The temporal patterns of office visits (primary care physicians or psychiatry and neurology specialty clinics) for attention deficit hyperactivity disorder (ADHD) and stimulant treatment for 5 to 14-year-old youths were studied at the University of Maryland and Johns Hopkins Medical Institutions, Baltimore, and the APA, Washington, DC. Youth visits for ADHD as a percentage of total physician visits increased 90%, from 1.9% in 1989 to 3.6% in 1996, and stimulant therapy rose from 63% to 77%. One third of ADHD youth visits were to specialty clinics, and complex multidrug therapy was usually prescribed by psychiatrists. [1]

COMMENT. ADHD youths treated with stimulants alone were seen mainly by primary care physicians, while youths receiving multidrug therapies attended psychiatry clinics. In the Practice Research Network survey, 53% of patients treated for ADHD received nonstimulant psychotherapeutic medications concomitantly (tricyclic antidepressants, clonidine, and antipsychotics). Complex therapy for comorbid disorders requires further evaluation of both efficacy and safety.

Efficacy vs effectiveness of stimulant medication. In an editorial, Wolraich ML [2] distinguishes between studies of efficacy and effectiveness of stimulant medication for ADHD. While efficacy studies examine the effects of a medication under ideal conditions, effectiveness research attempts to determine the success of the intervention in practice. Frequency of visits appropriate to monitor effects, dosing patterns, and sources of information need to be addressed. While there may be inappropriate treatment with methylphenidate with wide variation in physician and prescription rates, the prevalence of stimulant use does not exceed the prevalence rates for ADHD.

Measurements of attention deficits and impulsivity. The Gordon Diagnostic System (GDS), a computerized tool to measure impulse control, attention and vigilance and standardized for American children, is evaluated for use among Swedish children [3]. Statistically significant differences are found between ADHD children and age-matched control children.