Dr. Goodman is Director of the Adult Attention Deficit Disorder Center of Maryland, and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine in Baltimore.

Disclosure: Dr. Goodman is a consultant to Avacat, Clinical Global Advisors, Eli Lilly, Forest Laboratories, JK Associates, McNeil, Medscape, New River Pharmaceuticals, Novartis, Schering-Plough, Shire, Thompson Reuters, and WebMD; is on the speaker’s bureaus of Forest Laboratories, McNeil, Shire, and Wyeth; has received research grants from Cephalon, Eli Lilly, Excerpta Medicine, Forest Laboratories, McNeil, New River Pharmaceuticals, and Shire; has received honoraria from Eli Lilly, Elsevier, Forest Laboratories, JK Associates, McNeil, Medscape, Shire, Synmed, Veritas Institue, WebMD, and Wyeth; and receives royalties from MBL Communications.

Please direct all correspondence to: David W. Goodman, MD, Assistant Professor, Johns Hopkins Univ School of Medicine, Dept of Psychiatry and Behavioral Sciences, Johns Hopkins at Green Spring Station, 10751 Falls Road, St 306, Baltimore, MD 21093; Tel: 410-583-2723; E-mail: dgoodma4@jhmi.edu.


 

Abstract

In 1998, the American Medical Association Scientific Counsel wrote that attention-deficit/hyperactivity disorder (ADHD) is “one of the best researched disorders in medicine”. Since then, rapidly emerging research coupled with increased interest by clinicians and the public have advanced the identification, diagnosis, and treatment of ADHD in patients of all ages. In treating patients with ADHD and their families, we hope that symptoms are reduced throughout the day leading to improved functioning, enhanced self-confidence, and better quality of life for all involved. Because of the volume of information, there is a need for clinicians to have rapid access to up to date reviews of clinically relevant information to assist in the accurate diagnosis and effective treatment of ADHD and associated psychiatric comorbidities. For the clinician, satisfaction comes from playing an instrumental role in facilitating this optimal outcome. This educational review presents information in brief text and tables for quick reference for the busy practitioner.

 

Focus Points

• Diagnostic accuracy is increased by establishing age of onset of symptoms, chronicity of symptom course, presenting symptom threshold and impairments, and family history of attention-deficit/hyperactivity disorder while ruling out co-existing psychiatric disorders.
• Diagnostic prioritization facilitates instituting an effective treatment algorithm.
• Effective pharmacologic treatments take into consideration issues of safety, tolerability and adherence.
• Psychotherapeutic approaches are selected for the individual needs of the patient and family.

 

Introduction

“The Black Book of Attention-Deficit/Hyperactivity Disorder” is a concise presentation of rapidly accessible information important to clinicians diagnosing and treating these patients and their families. I have attempted to cull through the literature and present clinically relevant information in text and table format so that you can quickly find what you need to address the issues of the patient in front of you. I hope you find the format useful for the intended purpose and we welcome feedback for future editions.

Attention-deficit/hyperactivity disorder (ADHD) has been established as a valid psychiatric disorder in children for many years. In 1998, the American Medical Association Scientific Counsel wrote that ADHD is “one of the best researched disorders in medicine”.1 The explosion of neuroimaging research in the past 10 years has demonstrated clear differences in the ADHD brain from dopamine receptor density in the basal ganglion2 to morphologic differences in white matter,3 basal ganglion,4 and cerebellum5 to rate differences in the neurodevelopment of the frontal cortex.4,6 Heritability of 76% has been established with family, twin, and adoption studies.7 With a growing number of prospective longitudinal studies of ADHD children followed 10–20 years into adulthood,8 we have come to understand that up to 65% of these children will continue to have persistent and impairing ADHD symptoms. From these findings and epidemiologic data, the prevalence of ADHD in children is 7.8% (4.5 million)9 and 4.4% (9–10 million)11 in adults in the United States. Of the children with ADHD, <60% have been treated in the past year while only <15% of the ADHD adults have been treated in the past year.10

The criteria for diagnosing ADHD and its subtypes are enumerated by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.11 The original symptom criteria were field tested in children 5–17 years of age12 and not in older patients with ADHD. Therefore, when diagnosing adults, clinicians and researchers have had to extrapolate the symptoms that appear at older ages. This clinical extrapolation has been aided by following children with ADHD into adolescence and adulthood to see which symptoms persist with impairment and which subside. With age, some patients develop compensatory skills to limit the interference they experience from their symptoms. Although impairments may not appear evident, these patients are often working harder daily to achieve what someone else achieves with little effort.

