By: Jenna Schmidt

Attention Deficit Hyperactivity Attention Deficit Hyperactivity DisorderDisorder

ADHD is caused by a chemical imbalance in the ADHD is caused by a chemical imbalance in the brain that affects the parts controlling attention, brain that affects the parts controlling attention, concentration and impulsivity. This means a concentration and impulsivity. This means a child’s behavior can be anything from being ‘very child’s behavior can be anything from being ‘very dreamy’ (or unable to pay attention) through to dreamy’ (or unable to pay attention) through to being ‘always on the go’ (or hyperactive). being ‘always on the go’ (or hyperactive).

A person with ADHD has difficulty filtering out all A person with ADHD has difficulty filtering out all the information coming into his brain, so he’s the information coming into his brain, so he’s easily distracted, tends to respond before he has easily distracted, tends to respond before he has considered things properly and doesn’t know considered things properly and doesn’t know when to stop.when to stop.

A child with ADHD will take longer to settle and A child with ADHD will take longer to settle and concentrate than a child without, and may have concentrate than a child without, and may have problems following instructions. problems following instructions.

ADHD Continued…ADHD Continued…

Children with ADHD often have above-average Children with ADHD often have above-average intelligence but find it hard to learn. They often intelligence but find it hard to learn. They often also have problems socializing.also have problems socializing.

The condition is long term and can continue The condition is long term and can continue through adult life. There is a genetic component, through adult life. There is a genetic component, and children with ADHD often have relatives and children with ADHD often have relatives (frequently male) with ADHD. (frequently male) with ADHD.

It isn’t caused by bad parenting, but a child’s It isn’t caused by bad parenting, but a child’s surroundings and support can affect how severe surroundings and support can affect how severe the symptoms are and how well he can learn to the symptoms are and how well he can learn to deal with them.deal with them.

Past Names For ADHDPast Names For ADHD

ADHD was first described by George Still in 1902. He called ADHD was first described by George Still in 1902. He called it ‘morbid defect of moral control’. It’s also been called:it ‘morbid defect of moral control’. It’s also been called:

minimal brain damage (1930). minimal brain damage (1930).

minimal brain dysfunction (1960). minimal brain dysfunction (1960).

hyperkinetic reaction of childhood (1968). hyperkinetic reaction of childhood (1968).

attention deficit disorder (ADD) with or without attention deficit disorder (ADD) with or without hyperactivity (1980). hyperactivity (1980).

Since 1987, it has been known as ADHD or attention deficit Since 1987, it has been known as ADHD or attention deficit hyperactivity disorder. The World Health Organization hyperactivity disorder. The World Health Organization brought out a second definition in 1992, ‘hyperkinetic brought out a second definition in 1992, ‘hyperkinetic disorder’, a narrower definition than ADHD and comprises disorder’, a narrower definition than ADHD and comprises only the more serious cases.only the more serious cases.

DSM IV TR- 3 typesDSM IV TR- 3 types

ADHD combined type:ADHD combined type: this is the most common this is the most common type, and means the child has six or more type, and means the child has six or more symptoms in each category. symptoms in each category.

ADHD predominantly inattentive type:ADHD predominantly inattentive type: this this means the child has six or more inattention means the child has six or more inattention symptoms but fewer than six hyperactivity-symptoms but fewer than six hyperactivity-impulsivity symptoms. impulsivity symptoms.

ADHD predominantly hyperactive-impulsive ADHD predominantly hyperactive-impulsive type:type: this is the least common type and means this is the least common type and means that the child has six or more hyperactivity-that the child has six or more hyperactivity-impulsivity symptoms but fewer than six inattention impulsivity symptoms but fewer than six inattention symptoms symptoms

Symptoms of ADHDSymptoms of ADHDInattention Type:Inattention Type:

