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The recent issue of the Journal of the American Academy of Child & Adolescent Psychiatry, August 2020 is chucked full of articles related to the topic of ADHD. Here are the articles that are of significance:

 

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER MEDICATION AND UNINTENTIONAL INJURIES IN CHILDREN AND ADOLESCENTS

by Laura Ghirardi, MSc, et al.
Page 944 points out that the untreated ADHD patient is prone to more unintentional injuries and even severe head injuries than those adequately medicated.

 

EFFECTS OF CHILDHOOD AND ADULT PERSISTENT ATTENTION-DEFICIT/HYPERACTIVITY DISORDER ON RISK OF MOTOR VEHICLE CRASHES: RESULTS FROM THE MULTIMODAL TREATMENT STUDY OF CHILDREN WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

by Arunima Roy, MBBS,, PhD, et al
page 952 revealed a higher incident of motor vehicle crashes in the untreated ADHD patient.

 

TRAJECTORIES OF GROWTH ASSOCIATED WITH LONG-TERM STIMULANT MEDICATION IN THE MULTIMODAL TREATMENT STUDY OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

by Laurence L. Greenhill, M.D. el al
Page 978 presented a study showing diminishment of height gain with long-term stimulant therapy for ADHD. The potential ranged from 1.0 to 1.6 inches in decreased height and a 9 pound increase in weight.

 

This is the first complete article that showed this relation. Based on my own clinical experience I have not had any patients whose height trajectory has fallen below the normal value of 4 cm/year due to stimulant medication use. Nevertheless, the article quoted makes that potential observation something that should be factored into the medication use equation.
 

The effects of non-treatment are:

  1. Increase in unintentional injuries, which could lead to severe brain injury.
  2. Increase in motor vehicle crashes, the potential serious segues are obvious.
  3. The impulsive behaviors which can be viewed as anti-social and lead to peer rejection, poor self-image, academic underachievement and ultimately life underachievement.
  4. School underachievement which also effects self-image and life achievement.
 

If we balance a potential inch to the four negative elements of non-treatment I think the balance is far and away tipped to treatment.I write this article not to create anxiety in the parents of the primary ADHD child but to keep you informed of the latest articles.

 

In the same journal the article

RELATIVE AGE AND ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: DATA FROM THREE EPIDEMIOLOGICAL COHORTS AND A META-ANALYSIS

by Arthur Caye, M.D., et al.
Page 990 correctly points out that a younger student in a class of older, more mature students could appear to be ADHD. If the work-up of the patient is incomplete such a misdiagnosis could occur.

 

A complete evaluation will in fact solve the problem. In our clinical experience the patient who is not a true primary ADHD patient when given stimulant medication would get hyperactive and score lower on the Continuous Performance test.

 

The author is correct. We must always evaluate the relative age maturity because this could be secondary ADHD and thus a deleterious response to stimulant medication would occur. As an informed parent you must be sure your child has had a complete evaluation before a firm diagnosis is made.