As individuals with ADHD ages, life presents ever-changing demands often requiring a greater ability to remember and organize daily tasks. Children with ADHD not diagnosed in childhood because they did not present with disruptive behavior or severe academic decline may face challenges later in life as the demands of adulthood exceed their ability to compensate. It is at this time they may present to clinicians with complaints of frustration, demoralization, anxiety, and depression. Given the high prevalence rate in children and adults relative to other psychiatric disorders, an ADHD assessment should be included in every initial mental health evaluation.

In recent years, research has focused on the concurrent psychiatric comorbidities that can complicate the diagnostic process. In children, oppositional defiant disorder and conduct disorder were commonly understood and identified. With emerging research, anxiety and mood disorders in children with ADHD have necessitated greater clinical acumen for accurate diagnoses. The same diagnostic complexities are introduced in older patients with ADHD. The onset of substance abuse, major depression, bipolar disorder, and anxiety disorders add a new dimension to developing a treatment algorithm in the presence of ADHD. Diagnostic prioritization of multiple concurrent disorders is necessary to construct a treatment algorithm. The goal is to effectively treat one disorder without worsening the other disorders. For children and adolescents, the American Academy of Child and Adolescent Psychiatry guidelines lay out a systematic approach to the treatment of ADHD and co-existing disorders. For adults, there are no such guidelines established.

Because of our understanding of ADHD as a potentially life-long disorder, the American Psychiatric Association committee working on diagnostic revisions for the forthcoming DSM-V will consider the research accumulating on the presentation of ADHD across the life span. This means that symptom descriptions will need to be age congruent and the threshold number of symptoms will be reconsidered. The age of onset before 7 years of age is likely to be increased because individuals with inattentive type are typically diagnosed after 7 years of age.13 However, remember that ADHD is a childhood disorder that may persist into adulthood so the age of onset needs to be set in childhood/early adolescence. The criteria of impairment in >2 domains is likely to remain because this is a disorder that impacts multiple domains of life. However, the degree of impairment and the domains may require greater clarification because adaptive skills, IQ, and environmental structure may alter the appearance of impairments.11 The work to be done for the forthcoming DSM-V will greatly broaden and enhance our ability to identify ADHD accurately in all age groups.

This educational review has been divided into specific topics. “Neurobiology” reviews the epidemiology of child and adults with ADHD in the US and internationally, and a review of neuroimaging findings. “Diagnosis” presents the diagnostic criteria in the DSM-IV-TR; a review of extrapolated diagnostic criteria for adults; a list of ADHD rating scales for children, adolescents, and adults, and defines and reviews executive dysfunction and functional impact of ADHD. “Treatment Guidelines” reviews the current ADHD treatment guidelines for child, adolescent, and adults with ADHD established by the current meta-analyses of research findings; treatment algorithms for pure ADHD and ADHD with co-existing psychiatric comorbidities. “Treatment Options” provides a list of medications available and approved by the US Food and Drug Administration, a list of stimulant delivery vehicles, distinguishing efficacy from effectiveness of treatments, a review of complementary treatments and research findings in controlled studies, a review of current safety considerations and side effects for ADHD medications in age specific populations, and a review of psychotherapies employed.

The rapidly emerging research coupled with increased interest by clinicians and the public at large will advance the diagnosis and treatment of ADHD in patients of all ages. We hope that in treating patients with ADHD and their families symptoms are reduced throughout the day leading to improved functioning, enhanced self-confidence, and better quality of life for all involved. For you, the clinician, satisfaction comes from playing an instrumental role in facilitating this optimal outcome. I hope this article provides you with the assistance to achieve this goal.

 

Conclusion   

With decades of research on childhood ADHD, the validity of the disorder is well substantiated. Although adult ADHD was presented in psychiatric literature in the mid-1970s, the emerging body of literature on ADHD across the lifespan has exploded in the last 2 decades. New technologies have allowed science to investigate genetic markers. Neuro-imaging has facilitated a better understanding of developmental, structural, molecular, and functional difference in the brains of children and adults with ADHD. Longitudinal studies have verified that 1 in 2 children with ADHD will continue to have impairing symptoms into adulthood. The negative consequences of untreated ADHD have been enumerated across the lifespan of patients with ADHD. High rates of psychiatric comorbidities add complexity to the diagnostic assessment and prioritization in order to formulate a thoughtful treatment algorithm. The psychiatric literature is extensive for clinical guidance when treating children; however there remains a paucity of adult studies that offer clinical guidance for the treatment of adults with ADHD and co-existing psychiatric disorders.