(a) often fails to give close attention to details or makes (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities careless mistakes in schoolwork, work, or other activities (b) often has difficulty sustaining attention in tasks or play (b) often has difficulty sustaining attention in tasks or play activities activities (c) often does not seem to listen when spoken to directly (c) often does not seem to listen when spoken to directly (d) often does not follow through on instructions and fails to (d) often does not follow through on instructions and fails to finish finish schoolwork, chores, or duties in the workplace (not due to schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions) oppositional behaviour or failure to understand instructions) (e) often has difficulty organising tasks and activities (e) often has difficulty organising tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or that require sustained mental effort (such as schoolwork or homework). homework). (g) often loses things necessary for tasks or activities (e.g. (g) often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools) toys, school assignments, pencils, books, or tools) (h) is often easily distracted by extraneous stimuli (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities (i) is often forgetful in daily activities

6 (or more) of the following symptoms of hyperactivity-6 (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental that is maladaptive and inconsistent with developmental levellevel

Symptoms of ADHDSymptoms of ADHDHyperactivity Type:Hyperactivity Type:

(a) often fidgets with hands or feet or (a) often fidgets with hands or feet or squirms in seat squirms in seat (b) often leaves seat in classroom or in other (b) often leaves seat in classroom or in other situations in which remaining seated is situations in which remaining seated is expected expected (c) often runs about or climbs excessively in (c) often runs about or climbs excessively in situations in which it is inappropriate (in situations in which it is inappropriate (in adolescents or adults, may be limited to adolescents or adults, may be limited to subjective feelings of restlessness) subjective feelings of restlessness) (d) often has difficulty playing or engaging in (d) often has difficulty playing or engaging in leisure activities quietly leisure activities quietly (e) is often "on the go" or often acts as if (e) is often "on the go" or often acts as if "driven by a motor" "driven by a motor" (f) often talks excessively(f) often talks excessively

Symptoms of ADHDSymptoms of ADHDImpulsivity Type:Impulsivity Type:

(g) often blurts out answers before questions have (g) often blurts out answers before questions have been completed been completed (h) often has difficulty awaiting turn (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g. butts (i) often interrupts or intrudes on others (e.g. butts into conversations or games) into conversations or games)

B. Some hyperactive-impulsive or inattentive B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present symptoms that caused impairment were present before age 7 years. before age 7 years.

C. Some impairment from the symptoms is present in C. Some impairment from the symptoms is present in two or more settings (e.g. at school [or work] and at two or more settings (e.g. at school [or work] and at home). home).

D. There must be clear evidence of clinically significant D. There must be clear evidence of clinically significant impairment in social, academic, or occupational impairment in social, academic, or occupational functioning. functioning.

E. The symptoms do not occur exclusively during the E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g. better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)Disorder, or a Personality Disorder)

PopulationPopulation According to the National Institute of Mental According to the National Institute of Mental

Health two to three percent of children have Health two to three percent of children have ADHD.  This means that in a typical ADHD.  This means that in a typical classroom at least one child is ADHD.  The classroom at least one child is ADHD.  The NIMH estimates that about 2 million NIMH estimates that about 2 million children in the United States have ADHD.children in the United States have ADHD.

A neurologist by the name Dr. Fred A neurologist by the name Dr. Fred Baughman estimated that 500,000 children Baughman estimated that 500,000 children were diagnosed with ADHD in 1985 and he were diagnosed with ADHD in 1985 and he estimates that there are now 5 to 7 million estimates that there are now 5 to 7 million children with this diagnosis. children with this diagnosis. 

Treatment OptionsTreatment Options

medication medication behavioral therapy behavioral therapy psychotherapy psychotherapy educational techniques. educational techniques.

The most effective way to treat ADHD The most effective way to treat ADHD is a combination of these options.is a combination of these options.

Medication TreatmentMedication TreatmentSome Psychostimulants Include:Some Psychostimulants Include:

Methylphenidate (Ritalin, Concerta) Methylphenidate (Ritalin, Concerta) Dextroamphetamine/amphetamine (Adderall) Dextroamphetamine/amphetamine (Adderall) Dextroamphetamine (Dexedrine) Dextroamphetamine (Dexedrine) Atomoxetine (Strattera) – a non-stimulant with Atomoxetine (Strattera) – a non-stimulant with

similar effective action is also used. similar effective action is also used.

