Attention-deficit disorder - A paradigm for psychotropic medication intervention in pediatrics

A pleasant but harried young mother consults you regarding the behavior of her two children. Her ii-year-old son is galloping around the room, climbing on the scales, and defiantly ignoring his mother's commands to cease his rambunctiousness. On the other side of the room, her 14-year-old daughter is sitting quietly, somewhat oblivious to the commotion, aloofly and blankly staring toward the wall. During a break in the shenanigans created by her son, the distraught mother expresses concerns about her daughter's clumsiness, nearly failing grades, and forgetfulness. "She just doesn't have much energy anymore," she says. "Could she have a chemical imbalance?" Spying your exasperation with her son's dismantling of your office scales, she further queries, "Isn't he too young for medication?" You are obviously as concerned as the mother about the behavior of both children. As the family's pediatrician, you must decide whether their workup and eventual management is within your professional purview or whether these children should be referred. Does the son suffer from hyperactivity? Or is his activity level within the normal developmental range for children his age, but the mother lacks effective discipline tactics? The daughter appears to be an unlikely candidate for the classic diagnosis of attention-deficit disorder (ADD). Could she be a child with the inattentive form of ADD that has been recently reported? Or is she depressed? Yet, how reliable is the physician or the psychologist's one-time observation in the office for diagnosing ADD in children? Do you really have time for a formal evaluation? If you decide that either of the children is affected with ADD, are you comfortable prescribing psychotropic medications and further following these children? How do you treat her depressive symptoms? Should all children with ADD undergo formal psychometric testing? General pediatricians must routinely confront many of these critical issues when dealing with behavioral, academic, or mood problems in children and adolescents.