Pharmacotherapy of attention-deficit hyperactivity disorder in children and adolescents: Update on new stimulant preparations, atomoxetine, and novel treatments

Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric condition shown to occur in 3% to 10% of school-aged children worldwide [1-3]. The classic triad of impaired attention, impulsivity, and excessive motor activity characterizes ADHD, although up to one third of children may manifest only the inattentive aspects of ADHD [4]. In most patients ADHD persists to some degree from childhood through adolescence and into adulthood [5,6]. Pharmacotherapy remains the cornerstone of ADHD treatment [7-10]. As the number of children and adolescents diagnosed with and treated for ADHD tripled during the 1990s [11], research on the pharmacotherapy of ADHD has grown, enhancing the understanding of youth who have ADHD. Recent developments have improved the care of youth who have ADHD. First, the development and availability of novel delivery systems for methylphenidate (MPH) and mixed amphetamine salts (MAS) make it possible to extend coverage by a single dose. Second, the noradrenergic medication atomo-stop-signal reaction time. Nicotine, but not MPH, decreased the Stroop effect (interference by irrelevant stimuli) compared with placebo. These results support the neurobiologic hypothesis of impaired fronto-strial attentional networks. Although cigarette smoking remains an ongoing challenge in the treatment of adolescents who have ADHD, nicotine is, at this point, not a viable or recommended treatment. The nicotinic system remains a potential target for development of novel treatments, however.