Efficacy trials for children have clearly demonstrated the benefits of medication and behavioral psychotherapies tailored to the specific symptoms and needs of the child and family. Although limited, a growing body of efficacy trials in adult ADHD over the past 20 years also demonstrates the benefit of medications and specific therapies. The specific approval of medications by the FDA in the past 7 years to treat adults with ADHD helps encourage the identification and treatment of these patients. Advances in medication delivery systems have introduced different mechanisms in order to extend the duration of action. Safety issues have been recently highlighted by the FDA and physicians need to be knowledgeable about assessing medical risk factors in patients.  With the treatment of adults versus children, physicians have new considerations in treatment like pregnancy, substance abuse, and poly-pharmaceutical treatment of concurrent medical conditions (ie, cardiovascular disease, diabetes, hypertension, pain syndromes). Patients often use complementary and alternative treatments without substantial controlled trial efficacy. The conceptual distinction between efficacy and effectiveness will become increasingly relevant as treatment comparative trials look at the economics of treatment.

Because formal training in ADHD is highly variable and virtually absent for adult ADHD, many physicians find they need to learn about this disorder in clinical practice. Summarizing this literature into clinically relevant and rapidly accessible information is critical to facilitating this educational pursuit. This article presents a portion of the tables and text from the book, in which you will find additional tables and information on rating scales, child treatment algorithms for comorbid disorders, and elaboration of Americans with Disabilities Act and Individual Education Plan criteria. This educational review presents the distillation of literature into clinical topics, and is written in table format for a fast read. The unique format of this article and its presentation of up-to-date clinically relevant information makes it a useful addition to the library of clinicians caring for ADHD patients and their families.  PP
 

 

 

Author’s Note

The following references are the complete list from “The Black Book of ADHD­­—1st Edition” and the original numbering from that clinical handbook has been kept for this Educational Review. Although not every reference was used in this article, the inclusion of the entire reference list reflects the breath and depth of the clinical handbook’s content for readers who consider adding it to their library.

 

