Attention deficit hyperactivity disorder: Pinning down the diagnosis, implementing therapy

No single test can be used to diagnose attention deficit hyperactivity disorder (ADHD). However, reports of a child's restlessness, inattentiveness, and impulsivity from different teachers and caretakers over several years strongly support the diagnosis. Features commonly associated with ADHD (eg, sleep difficulties, emotional immaturity, and repeated rule violation) lend further support. Consider intervening when the child's behavior results in such major adjustment problems as failing grades, frequent referrals to the principal's office, and school suspensions. Drug therapy, behavior modification techniques, and educational counseling for parents are currently the primary therapies. Stimulants (methylphenidate, dextroamphetamine, or pemoline) are the medications of choice; these agents benefit about 75% of treated children. Side effects (eg, appetite suppression) are characteristically temporary and minor.