This article reviews current approaches to the diagnosis and management of children with attention deficit hyperactivity disorder in a multidisciplinary setting. The physician's role in terms of data collection, formulation of the diagnosis, and discussion of findings with the parents and child is reviewed. The use of psychostimulants in this condition is reviewed, and some case vignettes are presented. ( J Child Neurol 1991;6(Suppl):S49-S65).
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References
1.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised. Washington, DC, American Psychiatric Association, 1987.
2.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC, American Psychiatric Association, 1980.
3.
Achenbach TM , Edelbrock CS: Behavioral problems and competencies reported by parents of normal and disturbed children aged four through sixteen . Monogr Soc Res Child Dev1981;46:1-82.
4.
Walker JL, Lahey BB, Hynd GW, Frame CL: Comparison of specific patterns of antisocial behavior in children with conduct disorder with or without coexisting hyperactivity. J Consult Clin Psychol1987;55:910-913.
5.
Lahey BB, Schaughency EA, Hynd GW, et al: Attention deficit disorder with and without hyperactivity: Comparison of behavioral characteristics of clinic-referred children. J Am Acad Child Adolesc Psychiatry1987;26:718-723.
6.
Shaywitz SE, Shaywitz BA: Attention deficit disorder: Current perspectives, in Kavanaugh JF, Truss TJ , Tom J Jr (eds): Learning Disabilities: Proceedings of the National Conference. Parkton, MD, York Press, 1988, pp 369-523.
7.
Sleator EK: Diagnosis, in Sleator EK, Pelham WE Jr (eds): Attention Deficit Disorder. Norwalk, CT, Appleton Century Crofts, 1986, pp 11-42.
8.
Conners CK: A teacher rating scale for use in drug studies with children. Am J Psychiatry1969;126:805-888.
9.
Conners CK: Rating scales for use in drug studies with children. Psychopharmacol Bull1973;9(Special Issue: Pharmacotherapy of Children):24-84.
Werry JS, Sprague RL, Cohen MN: Conners' teacher rating scale for use in drug studies with children—An empirical study. J Abnorm Child Psychol1975 ;3:217-229.
12.
Goyette CH, Conners CK, Ulrich RF: Normative data on revised Conners parent and teacher rating scales . J Abnorm Child Psycho1978;6:221-236.
13.
Wilson JM, Kiessling LS: What is measured by the Conners' teacher behavior rating scale? Replication of factor analysis. J Dev Behav Pediatr1988 ;9:271-278.
14.
Loney J., Milich R.: Hyperactivity, aggression, and inattention in clinical practice, in Wolraich M, Routh D (eds): Advances in Developmental and Behavioral Pediatrics , vol 2. Greenwich, CT, JAI Press, 1982, pp 113-147.
15.
Atkins MS, Pelham WE, Licht MH: The differential validity of teacher ratings of inattention/overactivity and aggression. J Abnorm Child Psychol1989 ;17:423-435.
16.
Milich R., Fitzgerald G.: Validation of inattention/overactivity and aggression ratings with classroom observations. J Consult Clin Psychol1985;53:139-140.
17.
Milich R., Loney J., Landau S.: Independent dimensions of hyperactivity and aggression: A validation with playroom observation data. J Abnorm Psychol1982;91:183-198.
18.
Pelham WE, Milich R., Murphy DA, Murphy HA: Normative data on the Iowa Conners Teacher Rating Scale. J Clin Child Psychol1989;18:259-262.
19.
Pelham WE, Atkins MS, Murphy HA, White KS: Operationalization and validation of attention deficit disorders. Presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Toronto, November 1981.
20.
Lahey BB, Pelham WE, Schaughency EA, et al: Dimensions and types of attention deficit disorder. J Am Acad Child Adolesc Psychiatry1988;27:330-335.
21.
Achenbach T. , Edelbrock C.: Manual for the Child Behavior Checklist and Revised Child Behavior Profile . Burlington, VT, University of Vermont, 1983.
22.
Ullman RK, Sleator EK, Sprague RL: A new rating scale for diagnosis and monitoring of ADD children. Psychopharm Bull1983;20:160-164.
23.
Shaywitz SE , Schnell C., Shaywitz BA, Towle VR: Yale Children's Inventory (YCI): An instrument to assess children with attentional deficits and learning disabilities I. Scale development and psychometric properties . J Abnorm Child Psychol1986;14:347-364.
24.
Klein DR, Gittelman-Klein R.: Problems in diagnosis of minimal brain dysfunction and the hyperkinetic syndrome . Int J Ment Health1975;4:45-60.