References

1.     Baughman FA Jr. Treatment of attention-deficit/hyperactivity disorder. JAMA. 1999; 281:1490-1491.
2.     Volkow ND, Wang GJ, Newcorn J, et al. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2007;64:932-940.
3.     Castellanos FX, Lee PP, Sharp W, et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA. 2002;288:1740-1748.
4.     Shaw P, Lerch J, Greenstein D, et al. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2006;63:540-549.
5.     Castellanos FX, Giedd JN, Berquin PC, et al. Quantitative brain magnetic resonance imaging in girls with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2001;58:289-295.
6.     Shaw P, Eckstrand K, Sharp W, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proc Natl Acad Sci U S A. 2007;104:19649-19654.
7.     Faraone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:1313-1323.
8.     Barkley RA, Murphy K, Fischman M. ADHD in Adults: What the Science Says. New York, NY; Guilford Press: 2008.
9.     Mental health in the United States: Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder-United States, 2003. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm. Accessed December 16, 2008.
10. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716-723.
11. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
12. Lahey BB, Applegate B, Meburne HK, et al. DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents. Am J Psychiatry. 1994;151:1673-1685.
13. Faraone SV, Biederman J, Spencer T, et al. Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid? Am J Psychiatry. 2006;163:1720-1729.
14. Still GF. Some abnormal psychical conditions in children. Lecture I. Lancet. 1902;1:1008-1012.
15. Rasmussen N. Making the first anti-depressant: amphetamine in American medicine, 1929–1950. J Hist Med Allied Sci.  2006;61(3):288-323.
16. Bradley C. The behavior of children receiving Benzedrine. Am J Psychiatry. 1937;94:577-585.
17. Diagnostic and Statistical Manual of Mental Disorders. 2nd ed. Washington, DC: American Psychiatric Association; 1968.
18. Conners CK. A teacher rating scale for the use of drug studies with children. Am J Psychiatry. 1969;126(6):884-888.
19. Laufer MW, Benhoff D, Solomons G. Hyperkinetic impulse disorder in children’s behavior problems. Psychosom Med. 1957;19(1):38-49.
20. Wood DR, Reimherr FW, Wender PH, Johnson GE. Diagnosis and treatment of minimal brain dysfunction in adults: a preliminary report. Arch Gen Psychiatry. 1976;33(12):1453-1460.
21. Mann HB, Greenspan SI. The identification and treatment of adult brain dysfunction. Am J Psychiatry. 1976;133(9):1013-1017.
22. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.
23. Spitzer FL, Davies M, Barkley RA. The DSM-III-R field trial of disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry. 1990;29(5):690-697.
24. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. rev. Washington, DC: American Psychiatric Association; 1987.
25. Froehlich TE, Lamphear BP, Epstein JM, et al. Prevalence, recognition, and treatment of attention deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med. 2007;161:857-864.
26. Woodruff TJ, Axelrad DA, Kyle AD, Nweke O, Miller GG, Hurlaey BJ. Trends in environmentally related childhood illnesses. Pediatrics. 2004;113:1133-1140.
27. Nyman ES, Ogdie MN, Loukola A, et al. ADHD Candidate Gene Study in a Population-Based Birth Cohort: Association with DBH and DRD2. J Am Acad Child Adolescent Psychiatry. 2007;46(12):1614-1621.
28. Leung PW, Hung SF, Ho TP, et al. Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion: A pilot community study in Hong Kong. Eur Child Adolesc Psychiatry. 2008;17(7):452-461.
29. Fayyad J, De Graaf R, Kessler R, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivit disorder. Br J Psychiatry. 2007.190;402-409.
30. Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York, NY: Guilford Press; 1990.
31. Beiderman J, Faraone S, Milberger S, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry. 1996;53:437-446.
32. Claude D, Firestone P. The development of ADHD boys: a 12 year follow up. Can J Behav Sci. 1995;27;226-249.
33. Barkley RA ADHD-longterm course, adult outcome, and comorbid disorders. Attention Deficit Hyperactivity Disorder: State of the Science, Best Practices. In: Jensen PS, Cooper JY eds. Kingston, NH: Civic Research Institute, 2002;4-1-4-12.
34. Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:894-921.
35. Faraone SV, Khan SA. Candidate gene studies of attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2006;67:13-20.
36. Thapar A, Langley K, Owen MJ, O’Donovan MC. Advances in genetic findings on attention deficit hyperactivity disorder. Psychol Med. 2007;37:1681-1692.
37. Li D, Sham PC, Owen MJ, He L. Meta-analysis shows significant association between dopamine system genes and attention deficit hyperactivity disorder (ADHD). Hum Mol Genet. 2006;15:2276-2284.
38. Maher BS, Marazita ML, Ferrell RE, Vanyukov MM. Dopamine system genes and attention deficit hyperactivity disorder: a meta-analysis. Psychiatr Genet. 2002;12:207-215. 