Other Non-Stimulant Medications Include:Other Non-Stimulant Medications Include:

imipramine and bupropion (Brand name: imipramine and bupropion (Brand name: Wellbutrin) (both antidepressants) Wellbutrin) (both antidepressants)

clonidine, which may help children with ADHD clonidine, which may help children with ADHD who have aggressive antisocial behavior. who have aggressive antisocial behavior.

Behavioral Therapy Behavioral Therapy TreatmentTreatment

teachers and parents learn strategies teachers and parents learn strategies such as:such as:

• CBT- contingency management CBT- contingency management procedures to deal with children’s procedures to deal with children’s behavior. The strategy includes:behavior. The strategy includes:

• token reward systemtoken reward system• timeouts. timeouts.

Psychotherapy TreatmentPsychotherapy Treatment

Older children and adults suffering Older children and adults suffering from ADHD are allowed to talk and from ADHD are allowed to talk and discuss the issues that trouble them, discuss the issues that trouble them, explore negative behavioral patterns explore negative behavioral patterns and permitted to learn the ways to and permitted to learn the ways to deal with their symptoms. deal with their symptoms.

Educational TechniquesEducational Techniques Support Groups- These groups offer a net Support Groups- These groups offer a net

work of social support, information and work of social support, information and education to adults and children suffering education to adults and children suffering from ADHD and their parents, friends and from ADHD and their parents, friends and relatives.relatives.

Social Skills Training- This helps children to Social Skills Training- This helps children to learn appropriate social behavior.learn appropriate social behavior.

Parent Skills Training- This helps the parents Parent Skills Training- This helps the parents to develop ways to understand and guide to develop ways to understand and guide the child in his day-to-day life. Best results the child in his day-to-day life. Best results are be obtained with teachers, parents and are be obtained with teachers, parents and therapists or physicians working in teams. therapists or physicians working in teams.

Present ResearchPresent Research

Virtual Reality Study for Young males Virtual Reality Study for Young males ages 12–16 (Fitzgerald)ages 12–16 (Fitzgerald)

Genetics of ADHD (Kollins)Genetics of ADHD (Kollins)

Follow-up of the Multimodel Follow-up of the Multimodel Treatment Study of ADHD Children Treatment Study of ADHD Children (MTA) - (Murray/Wells)(MTA) - (Murray/Wells)

The MTA StudyThe MTA Study

ADHD ResearchersADHD Researchers

Russell Barkley, PhD,Russell Barkley, PhD, Rutter, M. & Smith, D. (1995) Rutter, M. & Smith, D. (1995) Kewely, G. (1998)Kewely, G. (1998) Hinshaw, S. (1994)Hinshaw, S. (1994) Hill, P., & Cameron, M. (1999)Hill, P., & Cameron, M. (1999) Farrington, D. (1990)Farrington, D. (1990) Cooper, P. (1997)Cooper, P. (1997) Angold, A., Costello, E., & Erkanli, A. (1999).Angold, A., Costello, E., & Erkanli, A. (1999).

Assessment InstrumentsAssessment Instruments The most important diagnostic tool is the clinical The most important diagnostic tool is the clinical

interview.interview.

A thorough medical examination is important to A thorough medical examination is important to identify other conditions that may be responsible for identify other conditions that may be responsible for symptoms that coexist with ADHD and require symptoms that coexist with ADHD and require treatment.treatment.

Various psychological tests are used to diagnose Various psychological tests are used to diagnose ADHD; ADHD; The Conners' Parent and Teacher Rating Scale The Conners' Parent and Teacher Rating Scale (for children) and the (for children) and the Brown Attention Deficit Disorder Brown Attention Deficit Disorder ScaleScale (BADDS) for teens and adults are useful tools for (BADDS) for teens and adults are useful tools for diagnosis of ADHD.diagnosis of ADHD.

Impulsivity and inattention are assessed with the Impulsivity and inattention are assessed with the Conners Continuous Performance Test Conners Continuous Performance Test (CPT), the (CPT), the Integrated Visual and AuditoryIntegrated Visual and Auditory (IVA) CPT, or both. The (IVA) CPT, or both. The Nadeau/Quinn/Littman ADHD Self-Rating Scale for Nadeau/Quinn/Littman ADHD Self-Rating Scale for Girls is a part of the assessment for all girls (3).Girls is a part of the assessment for all girls (3).

