Medical Health Encyclopedia

Specific Patient Populations. Unfortunately, such guidelines do not address the following specific patient groups:

• There are no authoritative treatment guidelines for treating adolescents and adults with ADHD. Increasingly, evidence suggests that psychostimulants are a reasonable choice for adults with a confirmed diagnosis of ADHD.
• There are no definite guidelines for treating preschool children with severe ADHD. Some parents have reported very good long-term results with behavioral interventions at this age.
• There are no reliable guidelines on how to treat the inattentive subtype of ADHD, which might be more common in girls.
• Finally, there are no defined treatments for ADHD patients with accompanying conditions, including impaired working memory and deficits in language processing.
• There are no defined treatments for children with ADHD and accompanying emotional problems, such as bipolar or anxiety disorders. (There is some evidence, for example, that children with ADHD plus anxiety disorders do worse on psychostimulants.)

Arguments For and Against Psychostimulants. Many parents are very disturbed by the idea of putting their children on intensive stimulant drug regimens, possibly for years, particularly given the uncertainties in diagnosis and the negative publicity surrounding the use of these drugs. Although the decision to use these drugs should not be made lightly, the negative social and emotional effects of the disorder itself for many children with ADHD are far more severe and long-lasting than the use of these drugs. For some parents and children, medication seems like a miracle and can provide desperate families with a quality of life for which they had almost given up hope.

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Still, there are a number of questions, particularly for taking psychostimulants alone without additional behavioral therapy. Of great concern is the dramatic increase in prescriptions for psychostimulants among preschool children, not only in the US but also in some European countries. There is evidence the drugs may be over-prescribed, and parents should discuss the question of medications very carefully with their doctors. ADHD represents a growing market for pharmaceutical companies. Although psychostimulants and alternative drugs are proving to be helpful for many families, no one should underestimate the influence of the economic issues involved.