A 7-year-old boy is brought by his parents because his teacher reports he is disruptive in class, cannot sit still, frequently calls out answers before questions are completed, and is constantly losing his school supplies. At home he cannot complete tasks, is easily distracted, and his parents say 'his engine is always running.' His IQ testing is in the average range. Symptoms have been present since age 4 and occur in both school and home settings. What is the most appropriate first-line pharmacological treatment?
- A Risperidone
- B Methylphenidate ✓
- C Valproate
- D Fluoxetine
Explanation
ADHD (combined presentation) requires at least 6 symptoms each of inattention and hyperactivity-impulsivity for at least 6 months in two or more settings, with onset before age 12. Stimulants — methylphenidate (a dopamine and norepinephrine reuptake inhibitor) and amphetamines — are first-line pharmacotherapy with the strongest evidence base, improving symptoms in approximately 70–80% of children. Atomoxetine (a selective norepinephrine reuptake inhibitor) is a non-stimulant alternative. Behavioral therapy should accompany pharmacotherapy, particularly in younger children.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.