ADHD Is Not Likely to Go Away

As the most common behavioral condition and the second most common chronic illness in children, attention-deficit/hyperactivity disorder (ADHD) affects approximately 9% of children in the United States.¹

Because ADHD is chronic, it usually requires lifelong care and coordination of interventions from education, medical, and mental health providers.

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders describes ADHD in behavioral terms,² so clinicians diagnose the condition using a clinical evaluation. No objective tests can confirm the diagnosis. In addition to a comprehensive history and physical examination, clinicians also use parent- or teacher-reported behavior rating scales in children.³ In adults, self-reporting and descriptions of behaviors from family members can help.

Animal models, neuroimaging studies, and pharmacologic studies suggest adrenergic and dopaminergic alterations in ADHD.^4,5 Approximately 76% of individuals with ADHD may be genetically predisposed, but investigators have not isolated specific genetic patterns.⁶ Environmental factors, such as childhood lead exposure, head trauma, maternal alcohol intake or smoking, or prematurity, increase risk.⁷

Treatment

Behavioral treatment and medication do not cure ADHD but can control symptoms, which include hyperactivity, impulsivity, and inattention. Behavior-modifying interventions, such as parent behavior management training and school behavior management programs, have been shown to help.⁸ They are considered first-line treatments.

The results of the multisite National Institute of Mental Health’s Multimodal Treatment of ADHD study showed that behavioral interventions and stimulant medication were effective over 14 months with follow-up at 10 years.⁹ Stimulant medication had the strongest effect on core ADHD symptoms. Families found behavioral interventions most acceptable, but behavioral therapy combined with medication was most effective. This was especially helpful when children had comorbid health concerns or family dysfunction. The investigators had difficulty demonstrating long-term benefits, because families did not necessarily receive the same level of behavioral interventions or medication once they left the active trial.⁹

Regardless, rigorous studies have consistently confirmed medication’s efficacy and safety when taken in the therapeutic dose range for ADHD.10 Table 1¹¹ has clinical tips about FDA-approved nonstimulants and stimulants that can reduce ADHD symptoms and improve functioning in children 6 years or older.

Other interventions, such as cognitive or neuropsychological training interventions, diets, electroencephalographic training, or supplements, lack empiric support.¹⁰

Table 2^12-19 lists common questions and information to help pharmacists with patients who have ADHD.

Conclusion

Pharmacists must manage patients’ expectations about medication and explain that individuals respond differently.

Many prescribers fail to counsel patients with ADHD and their families about drug abuse and diversion, and pharmacists can fill that gap.

Jeannette Y. Wick, MBA, RPh, FASCP, is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

REFERENCES

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16. FDA permits marketing of first medical device for treatment of ADHD. News release. FDA; April 19, 2019. Accessed July 20, 2021. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-medical-device-treatment-adhd
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