Treatment resistance in attention-deficit/hyperactivity disorder

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common and widely researched disorders of childhood. US prevalence estimates of attention-deficit/hyperactivity disorder in youth ages 4-17 range from 5% to 11%, with the childhood male to female ratio estimated to be 3-4:1 in epidemiological samples. The economic and psychosocial costs of ADHD are significant for patients, their families, and the society, and ADHD is associated with a higher risk for substance use disorders and other comorbid psychiatric disorders, increased mortality due to accidents, unwanted pregnancies, lower academic achievement and occupational performance, adult antisocial behavior, and poor social functioning, including higher divorce rates. ADHD is a heterogeneous disorder with a variety of core symptom presentations, degree of severity, and psychiatric comorbidities. Therefore, treatment involves a stepwise, systematic approach targeting the predominant clinical symptoms with the goal of minimizing the negative impact on social and academic functioning. Pharmacological treatment for ADHD, although highly effective, is associated with marked variabilities in clinical response, optimal dosage needed, and tolerability. In this chapter, the authors discuss both established and novel pharmacological treatment and neuromodulation in treatment-resistant ADHD.