EDITORIAL

One hundred years of managing ADHD—and where are we?

By Harlan R. Gephart, MD

In 1902, eminent British pediatrician and scholar Dr. George Still, writing in The Lancet, published what is probably the first description of the condition we now call attention deficit hyperactivity disorder, or ADHD.¹ One hundred years later, how far have we come in the diagnosis and treatment of this condition?

• We know that ADHD is highly genetic. It has a predilection for certain families, and is more common in boys than in girls—although the gender discrepancy is narrower than once thought.

• We know that for at least half of ADHD children, symptoms and impairment continue into adulthood.

• The application of newer research tools, such as single photon-emission computed tomography (SPECT) scanning, has shown that abnormal dopamine transport and uptake at the nerve synapse might well account for many of the symptoms of ADHD, although the specific cause or causes of the disorder remain obscure.

• The impact of ADHD on the patient, his family, and, ultimately, society can be monumental. For example, a person with ADHD who drives a car has a greater risk of being involved in a crash and has nearly double the likelihood of developing a substance abuse problem during his life—not to mention the accompanying risks of educational underachievement and occupational and marital dysfunction. In sum, the millions of people with ADHD have a major impact on the health, education, and legal systems of our society.

Despite all the negatives, some recent positive events give rise to optimism. First, the American Academy of Pediatrics's guidelines for the diagnosis² and treatment³ of ADHD, published in 2000 and 2001, respectively, offer great assistance to the primary care clinician in recognizing and treating this disorder early. Second, AAP's ADHD Toolkit, produced in collaboration with the National Initiative for Child Healthcare Quality (NICHQ), offers the clinician practical tools needed to manage this condition. The hope is that these educational endeavors will greatly enhance our ability to care for our patients with ADHD.

Last, we now have a number of medications and formulations of medications—new and longstanding, stimulant and nonstimulant—to offer to our ADHD patients. Used in conjunction with behavioral therapy, these agents provide a well-researched and evidence-based approach to treatment.

In this issue of Contemporary Pediatrics, I am joined by my colleagues Drs. Andrew Adesman, Laurel Leslie, and Yi Hui Liu in presenting the latest in what is known about, and available for, diagnosing and treating ADHD and managing its many serious coexisting disorders and problems. I hope you find what we have to say helpful to your work.

REFERENCES

1. Still GF: Lectures to the Royal College of Physicians. "Some abnormal psychical conditions in children." Lancet 1902:1008

2. Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. American Academy of Pediatrics. Pediatrics 2000;105:1158

3. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement: Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001;108:1033

DR. GEPHART, guest editor of this issue and a member of the editorial board of Contemporary Pediatrics, is clinical professor of pediatrics at the University of Washington School of Medicine, Seattle.

Harlan Gephart. Editorial: One hundred years of managing ADHD—and where are we?

Contemporary Pediatrics

December 2003;20:10.