25.
Cohen M., Becker MG, Campbell R.: Relationships among four methods of assessment of children with attention deficit-hyperactivity disorder. J School Psychol1990;28:189-202.
26.
Quay HC, Peterson DR: Manual for the Revised Behavior Problem Checklist. Coral Gables, FL, University of Miami, 1987.
27.
Kaufman AS: Intelligent Testing With the WISC-R. New York, Wiley, 1979.
28.
Morrison JR , Stewart MA: A family study of the hyperactive child syndrome . Biol Psychiatry1971;3:189-195.
29.
Cantwell DP : Psychiatric illness in the families of hyperactive children. Arch Gen Psychiatry1972;27:414-417.
30.
Cantwell DP : Genetics of hyperactivity. J Child Psychol Psychiatry1975;16:261-264.
31.
Safer DJ: A familial factor in minimal brain dysfunction. Behav Genet1973;3:175-186.
32.
Pauls DL, Shaywitz SE, Kramer PL, et al: Demonstration of vertical transmission of attention deficit disorder. Ann Neurol1983;14:363.
33.
Biederman J. , Munir K., Knee D., Armentano M., et al: High rate of affective disorders in probands with attention deficit disorder and in their relatives: A controlled family study. Am J Psychiatry1987;144:330-333.
34.
Lahey BB, Piacentini JC, McBurnett K., et al: Psychopathology in the parents of children with conduct disorder and hyperactivity. J Am Acad Child Adolesc Psychiatry1988; 27:163-170.
Denckla MB: Development of speed in repetitive and successive finger-movements in normal children. Dev Med Child Neurol1973 ;15:635-645.
37.
Rudel RG, Healey J., Denckla MB: Development of motor coordination by normal left-handed children. Dev Med Child Neurol1984;26:104-111.
38.
Gardner RA: The objective diagnosis of minimal brain dysfunction. Cresskill, NJ, Creative Therapeutics, 1979.
39.
Spreen O., Gaddes WH: Developmental norms for 15 neuropsychological tests age 6 to 15. Cortex1969;5:170-191.
40.
Wechsler D.: Wechsler Intelligence Scale for Children-Revised. Psychological Corp, New York, 1974 .
41.
Jastak S., Wilkinson GS: Wide Range Achievement Test-Revised. Wilmington, DE, Jastak Assoc, 1984.
42.
Trommer BL, Hoeppner J-AB, Lorber R., et al: Pitfalls in the use of a continuous performance test as a diagnostic tool in attention deficit disorder. J Dev Behav Pediatr1988;9:339-346.
43.
Gordon M.: Instruction Manual for the Gordon Diagnostic System. DeWitt, NY, Gordon DiagnosticSystems, 1986.
44.
Voeller KKS , Heilman KM: Motor impersistence in children with attention deficit hyperactivity disorder: Evidence for right hemisphere dysfunction . Ann Neurol1988;24:71.
45.
Trommer BL, Hoeppner JB, Lorber R., Armstrong K.: The go-no go paradigm in attention deficit disorder (ADD). Ann Neurol1988;24:610-614.
46.
Werry JS: Measures in pediatric psychopharmacology, in Werry JS (ed): Pediatric Psychopharmacology: The Use of Behavior Modifying Drugs in Children. New York, Brunner/Mazel , 1978, pp 29-78.
47.
Shaywitz B. , Shaywitz S.: Comorbidity: A critical issue in attention deficit disorder. J Child Neurol1991;6(Suppl): S13-S20.
48.
Weinberg WA , Emslie GJ: Attention deficit hyperactivity disorder: The differential diagnosis. J Child Neurol1991; 6(Suppl):S21-S34.
49.
Kerbeshian J., Burd L., Martsolf J.: A family with fragile X syndrome. J Nerv Ment Dis1984;172:549-551.
50.
Hier DB: Learning disorders and sex chromosome aberrations. J Ment Defic Res1980;24:17-26.
51.
Eliason MJ: Neurofibromatosis: Implications for learning and behavior. J Dev Behav Pediatr1986;7:175-179.
52.
Marshall P. : Attention deficit disorder and allergy: A neurochemical model of the relation between the illnesses. Psychol Bull1989;106:434-446.
53.
Pliszka SR: Effect of anxiety on cognition, behavior, and stimulant response in ADHD. J Am Acad Child Adolesc Psychiatry1989;28:882-887.
54.
