Taking the stress out of individualizing ADHD drug therapy.

Attention deficit hyperactivity disorder (ADHD) is characterized by 3 core symptoms: inattention, hyperactivity, and impulsivity.1,2 The presence and severity of these symptoms vary and characterize the 3 subtypes of ADHD: predominantly inattentive (10% to 20%), predominantly hyperactive or impulsive (5% to 10%), and combined inattentive and hyperactive (70% to 80%).3,4 Children with ADHD might experience substantial functional problems, such as academic underachievement, troublesome interpersonal relationships, and low self-esteem.3,5 Ultimately, the goals of treatment are to substantially reduce the core symptoms, improve behavioural and academic performance, and improve self-esteem and social functioning. Evidence supports the use of psychostimulant medication, particularly in school-aged children.6-8 Controlled trials demonstrate that approximately 70% of patients given stimulant medication will have clinically significant decreases in the core symptoms of ADHD.9-11 The Multimodal Treatment Study of ADHD established that combining pharmacologic and nonpharmacologic therapy (eg, behaviour modification programs) is an effective treatment strategy.12,13 Stimulant medications and atomoxetine are effective therapies for the core symptoms, while behavioural therapies play an important role in improving social interactions, self-esteem, and the common behaviour seen.3,9 Overall, the effect size for psychostimulants on ADHD core symptom control is larger compared with nonstimulant therapies, and some patients might respond better to one agent than another.14-16 Potential benefits must be weighed against concerns such as drug abuse or diversion, side effects, growth retardation, and cardiovascular risk.