Use and Management of Medications for Children Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed behavioral disorders among children in the United States, affecting approximately 3%-5% of all school-aged children (American Psychiatric Association, 1994; Barkley, 1998). ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity (APA, 1994). Although the ways of characterizing the disorder have changed somewhat throughout the years , the current classification system recognizes three empirically derived subtypes of ADHD: predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type (Lahey et al., 1994). Given the demonstrated academic and social outcomes associated with ADHD, the occurrence of this disorder in school-aged children represents a significant public health concern. For example, studies of co-occurring problems suggest that children diagnosed with ADHD also are more likely to be diagnosed with oppositional defiant disorder (ODD), conduct disorder (CD), depression and other mood problems, anxiety problems, and tics (see Barkley, 1998; and Biederman, Wilens, & Spencer, 1999, for reviews of the impairment associated with ADHD). When studied across time, children diagnosed with ADHD are at higher risk for continuing to have learning, behavioral, and emotional problems throughout childhood and adolescence (e.g., Barkley, Fischer, Edelbrock, & Smallish, 1991). Compared to controls, adults who were diagnosed with ADHD as children receive fewer years of formal schooling, achieve lower overall occupational status, and are more likely to have a range of psychiatric problems as adults, such as antisocial personality disorder and non-alcohol substance abuse (e.g., Mannuzza, Klein, Bessler, Malloy, & LaPadula, 1998). Further, children with ADHD have been shown to have difficulty with social interactions with peers (e.g., Flicek, 1992) and family members (e.g., Barkley et al., 1991; Fletcher, Fischer, Barkley, & Smallish, 1996), especially when co-occurring conditions such as learning problems or ODD are present.