OutcomesOutcomes

Several studies have followed children with Several studies have followed children with ADHD/ADD into adulthood. Although these results ADHD/ADD into adulthood. Although these results vary from study to study, it appears that about 50% vary from study to study, it appears that about 50% continue to show evidence of the disorder in continue to show evidence of the disorder in adulthood, especially attention problems and adulthood, especially attention problems and impulsivity. Almost a third will have dropped out of impulsivity. Almost a third will have dropped out of high school, and only 5% complete a university high school, and only 5% complete a university degree compared to 40% of their peers. degree compared to 40% of their peers. Approximately 25% have developed chronic patterns Approximately 25% have developed chronic patterns of anti-social behavior. Clearly, for many children with of anti-social behavior. Clearly, for many children with ADHD/ADD, this disorder is a chronic condition that ADHD/ADD, this disorder is a chronic condition that can adversely affect their development over many, can adversely affect their development over many, many years. (National Institute of Mental Health) many years. (National Institute of Mental Health)

Evidence Based PracticeEvidence Based Practice

The National Institute for Mental Health concluded The National Institute for Mental Health concluded that “long-term combination treatments and the that “long-term combination treatments and the medication-management alone were superior to medication-management alone were superior to intensive behavioral treatment and routine intensive behavioral treatment and routine community treatment. And in some areas—anxiety, community treatment. And in some areas—anxiety, academic performance, oppositionality, parent-child academic performance, oppositionality, parent-child relations, and social skills—the combined treatment relations, and social skills—the combined treatment was usually superior. Another advantage of was usually superior. Another advantage of combined treatment was that children could be combined treatment was that children could be successfully treated with lower doses of medicine, successfully treated with lower doses of medicine, compared with the medication-only group”.  Most compared with the medication-only group”.  Most professionals agree that this intervention should be professionals agree that this intervention should be available to all parents of kids with ADHD. available to all parents of kids with ADHD.

Evidence Based Practice Evidence Based Practice Cont…Cont…

The NIMH found that the combined The NIMH found that the combined treatment (medication management treatment (medication management with behavior therapy), compared with behavior therapy), compared with medication alone, offered with medication alone, offered improved scores on academic improved scores on academic measures, measures of conduct, and measures, measures of conduct, and some specific ADHD symptoms some specific ADHD symptoms

Prior AuthorizationPrior Authorization

Criteria:Criteria: Dose not to exceed 1.5 times the FDA approved maximum.Dose not to exceed 1.5 times the FDA approved maximum. No concurrent use of multiple products from this category, No concurrent use of multiple products from this category,

ie, Strattera + Stimulant, Methylphenidate + Amphetamineie, Strattera + Stimulant, Methylphenidate + Amphetamine Prior authorization is required for all stimulants for adults Prior authorization is required for all stimulants for adults

age 21 and older.age 21 and older. Gaining prior authorization for prescription medication Gaining prior authorization for prescription medication

requires phones calls, faxes and request forms, which often requires phones calls, faxes and request forms, which often can be time-consuming. Fortunately for both providers and can be time-consuming. Fortunately for both providers and patients, help is on the way to streamline and accelerate patients, help is on the way to streamline and accelerate this process.this process.

Prior authorization requires physicians to show the medical Prior authorization requires physicians to show the medical necessity for a patient to receive a particular medication. necessity for a patient to receive a particular medication.

