaceutical formulation.

  4. Recommend second-line and/or adjunctive agents that can be effective alternatives in the treatment of ADHD when stimulant therapy is less than adequate.

  5. Address potential cost–benefit issues associated with pharmacotherapy of ADHD.

  6. Recommend strategies for minimizing adverse effects of ADHD medications.

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KEY CONCEPTS

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  • Image not available. To meet current attention-deficit hyperactivity disorder (ADHD) diagnostic criteria, patients need to display hyperactivity, impulsivity, and/or inattentiveness before 7 years of age.

  • Image not available. The exact cause of ADHD is unknown, but dysfunction in neurotransmitters norepinephrine and dopamine has been implicated as a key component.

  • Image not available. ADHD is rarely encountered without comorbid conditions.

  • Image not available. Treatment goals for ADHD are to improve behavior, increase attention or response inhibition, and minimize side effects associated with pharmacotherapy.

  • Image not available. Pharmacotherapy is superior to behavioral therapy in the treatment of ADHD, but both should be emphasized in order to maximize outcomes.

  • Image not available. Stimulants are first-line agents for the treatment of ADHD. If the initial trial of a stimulant fails, then a trial of an alternative stimulant should be tried. On failure of the second stimulant, it is rational to attempt a third trial with a different stimulant formulation or select a nonstimulant agent such as bupropion, atomoxetine, guanfacine, or clonidine.

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A DHD is characterized by a core triad of symptoms: hyperactivity, impulsivity, and inattention. It can have a severe impact on a patient's ability to function in both academic and social environments. Early diagnosis and appropriate treatment are essential to compensate for areas of deficit.

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EPIDEMIOLOGY AND ETIOLOGY

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Image not available. This disorder usually begins by 3 years of age but must occur before 7 years of age to meet current diagnostic criteria. In the United States, ADHD is the most common neurobehavioral disorder that affects children.1,2,3, and 4 ADHD has been estimated to occur in 4.3% to 12% of school-aged children.4,5 ADHD occurs more in boys than girls by a factor of approximately 3:1 in school-aged children.6

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Although ADHD generally is considered a childhood disorder, symptoms can persist into adolescence and adulthood. The prevalence of adult ADHD is estimated to be 4%; however, 60% of adults with ADHD have symptoms that manifested in childhood.6,7 Furthermore, problems associated with ADHD (e.g., social, marital, academic, career, anxiety, depression, smoking, and substance abuse problems) increase with the transition of patients into adulthood.

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PATHOPHYSIOLOGY

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Image not available. The exact pathologic cause of ADHD has not been identi-fied. ADHD is generally thought of as a disorder of self-regulation or response inhibition. ...

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