CENTRAL STIMULANT TREATMENT OF CHILDHOOD ATTENTION-DEFICIT HYPERACTIVITY DISORDER - ISSUES AND RECOMMENDATIONS FROM A US PERSPECTIVE

The use of CNS stimulants for the treatment of attention deficit hyper activity disorder (ADHD) in children has steadily increased in most ar eas of the world over the last 30 years. In mid-1995, at least 1.5 mil lion US children were receiving methylphenidate or dexamphetamine (dex troamphetamine). However, in other countries these agents are not used as widely. Specific stimulant-induced benefits for children with ADHD include: improved schools grades, more completed classroom work, fewe r reprimands for disruptive behaviour, improved handwriting, and impro ved behaviour at home and in social situations. Stimulants benefit at least 75% of children with ADHD and are remarkably well tolerated, hav ing few (for the most part minor and temporary) adverse effects. Howev er, the benefits of stimulants that an obvious in most patients with A DHD during a brief clinical trial are primarily symptomatic. Although the behavioural benefits of stimulants are generally present during ea ch period of treatment for as long as the ADHD condition exists (and c hildren with ADHD are now often staying on stimulant medication into t heir mid-teens), the treatment has not been shown to change the long t erm outcome of the disorder. Before prescribing stimulants, paediatric physicians need to perform a careful diagnostic assessment for ADHD u sing multiple sources of information, including detailed ratings of th e child's behaviour from his/her teachers and from a parent. If at bas eline, the child's academic and behavioural adjustment in the classroo m is good, stimulant medication would be inappropriate. However, if th e child's pattern of ADHD has consistently and seriously interfered wi th his/her classroom and home adjustment, stimulant treatment should b e actively considered. Should stimulant therapy be initiated, knowledg eable medical follow-up is required.