Attention Deficit Hyperactivity Disorder and Its Treatment

• Symptoms and circuits: ADHD as a disorder of the prefrontal cortex
• States of deficient and excessive arousal in ADHD
• Deficient arousal and ADHD
• Excessive arousal and ADHD
• Stress, comorbidities, and simultaneous deficient and excessive arousal in ADHD
• ADHD and comorbidity: What should be treated first?
• ADHD in children versus adults
• Stimulant treatment of ADHD
• Noradrenergic treatment of ADHD
• Atomoxetine
• Alpha 2A adrenergic agonists
• The ADHD pharmacy
• Summary

Attention Deficit Hyperactivity Disorder and Its Treatment

Attention deficit hyperactivity disorder (ADHD) is an area of psychopharmacology that is changing rapidly. A myriad of new drugs, especially in new drug-delivery technologies, is entering clinical practice. ADHD is also increasingly being seen not just as a disorder of attention, nor just as a disorder of children. Paradigm shifts are altering the landscape for treatment options across the full range of ADHD symptoms, now reaching into treatment of comorbidities and being refined for the important differences involved in treating adults.

This chapter provides a brief overview of the psychopharmacology of ADHD. This includes a short discussion of the symptoms and treatments for ADHD, but information on the full clinical descriptions and formal criteria for how to diagnose and rate ADHD and its symptoms should be obtained by consulting standard reference sources. The discussion here emphasizes the links between various brain circuits and their neurotransmitters with the various symptoms and comorbidities of ADHD. The goal of this chapter is to acquaint the reader with ideas about the clinical and biological aspects of attention, impulsivity, hyperactivity, underarousal, overarousal, and stress. This chapter also covers some of the special aspects involved in treating adults, such as the impact of the frequent comorbidities of anxiety, substance abuse, and mood disorders. Emphasis is on the biological basis of symptoms and their relief by psychopharmacological agents as well as the mechanism of action of drugs that treat ADHD in children and adults. For details of doses, side effects, drug interactions, and other issues relevant to the prescribing of these drugs in clinical practice, the reader should consult standard drug handbooks (such as the Essential Psychopharmacology: Prescriber’s Guide).