EBP & PA Websites / formsEBP & PA Websites / forms

Evidence Based Practice:Evidence Based Practice:http://www.cde.state.co.us/cdesped/download/pdf/FF-ADHD.pdfhttp://www.cde.state.co.us/cdesped/download/pdf/FF-ADHD.pdf

Prior Authorization Forms:Prior Authorization Forms:www.okhca.orgwww.okhca.org

https://www.navitus.com/Prior%20Authorization%20Forms/ADHDhttps://www.navitus.com/Prior%20Authorization%20Forms/ADHD%20Stimulants%20-%20Arizona.pdf%20Stimulants%20-%20Arizona.pdf

http://www.dhhs.state.nh.us/NR/rdonlyres/http://www.dhhs.state.nh.us/NR/rdonlyres/e2emyzsepqvzbgjakmvxdxtm5l6zsw2b6qfjzcuzujpyjffyew2f3cqsi7e2emyzsepqvzbgjakmvxdxtm5l6zsw2b6qfjzcuzujpyjffyew2f3cqsi77f2ywlhnx2i4pnrsyfo3voo3injrlhvnc/CNSADHD+5-1.pdf7f2ywlhnx2i4pnrsyfo3voo3injrlhvnc/CNSADHD+5-1.pdf

https://tnm.rxportal.sxc.com/rxclaim/TNM/TC%20PA%20Requesthttps://tnm.rxportal.sxc.com/rxclaim/TNM/TC%20PA%20Request%20Form%20(Provigil).pdf%20Form%20(Provigil).pdf

Organizations & WebsitesOrganizations & Websites

Children and Adults with Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)Attention-Deficit/Hyperactivity Disorder (CHADD) Phone: (800) 233-4050Phone: (800) 233-4050http://chadd.orghttp://chadd.org

Attention Deficit Disorder Association (ADDA)Attention Deficit Disorder Association (ADDA) Phone: (856) 439-9099Phone: (856) 439-9099http://www.add.org/http://www.add.org/

American Psychiatric AssociationAmerican Psychiatric Association Phone: (888) 357-7924Phone: (888) 357-7924http://www.psych.org/http://www.psych.org/

American Psychological AssociationAmerican Psychological Association Phone: (800) 374-2721Phone: (800) 374-2721http://www.apa.org/http://www.apa.org/

ResourcesResources U.S. Department of Education. (2003). U.S. Department of Education. (2003). Identifying and Identifying and Colorado Advisory NetworkColorado Advisory Network

implementing educational practices supported by implementing educational practices supported by (303) 721-0648(303) 721-0648rigorous evidence: A user friendly guide. rigorous evidence: A user friendly guide. Email: canindiv@aol.comEmail: canindiv@aol.comWashington, D.C.: Washington, D.C.: Web: www.localsonsors.com/denver/canWeb: www.localsonsors.com/denver/can

Promising Practices Network:Promising Practices Network:http://www.promisingpractices.net/ Center for Attention Deficithttp://www.promisingpractices.net/ Center for Attention Deficit5835 Lehman Drive5835 Lehman Drive

What Works Clearinghouse: http://www.w-w-c.org/ Colorado Springs, CO 80918What Works Clearinghouse: http://www.w-w-c.org/ Colorado Springs, CO 80918(719) 531-9211(719) 531-9211

Children and Adults with Attention Disorders (CHADD)Children and Adults with Attention Disorders (CHADD)499 N.W. 70 Ave. Suite 101 National Information Center for Children499 N.W. 70 Ave. Suite 101 National Information Center for ChildrenPlantation, FL 33317 and Youth with DisabilitiesPlantation, FL 33317 and Youth with Disabilities(800) 233-4050 Rocky MT. CHADD (303) 761-5024 P.O. Box 1492(800) 233-4050 Rocky MT. CHADD (303) 761-5024 P.O. Box 1492Web: Web: www.chadd.org www.chadd.org Washington, DC 20013Washington, DC 20013(800) 695-0285 (202) 884-8200(800) 695-0285 (202) 884-8200

Parent Education and Assistance for Kids (PEAK) Email: Parent Education and Assistance for Kids (PEAK) Email: mail@aed.orgmail@aed.org611 N. Weber, Suite 200 Web: www.nichcy.org611 N. Weber, Suite 200 Web: www.nichcy.orgColorado Springs, CO 80903Colorado Springs, CO 80903(800) 284-0251 (719) 531-9400 National Attention Deficit Disorder Assoc.(800) 284-0251 (719) 531-9400 National Attention Deficit Disorder Assoc.Web: Web: www.peakparent.org www.peakparent.org 1788 Second Street, Suite 200 Highland Park, IL 600351788 Second Street, Suite 200 Highland Park, IL 60035