39. Brookes KJ, Mill J, Guindalini C, et al. A common haplotype of the dopamine transporter gene associated with attention-deficit/hyperactivity disorder and interacting with maternal use of alcohol during pregnancy. Arch Gen Psychiatry. 2006;63:74-81.
40. Purper-Ouakil D, Wohl M, Mouren MC, et al. Meta-analysis of family-based association studies between the dopamine transporter gene and attention deficit hyperactivity disorder. Psychiatr Genet. 2005;15:53-59.
41. Squassina A, Lanktree M, et al. Investigation of the dopamine D5 receptor gene (DRD5) in adult attention deficit hyperactivity disorder. Neurosci Lett. 2008;432(1):50-53.
42. Bush G, Spencer TJ, Holmes J, et al. Functional magnetic resonance imaging of methylphenidate and placebo in attention-deficit/hyperactivity disorder during the multi-source interference task. Arch Gen Psychiatry. 2008;65:102-114.
43. Banerjee TD, Middleton F, Faraone SV. Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr. 2007;96(9):1269-1274.
44. Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environ Health Perspect. 2006;114(12):1904-1909.
45. Knopik VS, Heath AC, Jacob T, et al. Maternal alcohol use disorder and offspring ADHD: disentangling genetic and environmental effects using a children-of-twins design. Psychol Med. 2006;36(10):1461-1471.
46. Langley K, Rice F, van den Bree MB, Thapar A. Maternal smoking during pregnancy as an environmental risk factor for attention deficit hyperactivity disorder behaviour. A review. Minerva Pediatr. 2005;57(6):359-371.
47. Thapar A, Fowler T, Rice F, et al. Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring. Am J Psychiatry. 2003;160(11):1985-1989.
48. Linnet KM, Dalsgaard S, Obel C, et al. Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence. Am J Psychiatry. 2003;160(6):1028-1040.
49. Kotimaa AJ, Moilanen I, Taanila A, et al. Maternal smoking and hyperactivity in 8-year-old children. J Am Acad Child Adolesc Psychiatry. 2003;42(7):826-833.
50. Milberger S, Biederman J, Faraone SV, Chen L, Jones J. Is maternal smoking during pregnancy a risk factor for attention deficit hyperactivity disorder in children? Am J Psychiatry. 1996;153(9):1138-1142.
51. Langley K, Holmans PA, van den Bree MB, Thapar A. Effects of low birth weight, maternal smoking in pregnancy and social class on the phenotypic manifestation of Attention Deficit Hyperactivity Disorder and associated antisocial behaviour: investigation in a clinical sample. BMC Psychiatry. 2007:20;7:26.
52. Knopik VS, Sparrow EP, Madden PA, et al. Contributions of parental alcoholism, prenatal substance exposure, and genetic transmission to child ADHD risk: a female twin study. Psychol Med. 2005;35(5):625-635.
53. Sasaluxnanon C, Kaewpornsawan T. Risk factor of birth weight below 2,500 grams and attention deficit hyperactivity disorder in Thai children. J Med Assoc Thai. 2005;88(11):1514-1518.
54. Mick E, Biederman J, Prince J, Fischer MJ, Faraone SV. Impact of low birth weight on attention-deficit hyperactivity disorder. J Dev Behav Pediatr. 2002;23(1):16-22.
55. Nigg JT, Knottnerus GM, Martel MM, et al. Low blood lead levels associated with clinically diagnosed attention-deficit/hyperactivity disorder and mediated by weak cognitive control. Biol Psychiatry. 2008;63:325-331.
56. Linnet KM, Wisborg K, Secher NJ, et al. Coffee consumption during pregnancy and the risk of hyperkinetic disorder and ADHD: a prospective cohort study. Acta Paediatr. 2009;98:173-179..
57. Pliszka SR, Crismon ML, Hughes CW, et al. The Texas Children’s Medication Algorithm Project: Revision of the algorithm or pharmacotherapy of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45:642-657.
58. Chrisman A. Pediatric ADHD: Guidelines for Initiating and Monitoring Treatment. Available at: www.medscape.com/viewprogram/7656. Accessed October 29, 2008.
59. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scales-IV: Checklists, Norms and Clinical Interpretation. New York, NY: Guilford Press; 1998.
60. Conners CK. Conner’s Rating Scales-Revised. Available at: www.pearsonassessments.com/tests/crs-r.htm. Accessed October 29, 2008.
61. Brown TE. Brown ADD Rating Scales for Children, Adolescents, and Adults. Available at: www.drthomasebrown.com/assess_tools/index.html. Accessed October 29, 2008.
62. Wolraich ML, Lambert W, Doffing MA, et al. Psychometric properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a referred population. J Pediatr Psychol. 2003;28:559-568.
63. Conners CK, Erhardt D, Sparrow E. Conners’ Adult ADHD Rating Scales. www.pearsonassessments.com/tests/caars.htm. Accessed October 29, 2008.
64. Achenbach TM, Edelbrock C. The Child Behavior Checklist. Burlington, VT: University Associates in Psychiatry; 1983.
65. Murphy KR, Adler LA. Assessing attention-deficit/hyperactivity disorder in adults: focus on rating scales. J Clin Psychiatry. 2004;65(suppl 3):12-17.
66. Kessler RC, Adler LA, Gruber MJ, et al. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatr Res. 2007;16(2):53-65.
67. Brown TE. Brown Attention-Deficit Disorder Scales. San Antonia, TZ; The Psychological Corporation; 1996.
68. Ward MF, Wener PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disoder. Am H Psychiatry. 1993;150(8):1285-1290.
