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Psychostimulant Increase

Although some studies have suggested the prevalence of ADHD at 16% to 17%,7, 8 communication disorders have been estimated to occur in 15% to 25% of children.9 All these estimates are probably as far from determining the true occurrence of these conditions as those derived from counts of sometimes intermittent prescription use. As with an equation describing a chemical equilibrium reaction, the presence of an extremely effective treatment (or of readily available reimbursement for a treatment

Variations in Use

African Americans apparently have decreased access (by a ratio of 2 to 1) to the benefits of medication.3, 4 This large difference with respect to race, possibly related to fiscal concerns, needs further investigation. Non-hyperactive girls with attentional disorders remain a similarly underdiagnosed and undertreated group.

Preschool-Aged Children

Because ADHD is a life-span problem, the incidence of ADHD in preschoolers should not differ from that in older children. Differential diagnosis may be more challenging, but it is certainly not impossible in these younger children. It might be advisable to withhold a diagnosis of ADHD until the child’s behavior can be observed in a group setting such as preschool, nursery school, or day care. In some states this recommendation is part of the formal policy of the state’s Board of Pharmacy.

Long-Term Effects

Little is known about the long-term effects of psychostimulants on the developing brain. Concern has been raised that both cocaine and methylphenidate target the dopamine transporter and have certain similarities in their action,14 but their clinical effects have few similarities.15 Stimulants have been used since the 1930s16; the only one to have exhibited any sort of unexpected long-term side effect was pemoline, and that involved the liver rather than the brain. Finally, stimulant use does

Some Sources of Criticism

Progress in neuropsychopharmacology is revolutionizing the treatment of a wide variety of conditions previously resistant to behavioral interventions,18, 19 but not without criticism. Despite a long history,20, 21 such criticism seems unable to generate any novel arguments. Although the neuroscience of ADHD continues to progress with, for example, the identification of genetic linkages,22 the same logical fallacies continue to reappear, sometimes under religious guises.23, 24, 25 How can one

Diagnosis and Treatment

With and without a complex multidisciplinary team assessment, ADHD is sometimes overdiagnosed but is possibly more often underdiagnosed. Although the magnitude of the error in both directions remains unknown, it is imperative to avoid both errors and not focus exclusively on the overdiagnosis.

As demonstrated by over a half century of clinical experience, psychostimulants exhibit an extremely low risk-to-benefit ratio.32 Although psychostimulant medication is safe and effective,33 it is also

Recommendations

Pediatricians need to assume a proactive role in the screening, diagnosis, and treatment of ADHD: the screening, diagnosis, and treatment of ADHD should be the prerogative of the primary care pediatrician and not the purview of subspecialists and multidisciplinary teams. The majority of cases of ADHD can be managed in an efficient office setting.34, 35, 36 The physician who does not believe in the existence of ADHD, except in the most severe cases, will not typically diagnose it. That reflects

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    • Cited by (43)

    • Glutamate and dopamine in the VTA participate differently in the acute and chronic effect of methylphenidate

      2020, Behavioural Brain Research

    • Glutaminergic signaling in the caudate nucleus is required for behavioral sensitization to methylphenidate

      2019, Pharmacology Biochemistry and Behavior

    • Long-term challenge of methylphenidate changes the neuronal population and membrane property of dopaminergic neuron in rats

      2019, Neurochemistry International

    • Caudate nucleus neurons participate in methylphenidate function: Behavioral and neuronal recordings from freely behaving adolescent rats

      2018, Brain Research Bulletin
      Citation Excerpt :

      Presynaptic reuptake inhibition leads to increased extracellular DA levels in the synaptic cleft and stimulation of postsynaptic DA receptors (Dresel et al., 2000; Volkow et al., 2012). Both the structure and the neuropharmacological profile of MPD resemble cocaine and amphetamines (Accardo and Blondis, 2001; Diaz Heijtz et al., 2004; Kuczenski and Segal, 1997; Volkow et al., 1999). Such similarities raise concern whether MPD has addictive properties (like cocaine and amphetamines) that can potentially lead to substance abuse in the normal adolescent and young adult population.

    • Methylphenidate modulates dorsal raphe neuronal activity: Behavioral and neuronal recordings from adolescent rats

      2017, Brain Research Bulletin

    • Nucleus accumbens neuronal activity correlates to the animal's behavioral response to acute and chronic methylphenidate

      2014, Physiology and Behavior
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    ☆

    Reprint requests: Pasquale Accardo, MD, Professor of Pediatrics, New York Medical College, Director of Pediatrics, Westchester Institute for Human Development, Valhalla, NY 10595.

    ☆☆

    J Pediatr 2001:138:6-9.

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    Copyright © 2001 Mosby, Inc. All rights reserved.