Attention deficit / hyperactivity disorder (ADHD) : main topic

ADHD is not a benign disorder and its management is important, especially as it may lead to so much dysfunction in adults. Eighty per cent of cases are polygenetically inherited, and in these cases there is dopamine deficiency in the synapses of specific areas of the brain due to overactive elimination. The diagnosis is based on the DSM IV criteria, and 4 distinct clinical variants are identifiable. Co-morbidity is common, especially learning disorders. The management of ADHD demands a multi-modal approach, and may include medical, educational, psychosocial and dietary interventions. Stimulants are the mainstay of the medical management of ADHD; they are effective and safe, with relatively few long- and short-term side-effects. A 2-week clinical trial with a shortacting methylphenidate is important to ascertain whether the medication is beneficial and to monitor side-effects. The most important contraindication to the use of methylphenidate is uncontrolled epilepsy. If taken as prescribed the side-effects of methylphenidate are usually mild and temporary.