69. Barkley RA, Murphy KR. Attention-Deficit Hyperactivity Disorder: A Clinical Workbook. 2nd ed. New York, NY: Guilford Press; 1998.
70. Biederman J Monuteaux MC, Doyle AE, et al. Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. J Consult Clin Psychol. 2004;72:757-766.
71. Beiderman J, Faraone SV, Fried R, Valera EM. Adult ADHD: A Neurobiological Disorder with Lifetime Impact. CME Monograph from the Adult Academic Council. January 2007. Haymarket Medical.
72.  DiScala C, Lescohier I, Barthel M, Li G. Injuries to children with attention deficit hyperactivity disorder. Pediatrics. 1998;102(6):1415-1421.
73. Barkley RA, Fischer M, Edelbrock CS, Smallish L. The adolescent outcome of hy peractive children diagnosed by research criteria: I. An 8-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry. 1990;29:546-557.
74. Mrug S, Hoza B, Gerdes AC, et al. Discrimination between children with ADHD and classmates using peer variables. J Atten Disord. 2008;(epub ahead of print). 
75. Hoza B, Mrug S, Gerdes AC, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? J Consult Clin Psychol. 2005;73(3):411-423.
76. Hoza B. Peer functioning in children with ADHD. J Pediatr Psychol. 2007;32(6):655-663.
77. Hoza B, Gerdes AC, Mrug S, et al. Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyoperactivity disorder. J Clin Child Adolesc Psychol. 2005;34(1):74-86.
78. Hoza B, Mrug S, Pelham VE Jr, et al. A friendship intervention for children with Attention Deficit/Hyperactivity Disorder: preliminary findings. J Atten Disord. 2003;6(3):387-398.
79. Lambert NM, Hartsough CS. Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants. J Learn Disabil. 1998;31(6):533-544.
80. Elkins IJ, McGue M, Iacono WG. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007;64(10):1145-1152.
81. Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry. 2006;45:192-202.
82. Murphy K, Barkley RA. Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry. 1996;37(6)393-401.
83. Barkley RA, Guevremont DC, Anastopoulos AD, DuPaul GJ, Shelton TL. Driving-related risks and outcomes of attention deficit hyperactivity disorder in adolescents and yound adults: a 3-to 5-year follow-up survey. Pediatrics. 1993;92(2):212-218.
84. Barkley RA, Murphy KR, DuPaul GI, Bush T. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes and the role of executive functioning. J Int Neuropsychol Soc. 2002;8(5):655-672.
85. Fried R, Petty C, Surman C, et al. Characterizing impaired driving in adults with attention-deficit/hyperactivity disorder: A controlled study. J Clin Psychiatry. 2006;67:567-574.
86. Barkley R. Driving impairments in teens and adults with attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004;27:233-260.
87. Leibson CL, Katusic SK, Barbaresi WJ, Ransom J, O’Brien PC. Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder. JAMA. 2001;285(1):60-66.
88. Murphy KR, Barkley RA. Occupational functioning in adults with ADHD. ADHD Report. 2007;15(1):6-10.
89. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairment in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry. 2006;67(4):524-540.
90. Biederman J, Faraone SV. The effects of attention-deficit/hyperactivity disorder on employment and household income. MedGenMed. 2006;8(3):12.
91. Goodman D. The consequences of attention deficit hyperactivity disorder. J Psychiatr Prac.
2007;13(5):318-327.
92. Biederman J, Petty CR, Fried R, et al. Educational and occupational underattainment in adults with attention-deficit/hyperactivity disorder: a controlled study. J Clin Psychiatry. 2008;69(8):1217-1222.
93. Biederman J, Wilens TE, Mick E, et al. Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity. Am J Psychiatry. 1995;152:1642-1658.
94. Kollins SH, McClernon FJ, Fuemmeler BF. Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Arch Gen Psychiatry. 2005;62:1142-1147.
95. Upadhyaya HP, Carpenter MJ. Is attention deficit hyperactivity disorder (ADHD) symptom severity associated with tobacco use? Am J Addict. 2008;17(3):295-298.
96. Mannuzza S, Klein RG, Moulton JL 3rd. Lifetime criminality among boys with attention deficit hyperactivity disorder: a prospective follow-up study into adulthood usng official arrest records. Psychiatry Res. 2008;160(3):237-246.
97. Swensen A, Birnbaum H, Hamadi R, et al. Incidence and costs of accidents among attention-deficit/hyperactivity disorder patients. J Adolesc Health. 2004;35:346.e1-e9.
98. Matza LS, Paramore C, Prasad M. A review of the economic burden of ADHD. Cost Eff Resour Alloc. 2005;3:5.
99. Posner K, Melvin GA, Murray DW, et al. Clinical presentation of attention-deficit/hyperactivity disorder in preschool children: the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS). J Child Adolesc Psychopharmacol. 2007;17(5):547-562.   
100. Jensen PS, Hinshaw SP, Kraemer HC, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40(2):147-158.
101. Searight HR, Burke JM, Rottnek F. Adult ADHD: evaluation and treatment in family medicine. Am Fam Physician. 2000;62:2077-2086.
102. Brown TE, McMullen WJ. Attention deficit disorders and sleep/arousal disturbance. Ann N Y Acad Sci. 2001;931:271-286.