Cunningham CE, Barkley RA: The role of academic failure in hyperactive behaviour. J Learn Disabil1978 ;11:15-21.
55.
De Haas PA, Young RD: Attention styles of hyperactive and normal girls. J Abnorm Child Psychol1984 ;12:531-546.
56.
Berry CA, Shaywitz SE, Shaywitz BA: Girls with attention deficit disorder: A silent minority? A report on behavioral and cognitive characteristics. Pediatrics1985;76:801-809.
57.
Breen MJ: Cognitive and behavioral differences in ADHD boys and girls. J Child Psychol Psychiatry1989;30:711-716.
58.
Horn WF, Wagner AE, Ialongo N.: Sex differences in school-aged children with pervasive attention deficit hyperactivity disorder. J Abnorm Child Psychol1989;17:109-125.
59.
McGee R. , Williams S., Silva PA: A comparison of girls and boys with teacher-identified problems of attention. J Am Acad Child Adolesc Psychiatry1987;26:711-717.
60.
Schachar R. , Sandberg S., Rutter M.: Agreement between teacher's ratings and observations of hyperactivity, inattentiveness, and defiance. J Abnorm Child Psychol1986 ;14:331-345.
61.
Klorman R., Brumaghim JT, Salzman LF, et al: Effects of methylphenidate on attention-deficit hyperactivity disorder with and without aggressive-noncompliant features. J Abnorm Psychol1988;97:413-422.
62.
Gadow KD, Nolan EE, Sverd J., et al: Methylphenidate in aggressive-hyperactive boys. I. Effects on peer aggression in public school settings. J Am Acad Child Adolesc Psychiatry1990;29:710-718.
63.
Bugental DB , Whalen CK, Henker B.: Causal attributions of hyperactive children and motivational assumptions of two behavior change programs: Evidence for an interactionist position. Child Dev1977 ;48:874-884.
64.
Milich R., Licht BG, Murphy DA, Pelham WE: Attention-deficit hyperactivity disordered boys' evaluations of and attributions for task performance on medication versus placebo. J Abnorm Psychol1989;98:280-284.
65.
Rapoport JL , Buchsbaum M., Weingartner H., et al: Dextroamphetamine: Cognitive and behavioral effects in normal and hyperactive boys and normal adult males. Arch Gen Psychiatry1980;37:933-943.
66.
McBride MC: An individual double-blind crossover trial for assessing methylphenidate response in children with attention deficit disorder. J Pediatrics1988;113:137-145.
67.
Fulton AI, Yates WR: Family abuse of methylphenidate. Am Fam Physician1988;38:143-145.
68.
Axelrod J.: Amphetamine: Metabolism, pharmacological disposition and its effect on catecholamine storage, in E Costa, S Garattini (eds): Amphetamines and Related Compounds. New York, Raven Press , 1970, pp 221-236.
69.
Glowinski J. : Effects of amphetamine on various aspects of catecholamine metabolism in the central nervous system of the rat, in E Costa, S Garattini (eds): Amphetamines and Related Compounds. New York, Raven Press, 1970, pp 301-316.
70.
Solanto MV: Neuropharmacological basis of stimulant drug action in attention deficit disorder with hyperactivity: A review and synthesis. Psychol Bull1984;95:387-409.
71.
Lou HC, Henriksen L., Bruhn P., et al: Striatal dysfunction in attention deficit and hyperkinetic disorder . Arch Neurol1989; 46:48-52.
72.
Peloquin LJ , Klorman R.: Effects of methylphenidate on normal children's mood, event-related potentials, and performance in memory scanning and vigilance . J Abnorm Psychol1986;95:88-98.
73.
Syrigou-Papavasillou A., Lycaki H., LeWitt PA, et al: Dose-response effects of chronic methylphenidate administration on late event-related potentials in attention deficit disorder . Clin Electroencephalogr1988;19:129-133.
74.
Physicians' Desk Reference. Oradell, NJ , Medical Economics, 1990.
75.
Pelham WE, Sturges J., Hoza J., et al: Sustained release and standard methylphenidate effects on cognitive and social behavior in children with attention deficit disorder. Pediatrics1987;80:491-501.
76.
Swanson JM, Sandman CA, Deutsch C., Baren M.: Methylphenidate hydrochloride given with or before breakfast: I. Behavioral, cognitive and electrophysiologic effects. Pediatrics1983;72:49-55.
77.
Kupietz SS, Winsberg BG, Richardson E., et al: Effects of methylphenidate dosage in hyperactive reading disabled children. I. Behaviour and cognitive effects. J Am Acad Child Adolesc Psychiatry1988;27:70-77.
