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Abstract

We commence this, the last issue of the century, nay the millennium, with a timely annotation by Overmeyer and Taylor on one of the most controversial topics in child psychiatry at present. As the diagnosis of ADHD (or, in its more limited diagnostic form, hyperkinetic disorder) becomes ever more widely recognised in all corners of the world, the use of medical management to control young children (mainly boys) whose behaviour irritates parents and teachers alike is growing almost exponentially. The authors provide a valuable review of the use of medication for hyperkinetic/ADHD disorders. They point out that the use of stimulants can reduce the severity of symptoms, although they acknowledge that merely suppressing those symptoms will not necessarily affect the prognosis; there is no evidence that long-term outcome is better for medically treated individuals. It has now been shown by several trials that medication can be relatively more effective than behavioural treatments alone: however, this conclusion should not be taken as a license to prescribe medication as a first line of treatment in all circumstances and at all ages. It is worth bearing in mind that methylphenidate and dexamphetamine are the only drugs licensed in the United Kingdom for the treatment of hyperactivity. The review also discusses the use of pemoline (now unlicensed in the United Kingdom because of risk of liver damage), antidepressants, and clonidine. It does not mention risperidone, which has recently attracted a certain vogue amongst private paediatric practitioners. Risperidone does not yet have an evidence base, but it is less prone to induce extra-pyramidal symptoms than other neuroleptics such as haloperidol. It is not, however, free of hazards, which include obesity and endocrinological disorders. Interestingly, the “elimination diet” that every other parent seemed to be demanding for their “hyperactive” child a few years ago has gone out of fashion, presumably because there was hardly any convincing evidence that it was beneficial in the first place.