Managing Safety and Efficacy In ADHD: A New Wave Of Approaching Treatment Options

PURPOSE: Attention Deficit and Hyperactivity Disorder (ADHD) is a common neurologic disorder affecting approximately 9% of the population according to the National Center for Health Statistics. A variety of diagnostic and treatment guidelines exist, complicating the pharmacological and nonpharmacological treatment options. The objective of the study was to summarize key aspects in the diagnosis and treatment options in children with ADHD through a systematic review of current literature. METHODS: The following databases were searched: MEDLINE, PubMed, and Scopus for meta- analysis, randomized control trials, and other systematic reviews in English, children or adolescent study group, and published between 2007 - 2017. Two authors independently assessed the results of each database and disagreements were resolved through discussion. An algorithm was developed and EBM grading scales were utilized to evaluate quality. Five main topics were evaluated based on a preliminary relevancy search. Topics included: ADHD diagnosis, pharmacologic treatment options and safety profile, and efficacy of non-pharmacologic options including diet and cognitive behavioral therapy. Search terms included ADHD, stimulant, safety, diet, and cognitive behavioral therapy. Selection criteria for relevant studies included those with a control group, randomization, used an official ADHD rating scale to determine efficacy, and ADHD as a primary diagnosis. RESULTS: A variety of guidelines exist regarding ADHD diagnosis. Most follow DSM-IV (or updated DSM-V) although no clear consensus has been developed. However, based on a patient's age, stimulants are a typical first line therapy in treating children and adolescents with ADHD. Stimulants pose a variety of safety concerns including reduced appetite, insomnia, and cardiovascular events. Based on stigma regarding stimulant use, parents have sought nonpharmacologic options to therapy. The primary nonpharmacologic option is behavioral therapy (as an adjunct to medication or alone). Dietary changes and supplementation have shown potential additional benefits. CONCLUSION: ADHD remains a prevalent and growing topic among parents, teachers, caregivers, and healthcare providers. Individualization plays a key role in determining treatment. Depending on the patient’s current health status, medical history, and use of other medications, parents need to work with their physician and pharmacist to determine the best treatment.