103. Vetter VL, Elia J, Erickson C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs. A scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovasular Nursing. Circulation. 2008;117(18):2407-2423.
104. MedLearning Inc (Medical Education Resources, Inc 2008).
105. Perrin JM, Friedman RA, Knilans TK; Black Box Working Group; Section on Cardiology and Cardiac Surgery. Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder. Pediatrics. 2008;122(2):451-453.
106. Janicak PG, Davis JM, Preskorn SH, Ayd FJ. Principles and Practice of Psychopharmacotherapy. 2nd ed. New York, NY: Lippincott Williams and Wilkins; 1997.
107. Cohen J. Statistical Power Analysis of Treatment Response in a Patient. Mahwah, NJ; Lawrence Erlbaum Associates, Inc.: 1998.
108. Faraone S. Comparing the efficacy of medications for ADHD using meta-analysis. Abstract presented at: The 159th Annual Meeting of the America Psychiatric Association; May 2006; Toronto, Canada.
109. Faraone SV. Medscape Psychiatry and Mental Health. 2003;8(2).
110. Haxell P. Pharmacological management of attention-deficit hyperactivity disorder in adolescents. CNS Drugs. 2007;21(1):37-46.
111. IDEA Parent Guide, National Center for Learning Disabilities, April 2006. Available at: www.ncld.org/images/stories/downloads/parent_center/idea2004parentguide.pdf. Accessed October 17, 2008.
112. Wilens TE, Spencer T. Handbook of Substance Abuse: Neurobehavioral Pharmacology. New York, NY: Plenum Press; 1998.
113. Goodman D. Treatment and assessment of adults with ADHD. In: Biederman J, ed. ADHD Across the Life Span: From Research to Clinical Practice—An Evidence-Based Understanding. Hasbrouck Heights, NJ; Veritas Institute for Medical Education, Inc.: 2006.
114. American Academy of Pediatrics  Committee on Drugs. Pediatrics. 2001;108:776-789. 
115. Ilett KF, Hackett LP, Kristensen JH, Kohan R. Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder. Br J Clin Pharmacol. 2007;63(3):371-375.
116. Steiner E, Villen T, Hallberg M, Rane A. Amphetamine secretion in breast milk. Eur J Clin Pharmacol. 1984;27:123-124.
117. Spigset O, Brede WR, Zhalsen K. Excretion of methylphenidate in breast milk. Am J Psychiatry. 2007;164(2):348.
118. Hackett LP, Kristensen JH, Hale TW, Paterson R, Ilett KF. Methylphenidate and breast-feeding. Ann Pharmacother. 2006;40(10):1890-1891.
119. Stubberfield T, Parry T. Utilization of alternative therapies in attention-deficit hyperactivity disorder. J Paediatr Child Health. 1999;35(5):450-453. 
120. Bussing R, Zima BT, Gary FA, et al. Use of complementary and alternative medicine for symptoms of attention-deficit hyperactivity disorder. Psychiatr Serv. 2002;53(9):1096-1102.
121. Chan E. The role of complementary and alternative medicine in attention-deficit hyperactivity disorder. J Dev Behav Pediatr. 2002;23(1 Suppl):S37-S45.
122. Chan E, Rappaport LA, Kemper KJ. Complementary and alternative therapies in childhood attention and hyperactivity problems. J Dev Behav Pediatr. 2003;24(1):4-8.
123. Jacobs J, Williams AL, Girard C, Njike VY, Katz D. Homeopathy for attention-deficit/hyperactivity disorder: a pilot randomized-controlled trial. J Altern Complement Med. 2005;11(5):799-806.
124. Weber W, Vander Stoep A, McCarty RL, et al. Hypericum perforatum (St John’s wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. JAMA. 2008;299(22):2633-2641.
125. Frei H, Everts R, von Ammon K, et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. Eur J Pediatr. 2005;164(12):758-767.
126. Lamont J. Homeopathic treatment of attention deficit hyperactivity disorder: a controlled trial. British Homeopathic Journal. 1997;86:196-200.
127. Strauss L. The efficacy of a homeopathic preparation in the management of attention deficit hyperactivity disorder. Journal of Biomedical Therapy. 2000;18(2):197-201.
128. Jacobs J, Williams AL, Girard C, et al. Homeopathy for attention-deficit/hyperactivity disorder: a pilot randomized-controlled trial. J Altern Complement Med. 2005;11(5):799-806.
129. Trebaticka J, Kopasova S, Hradecna Z, et al. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. Eur Child Adolesc Psychiatry. 2006;15(6):329-335.
130. Tenenbaum S, Paull JC, Sparrow EP, Dodd DK, Green L. An experimental comparison of Pycnogenol and methylphenidate in adults with attention-deficit/hyperactivity disorder (ADHD). J Atten Disord. 2002;6:49-60.
131. Feingold B. Why Your Child is Hyperactive. New York, NY: Random House; 1975.
132. Wender EH. The food additive-free diet in the treatment of behavior disorders: a review. J Dev Behav Pediatr. 1986;7(1):35-42.
133. Schnoll R, Burshteyn D, Cea-Aravena J. Nutrition in the treatment of attention deficit hyperactivity disorder: a neglected but important aspect. Appl Psychophysiol Biofeedback. 2003;28(1):63-75.
134. Haslam RH, Dalby JT, Rademaker AW. Effects of megavitamin therapy on children with attention deficit disorders. Pediatrics. 1984;74(1):103-111.
135. Voigt RG, Llorente AM, Jensen CL, et al. A randomised, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. J Pediatr. 2001;139:189-196.
