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No one needs much convincing that the topic of ADHD diagnosis and treatment is a “hot topic.” Just in case you do, a couple of quick internet searches for attention deficit disorder make the point: I got a whopping 953 “hits” for books on this topic at Barnes and Noble’s website, 60 “hits” for articles in the past year at the New York Times, and 1309 “hits” on Medline for articles published since the beginning of 2004. Part of the ongoing debate in both the lay press and the medical community involves diagnosis: is ADHD correctly diagnosed? Under-diagnosed? Over-diagnosed? Along with diagnosis, there is also debate about treatment and the use of psychostimulant medications: are they prescribed appropriately? Are they under-prescribed? Over-prescribed? What about the role of behavioral therapy? There are also significant questions about the diagnosis and management of younger, pre-school age children, particularly with respect to labeling, and the use of medications.

Both before and after the publication of practice guidelines by the American Academy of Pediatrics,¹ pediatricians have continued to struggle to understand the established evidence and to chart out the best treatment course for individual patients.², ³ While most are familiar with the existence of practice guidelines, few have adopted all or even most of the recommended practices in making the diagnosis of ADHD.

This month, our readers have the opportunity to avail themselves of a highly evidence-based, thorough and well-written review of the issues involved in the diagnosis and treatment of ADHD. While Dr. Dreyer’s focus is on preschool children, he also provides the reader with a review of available knowledge regarding the diagnosis and management of ADHD in school-age children. Armed with the information presented in this article, we should all be better prepared to deal with many of the questions about ADHD—our own and those of our patients.

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References 

1. Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder . Clinical Practice Guideline (Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder) . Pediatrics . 2000;105:1158–1170
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2. Rushton JL , Fant KE , Clark SJ . Use of Practice Guidelines in the Primary Care of Children With Attention-Deficit/Hyperactivity Disorder . Pediatrics . 2004;114:e23–e28
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3. Chan E , Hopkins MR , Perrin JM , et al.   Diagnostic Practices for Attention Deficit Hyperactivity Disorder (A National Survey of Primary Care Physicians) . Ambulatory Pediatrics . 2005;5:201–208
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