The following are notes personally taken at a presentation on the subject of ADHD by Dr. Wilens, pediatric psycho-pharmacologist from Massachusetts General Hospital and Harvard Medical School.  Once again, as noted elsewhere in this section, the key to the proper treatment of children with this spectrum of disorders is a proper multi-disciplinary diagnostic evaluation.

• The prevalence of ADHD in the United States and in the developed world is about 8% of the population.  The condition is highly genetically based.
• "Regarding over-diagnosis, half are being diagnosed, and of those, one-quarter are being treated."
• In vitro use of alcohol and/or tobacco is definitely associated with an increased likelihood of ADHD in the offspring so exposed.
• Developmentally inappropriate hyperactivity and impulsivity are both important, with one finding outweighing the other in any given case.  At least six of the symptoms and signs outlined in the ADHD section of DSM - 1V should be present.  Duration should be at least 6 months for the diagnosis to be considered.
• The problems arise before the age of 7 years old, even as early as age three years.  By age 6-9 years, the condition may well be chronic and less amenable to treatment.
• The degree of impairment is often not marked.
• The results of a missed diagnosis and no treatment include: low self-esteem; increase in tendency for substance abuse; increased incidence of accidents and injuries, especially motor vehicle accidents and especially while "multi-tasking" and driving;
• Co-morbidities like anxiety and depression are common, even in pre-schoolers.
• Regarding prognosis, hyper-activity tends to improve by ages 9-12.  In adults, inattentiveness tends to persist, and the condition often leads to substance abuse.
• Treatment includes medications and behavior modification.  "Just medications are effective also".
• Medicatons include stimulants (eg. methylphenedate: ritalin or concerta), tricyclic anti-depressants, and anti-hypertensives (eg. clonidine)  - or atomoxetine.  Results with stimulants are dose-dependent.
• Controversies regarding the use of stimuants.  Growth suppression? "No".  Tics?  "No".  Substance abuse?  "No".  Effects on vital signs?  "No".

GS