ADHD is the most prevalent neuro-developmental disorder in children. The disorder is defined by inattention, hyperactivity, impulsivity, or a combination of these symptoms, which must cause functional impairment.
In the United States, approximately 5.4 million (9.5%) children ages 6 to 17 are diagnosed with ADHD. Although the prevalence of ADHD has seen a dramatic increase of more than 30% in the last two decades, considerable debate continues regarding to over diagnosis and reporting, without confirmation of functional impairment.
The diagnosis of ADHD relies on the use of validated parent and teacher rating scales to demonstrate a child’s impairment across a variety of settings (eg, home and school) as well as a clinical history of symptoms obtained by a trained clinician.
Stimulants are first-line treatments, but a family history of cardiac disease should be obtained. While no formal guidelines exist regarding cardiac risk, a strong family history of early-onset cardiac disease warrants greater caution when prescribing stimulants or certain nonstimulants (atomoxetine). While being treated with stimulants, blood pressure, heart rate, weight, height, and history about sleep patterns should be obtained and followed every 3 months. I baseline EKG and additional cardiac workup should be decided in a case by case basis.
The process of making the diagnosis and proper evaluation will need to be based on a detailed history of the event(s) as well as past medical and family history in conjunction a Neurological examination.
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