Beyond the ‘typical’ patient: Treating attention-deficit/hyperactivity disorder in preschoolers and adults

Abstract

Attention-deficit/hyperactivity disorder (ADHD), typically affects school-aged children, but can present during the preschool years and persist into adulthood. Accurate diagnosis for preschoolers and adults requires adaptation of the current diagnostic criteria to account for differences in symptomatology across the age span. The differential diagnosis of ADHD and the pattern of psychiatric comorbidity vary with each age group and complicate diagnosis and management. To maximize outcomes clinicians must be able to accurately identify ADHD across the lifespan, and develop comprehensive, collaborative treatment plans. The Preschool ADHD Treatment Study (PATS) demonstrated the potential utility of methylphenidate for treating ADHD in preschoolers, and trials of psychostimulants and atomoxetine have shown some benefits for adults. Behavioural interventions likely have an adjunctive role in ADHD treatment for both groups. More research, however, is needed to determine the safest and most effective pharmacotherapies and psychosocial interventions for these non-typical patients.

Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention?

“…Such aetiological heterogeneity is increasingly apparent in the literature and suggests that different sub‐groups of patients may ‘follow’ different pathways (Nigg, 2006). It is also evident in everyday clinical reality (Taylor et al, 2004) where treatments should be tailored to meet specific needs of individual patients (Leslie, Stallone, Weckerly, McDaniel, & Monn, 2006); (iv) ADHD is a lifespan developmental disorder; its roots can be traced back to the early stages of life and its clinical manifestations often persist into adolescence and adulthood (Vaughan, Wetzel, & Kratochvil, 2008; Schmidt & Peterman, 2008).…”

Methylphenidate potentiates morphine-induced antinociception, hyperthermia, and locomotor activity in young adult rats

“…While repeated exposure to psychostimulants can be addictive in adults, studies suggest that treating school-aged children with methylphenidate does not increase the likelihood of later illicit drug use and may reduce the probability of substance abuse disorder (Hechtman and Greenfield, 2003; Mannuzza et al, 2003, 2008; Wilens et al, 2003; but see Lambert and Hartsough, 1998). Increasingly, methylphenidate is being used to treat a small but growing percentage of preschool-aged children (i.e., 3–5 year olds), although very limited information exists on the efficacy and safety of psychostimulant use in this age group (Greenhill et al, 2008; Vaughan et al, 2008). The available clinical trials, however, suggest there are age-dependent differences in response to methylphenidate, with older children showing greater symptom reduction and fewer adverse effects than preschool-aged children (Gleason et al, 2007; Kratochvil et al, 2004).…”

Komorbide Belastungen bei Jugendlichen und jungen Erwachsenen mit ADHS

“…Während es eine erschöpfende Anzahl von Studien gibt, die sich auf das Kindes-und Erwachsenenalter beschränken, lässt sich feststellen, dass die Studienlage zu konkreten Entwicklungsphasen und -übergängen deutlich geringer ausfällt. Eine besonders wichtige Phase ist beispielsweise das Vorschulalter (Posner et al, 2007;Schmidt & Petermann, 2008;Vaughan, Wetzel & Kratochvil, 2008;Verduin, Abikoff & Kurtz, 2008). So weisen ADHS betroffene Kinder bereits zu die-sem Zeitpunkt eine sehr hohe Ausprägung entsprechender Symptome auf -auch wenn diese vorbehaltlich des Entwicklungsstandes und der Altersangemessenheit beurteilt werden müssen (vgl.…”