78.
Winsberg BG, Kupietz SS, Sverd J., et al: Methylphenidate oral dose plasma concentration and behavioral response in children. Psychopharmacology1982 ;76:329-332.
79.
Shaywitz SE, Heint RD, Jatlow P., et al: Psychopharmacology of attention deficit disorder: Pharmacokinetic, neuroendocrine, and behavioral measures following acute and chronic treatment with methylphenidate. Pediatrics1982;69:688-694.
80.
Sebrechts MM , Shaywitz SE, Shaywitz BA, et al: Components of attention, methylphenidate dosage, and blood levels in children with attention deficit disorder. Pediatrics1986; 77:222-228.
81.
Gualtieri CT , Wargin W., Kanov R., et al: Clinical studies of methylphenidate serum levels in children and adults. J Am Acad Child Adolesc Psychiatry1982;21:19-26.
82.
Quinn PO, Rapoport JL: One-year follow-up of hyperactive boys treated with imipramine or methylphenidate . Am J Psychiatry132:1975;241-245.
83.
Zametkin A. , Rapoport JL, Murphy DL, et al: Treatment of hyperactive children with monoamine oxidase inhibitors. I. Clinical efficacy. Arch Gen Psychiatry1985;42:962-966.
84.
Gualtieri CT : Imipramine and children: A review of some speculations about the mechanisms of drug action. Dis Nerv Sys1977;38:368-375.
85.
Gualtieri CT , Evans RW: Motor performance in hyperactive children treated with imipramine. Percept Mot Skills1988; 66:763-769.
86.
Zametkin AJ , Rapoport JL: Neurobiology of attention deficit disorder with hyperactivity. Where have we come in 50 years?J Am Acad Child Adolesc Psychiatry1987;26:676-686.
87.
Douglas VI, Barr RG, Amin K., et al: Dosage effects and individual responsivity to methylphenidate in attention deficit disorder. J Child Psychol Psychiatry1988;29:453-465.
88.
Tannock R., Schachar RJ, Carr RP, Logan GD: Dose-response effects of methylphenidate on academic performance and overt behavior in hyperactive children. Pediatrics1989; 84:648-657.
89.
Rapoport JL , Buchsbaum MS, Zahn TP, et al: Dextroamphetamine: Cognitive and behavioral effects in normal prepubertal boys. Science1978;199:560-562.
90.
Porrino LJ, Rapoport JL, Behar D., et al: A naturalistic assessment of the motor activity of hyperactive boys. II. Stimulant drug effects. Arch Gen Psychiatry1983;40:688-693.
91.
Johnston C. , Pelham WE, Hoza J., Sturges J.: Psychostimulant rebound in attention deficit disordered boys. J Am Acad Child Adolesc Psychiatry1988;27:806-810.
92.
Golinko B.: Side effects of dextroamphetamine and methylphenidate in hyperactive children—a brief review. Prog Neuropsychopharmacol Biol Psychiatry1984;8:1-8.
93.
Safer DJ, Allen RP, Barr E.: Depression of growth in hyperactive children on stimulant drugs. N Engl J Med1972; 287:217-220.
94.
Hechtman L. , Weiss G., Perlman T.: Growth and cardiovascular measures in hyperactive individuals as young adults and in matched normal controls. Can Med Assoc J1978; 118:1247-1250.
95.
Loney J., Whaley-Klahn MA, Ponto L., Adney K.: Predictors of adolescent height and weight in hyperkinetic boys treated with methylphenidate. Psychopharmacol Bull1981 ;17:132-134.
96.
Mattes JA, Gittelman R.: Growth of hyperactive children on maintenance regimen of methylphenidate . Arch Gen Psychiatry1983;40:317-321.
97.
Gross MD: Growth of hyperkinetic children taking methylphenidate, dextroamphetamine, or imipramine/desipramine. Pediatrics1976 ;58:423-431.
98.
McNutt BA, Boileau RA, Cohen MN: The effects of longterm stimulant medication on the growth and body composition of hyperactive children . Psychopharmacol Bull1977; 13:36-38.
99.
Kalachnik JE , Sprague RL, Sleator EK, et al: Effects of methylphenidate hydrochloride on stature of hyperactive children. Dev Med Child Neurol1982;24:586-595.
100.
Roche AF, Lipman RS, Overall JE, Hung W.: The effects of stimulant medication on the growth of hyperkinetic children . Pediatrics1979;63:847-850.