136. Stevens LJ, Zhang W, Peck L, et al. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids. 2003;38:1007-1021.
137. Hirayama S, Hamazaki T, Terasawa K. Effect of docosahexaenoic acid-containing food administration on symptoms of attention-deficit/hyperactivity disorder–a placebo controlled double-blind study. Eur J Clin Nutr. 2004;58:467-473.
138. Richardson AJ, Puri BK. A randomised double-blind, placebocontrolled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26:233-239.
139. Sinn N, Bryan J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on ADHD-related problems with attention and behavior. J Dev Behav Pediatr. 2007;28:82-91.
140. Bilici M, Yildirim F, Kandil S, et al. Double-blind, placebocontrolled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28:181-190.
141. Akhondzadeh S, Mohammadi M-R, Khademi M. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial. BMC Psychiatry. 2004;4:9.
142. Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention deficit hyperactivty disorder in children. Pediatr Neurol. 2008;38:20-26.
143. Monastra VJ, Lynn S, Linden M, et al. Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback. 2005;30(2):95-114.
144. Lerner M, Wigal T. Effects of Long-term Stimulants Therapy on Safety Outcomes in Children with ADHD. Psychiatric Annuals. 2008;38(1):43-51.
145. Pliszka SR, Matthews RL, Braslow KJ, Watson MA. Comparative effects of methylphenidate and mixed salts amphetamine on height and weight in children with attention-deficit/hyperactivity disorder. J Am Acad Chld Adolesc Psychiatry. 2006:45(5):520-526.
146. Charach A, Figueroa M, Chen S, Ickowixz A, Schochar R. Stimulant treatment over 5 years effects on growth. J Am Acad Chld Adolesc Psychiatry. 2006;45(4):415-421.
147. Zachor DA, Roberts AW, Hadgens JB, Isaacs JS, Merrick J. Effects of long-term psychostimulant medication on growth of children with ADHD. Res Dev Disabil. 2006;27(2):162-174.
148. Faraone SV, Biederman J, Monuteauz M, Spencer T. Long-term effects of extended release mixed amphetamine salts treatment of attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2005;15(2):191-202.
149. Spencer TJ, Faraone SV, Biederman J, et al: Concerta Study Group. Does prolonged therapy with a long-acting stimulant suppress growth in children with ADHD? J Am Acad Chld Adolesc Psychiatry. 2006;45(5):527-537.
150. Swanson JM, Elliott GR, Greenhill LL, et al. Effects of stimulant medication on growth rates across 3 Years in the MTA follow-up. J Am Acad Chld Adolesc Psychiatry. 2007;46(8):1015.
151. Wilens TE, Beiderman J, Lerner M: Concerta Study Group. Effects of once-daily osmotic release methylphenidate on blook pressure and heart rate in children with attention-deficit/hyperactivity disorder: results from a one year follow-up study. J Clin Psychopharmacol. 2004;24(1):36-41.
152. Wilens TE, McBurneet K, Stein M, et al. ADHD treatment with once-daily OROS methylphenidate: final results from a long-term open-label study. J Am Acad Chld Adolesc Psychiatry. 2005;44(10):1015-1023.
153. Donner RM, Michaels MA, Ambrosini PH. Cardiovascular effects of mixed amphetamine salts extended release in the treatment of school-aged children with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2007;61(5):706-712.
154. Findling RL, Biederman J, Wilens TE, et al, and the SLI381.301 and .302 Study Groups. Short- and long-term cardiovascular effects of mixed amphetamine salts extended release in children. J Pediatr. 2005;147(3)348-354.
155. Varley CK, Vincent J, Varley P, Calferon R. Emergence of tics in children with attention deficit hyperactivity disorder treated with stimulant medications. Compr Psychiatry. 2001;42(3):228-233.
156. Roessner V, Robatzek M, Knapp G, Banaschewski T, Tothenberger A. first-onset tics in patients with attention-deficit-hyperactivity disorder: impact of stimulants. Dev Med Child Neurol. 2006;48(7):616-621.
157. Palumbo D, Spencer T, Lynch J, Co-Chien H, Faraone SB. Emergence of tics in children with AHDD: impact of once-daily OROS methylphenidate therapy. J Child Adolesc Psychopharmacol. 2004;14(2):185-194.
158. Gadow KD, Sverd J, Sprafkin J, Nolan EE, Grossman S. Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder. Arch Gen Psychiatry. 1999;56(4);330-336.
159. Title 34-Educatio­—Definition of individualized education program. Available at: http://edocket.access.gpo.gov/cfr_2007/julqtr/34cfr300.320.htm. Accessed October 17, 2008.
160. Title 34-Education—IEP Team. Available at: http://edocket.access.gpo.gov/cfr_2007/julqtr/34cfr300.321.htm. Accessed October 17, 2008.
161. Individualized Education Program. Available at: http://en.wikipedia.org/wiki/Individualized_Education_Program. Accessed October 17, 2008.
162. Kamens MW. Learning to write IEPs: a personalized, reflective approach for preservice teachers. Intervention in School and Clinic. 2004;40(2):76-80.
163. Katsiyannis A, Maag JW. Educational methodologies: Legal and practical considerations.
Preventing School Failure. 2001;46(1):31-36.
164. Lewis AC. The old, new IDEA. The Education Digest. 2005;70(5):68-70.
165. ADA Home page. www.ada.gov. Accessed October 17, 2008.