Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that manifests in childhood and can persist into adolescence and adulthood. Impairments associated with ADHD can impact quality of life, social interactions, and increase the risk of morbidity and mortality; however, for many patients, effective treatment can lessen these effects. Pharmacotherapy with stimulants or nonstimulants is recommended in conjunction with psychosocial therapy for most patients. Determining the optimal pharmacotherapy can be complex, and the clinician needs to consider many factors such as the patient's age, comorbidities, and lifestyle. Furthermore, the needs of the patient with ADHD will change over time, with specific challenges to consider at each stage of life. A variety of Food and Drug Administration (FDA)-approved stimulant and nonstimulant formulations are available with different modes of delivery and durations of effect. This armamentarium of ADHD medications can be used to individualize ADHD treatment for each patient's needs. This article combines current information from the literature and the first-hand experience of the authors to provide guidance on ADHD treatment options for patients of different ages and for some of the more common comorbidities.
Highlights
Clinicians often struggle with managing a multitude of issues that arise in patients with attentiondeficit/hyperactivity disorder (ADHD) including increased anxiety, stress, depression, and sleep problems; difficulty swallowing and unwillingness to eat; as well as issues with medicating
We may attend to a child with autism and ADHD whose cognitive abilities are improved with medication but has difficulty swallowing a pill; a teenager with ADHD and depression who feels that his medicine helps but causes unwanted mood-related side effects; a mother who presents to her primary care physician feeling overwhelmed and anxious but forgets to mention that her son was recently diagnosed with ADHD and that she has always struggled with similar symptoms; and a dad who drinks and smokes to try to self-medicate his symptoms
Further complicating the issue of treatment are the natural change of ADHD symptoms over time, the different manifestations of symptoms based on the environmental context, and evolving comorbidities
Summary
Clinicians often struggle with managing a multitude of issues that arise in patients with attentiondeficit/hyperactivity disorder (ADHD) including increased anxiety, stress, depression, and sleep problems; difficulty swallowing and unwillingness to eat; as well as issues with medicating (eg, self-medicating, not medicating, or over-medicating).
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