ATTENTION-DEFICIT DISORDER - A PARADIGM FOR PSYCHOTROPIC MEDICATION INTERVENTION IN PEDIATRICS

A pleasant but harried young mother consults you regarding the behavio r of her two children. Her ii-year-old son is galloping around the roo m, climbing on the scales, and defiantly ignoring his mother's command s to cease his rambunctiousness. On the other side of the room, her 14 -year-old daughter is sitting quietly, somewhat oblivious to the commo tion, aloofly and blankly staring toward the wall. During a break in t he shenanigans created by her son, the distraught mother expresses con cerns about her daughter's clumsiness, nearly failing grades, and forg etfulness. ''She just doesn't have much energy anymore,'' she says. '' Could she have a chemical imbalance?'' Spying your exasperation with h er son's dismantling of your office scales, she further queries, ''Isn 't he too young for medication?'' You are obviously as concerned as th e mother about the behavior of both children. As the family's pediatri cian, you must decide whether their workup and eventual management is within your professional purview or whether these children should be r eferred. Does the son suffer from hyperactivity? Or is his activity le vel within the normal developmental range for children his age, but th e mother lacks effective discipline tactics? The daughter appears to b e an unlikely candidate for the classic diagnosis of attention-deficit disorder (ADD). Could she be a child with the inattentive form of ADD that has been recently reported? Or is she depressed? Yet, how reliab le is the physician or the psychologist's one-time observation in the office for diagnosing ADD in children? Do you really have time for a f ormal evaluation? If you decide that either of the children is affecte d with ADD, are you comfortable prescribing psychotropic medications a nd further following these children? How do you treat her depressive s ymptoms? Should all children with ADD undergo formal psychometric test ing? General pediatricians must routinely confront many of these criti cal issues when dealing with behavioral, academic, or mood problems in children and adolescents.