Parent to Parent of Colorado 847-423-ADDAParent to Parent of Colorado 847-423-ADDA2200 S. Jasmine Street Email: mail@add.org2200 S. Jasmine Street Email: mail@add.orgDenver, CO 80222 Web: www.add.orgDenver, CO 80222 Web: www.add.org(877) 472-7201 (toll free) (719) 336-2389(877) 472-7201 (toll free) (719) 336-2389

Resources Continued…Resources Continued…Books:Books:

Brown, T.E. (Ed.) (2000). Brown, T.E. (Ed.) (2000). Attention-Deficit Attention-Deficit Disorders and Comorbidities in Children, Disorders and Comorbidities in Children, Adolescents, and Adults. Adolescents, and Adults. Washington, DC: Washington, DC: American Psychiatric Press.American Psychiatric Press.

Goldstein, S., & Teeter Ellison, A. (Eds.) (2002). Goldstein, S., & Teeter Ellison, A. (Eds.) (2002). Clinician's guide to adult AD/HD: Assessment Clinician's guide to adult AD/HD: Assessment and intervention.and intervention. New York: Academic Press. New York: Academic Press.

Murphy, K.R., & Gordon, M. (1998). Murphy, K.R., & Gordon, M. (1998). Assessment of Assessment of adults with AD/HDadults with AD/HD. In Barkley, R. (Ed.) Attention-. In Barkley, R. (Ed.) Attention-Deficit Hyperactivity Disorder: A handbook for Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment. (pp. 345-369). New York: diagnosis and treatment. (pp. 345-369). New York: Guilford Press. Guilford Press.

Discussing Diagnosis with Discussing Diagnosis with FamilyFamily

Medications, including side effects of treatment Medications, including side effects of treatment and side effects of no treatment along with dosageand side effects of no treatment along with dosage

Other interesting facts: Other interesting facts: 60-80% of children with ADHD continue to have 60-80% of children with ADHD continue to have

symptoms in adolescence symptoms in adolescence 4-12% of school age children are thought to have 4-12% of school age children are thought to have

ADHD ADHD Stimulants can cause unpredictable effects on Stimulants can cause unpredictable effects on

motor tics, which transiently occur in 15-30% of motor tics, which transiently occur in 15-30% of children taking stimulants, but the 'presence of tics children taking stimulants, but the 'presence of tics before or during medical management of ADHD is before or during medical management of ADHD is not an absolute contradindication to the use of not an absolute contradindication to the use of stimulant medications.'stimulant medications.'

Other Information to discuss Other Information to discuss with Parents:with Parents:

Stimulants include different formulations of Stimulants include different formulations of methylphenidate: methylphenidate:

short acting, such as Ritalin and Focalin, with a duration of short acting, such as Ritalin and Focalin, with a duration of 3-5 hours 3-5 hours

intermediate acting, such as Ritalin SR, Metadate ER, and intermediate acting, such as Ritalin SR, Metadate ER, and Methylin ER, with a duration of 3-8 hours Methylin ER, with a duration of 3-8 hours

long acting, such as Concerta, Rilatin LA and Metadate CD, long acting, such as Concerta, Rilatin LA and Metadate CD, with a duration of 8-12 hours and which can be used just with a duration of 8-12 hours and which can be used just once a dayonce a day

The other type of stimulant includes different formulations The other type of stimulant includes different formulations of amphetamine: of amphetamine:

short acting, such as Dexedrine and Dextrostat, with a short acting, such as Dexedrine and Dextrostat, with a duration of 4-6 hours intermediate acting, such as Adderall duration of 4-6 hours intermediate acting, such as Adderall and Dexedrine spansule, with a duration of 6-8 hours and Dexedrine spansule, with a duration of 6-8 hours

long acting, such as Adderall-XRlong acting, such as Adderall-XR

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methylphenidate for adhd. methylphenidate for adhd. London: NICE Press. London: NICE Press. Palmer, E., & Finger, S. (2001). An early description of ADHD: Dr. Alexander Crichton and Palmer, E., & Finger, S. (2001). An early description of ADHD: Dr. Alexander Crichton and

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