101.
Klein RG, Landa B., Mattes JA, Klein DR: Methylphenidate and growth in hyperactive children: A controlled withdrawal study. Arch Gen Psychiatry1988;45:1127-1130.
102.
Klein RG, Mannuzza S.: Hyperactive boys almost grown up. III. Methylphenidate effects on ultimate height. Arch Gen Psychiatry1988;45:1131-1134.
103.
Sverd J., Hurwic MJ, David O., Winsberg BG: Hypersensitivity to methylphenidate and dextroamphetamine: A report of two cases. Pediatrics1977;59:115-117.
104.
Brown RT, Sexson SB: Effects of methylphenidate on cardiovascular responses in attention deficit hyperactivity disordered adolescents. J Adolesc Health Care1989;10:179-183.
105.
Case Q., McAndrew JB: Dexedrine dyskinesia: An unusual iatrogenic tic. Clin Pediatr1974;13:69-72.
106.
Sprague RL , Sleator EK: Methylphenidate in hyperkinetic children: Differences in dose effects on learning and social behavior. Science1977;198:1274-1276.
107.
Winsberg BG , Kupietz S., Sverd J., Hungund BL: Methylphenidate oral dose, plasma concentration, and behavioral response in children. Psychopharmacology1982;76:329-332.
108.
Braff DL, Huey L.: Methylphenidate-induced information processing dysfunction in nonschizophrenic patients. Arch Gen Psychiatry1988;45:827-832.
109.
Koehler-Troy C., Strober M., Malenbaum R.: Methylphenidate-induced mania in a prepubertal child. J Clin Psychiatry1986;47:566-567.
110.
Bloom AS, Russell LJ, Weisskopf B., Blackerby JL: Methylphenidate-induced delusional disorder in a child with attention deficit disorder with hyperactivity. J Am Acad Child Adolesc Psychiatry1988;27:88-89.
111.
Lucas AR, Weiss M.: Methylphenidate hallucinosis. JAMA1971;217:1079-1081.
112.
Young J.: Methylphenidate-induced hallucinosis: Case histories and possible mechanisms of action. J Dev Behav Pediatrics1981;2:35-38.
113.
Volkmar F. , Hoder E., Cohen A.: Inappropriate uses of stimulant medications . Clin Pediatr1985 ;25:127-130.
114.
Sverd J., Curley AD, Jandorf L., Volkersz L.: Behavior disorder and attention deficits in boys with Tourette syndrome . J Am Acad Child Adolesc Psychiatry1988 ;27:413-417.
Erenberg G. , Cruse RP, Rothner AD: Gilles de la Tourette's syndrome: Effect of stimulant drugs. Neurology1985; 35:1346-1348.
117.
Comings DE , Comings BG: A controlled study of Tourette syndrome. I. Attention deficit disorder, learning disorders and school problems . Am J Hum Genet1987;41:742-760.
118.
Shapiro AK , Shapiro E.: Do stimulants provoke, cause or exacerbate tics and Tourette syndrome?Compr Psychiatry1981; 22:265-273.
119.
Sverd J., Gadow KD, Paolicelli LM: Methylphenidate treatment of attention-deficit hyperactivity disorder in boys with Tourette's syndrome. J Am Acad Child Adolesc Psychiatry1989; 28:574-579.
120.
Feldman H., Crumrine P., Handen BL, Alvin R.: Methylphenidate in children with seizures and attention-deficit disorder . Am J Dis Child1989;143:1081-1086.
121.
Richardson E. , Kupietz SS, Winsberg BG, et al: Effects of methylphenidate dosage in hyperactive reading-disabled children: II. Reading achievement. J Am Acad Child Adolesc Psychiatry1988;27:78-87.
122.
Hunt RD: Treatment effects of oral and transdermal clonidine in relation to methylphenidate: An open pilot study in ADD-H. Psychopharmacol Bull1987;23:111-114.
123.
Delong GR, Aldershof AL: Long-term experience with lithium treatment in childhood: Correlation with clinical diagnosis. J Am Acad Child Adolesc Psychiatry1987;26:389-394.
124.
Scheel-Kruger J., Randrup A.: Stereotype hyperactive behaviour produced by dopamine in the absence of noradrenaline. Life Sci1967;6:1389-1398.
125.
Porrino LJ , Lucignani G., Dow-Edwards D., Sokoloff L.: Correlation of dose dependent effects of acute amphetamine administration on behavior and local cerebral metabolism in rats. Brain Res1984;307:311-320.