Pediatric Attention Deficit Hyperactivity Disorder Differential Diagnoses
- Author: Zainab P Contractor, MD; Chief Editor: Caroly Pataki, MD more...
Differential Diagnoses
- Anxiety Disorder: Generalized Anxiety
- Anxiety Disorder: Obsessive-Compulsive Disorder
- Anxiety Disorder: Separation Anxiety and School Refusal
- Conduct Disorder
- Eating Disorder: Anorexia
- Eating Disorder: Bulimia
- Learning Disorder: Mathematics
- Learning Disorder: Reading
- Learning Disorder: Written Expression
- Mood Disorder: Bipolar Disorder
- Mood Disorder: Depression
- Oppositional Defiant Disorder
- Pervasive Developmental Disorder
- Pervasive Developmental Disorder: Asperger Syndrome
- Sleep Disorder: Night Terrors
- Sleep Disorder: Nightmares
- Sleep Disorder: Problems Associated With Other Disorders
APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association Press; 1994:78-85.
Spinelli S, Joel S, Nelson TE, Vasa RA, Pekar JJ, Mostofsky SH. Different neural patterns are associated with trials preceding inhibitory errors in children with and without attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. Jul 2011;50(7):705-715.e3. [Medline].
Ducharme S, Hudziak JJ, Botteron KN, Albaugh MD, Nguyen TV, Karama S, et al. Decreased regional cortical thickness and thinning rate are associated with inattention symptoms in healthy children. J Am Acad Child Adolesc Psychiatry. Jan 2012;51(1):18-27.e2. [Medline].
Brown TE. Brown ADD Scales. San Antonio, TX: Psychological Corp; 1996:5-6.
Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. Jan 2012;51(1):86-97.e8. [Medline].
[Best Evidence] Blader JC, Schooler NR, Jensen PS, Pliszka SR, Kafantaris V. Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy. Am J Psychiatry. Dec 2009;166(12):1392-401. [Medline].
Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA. Dec 28 2011;306(24):2673-83. [Medline].
Wilens TE, Bukstein O, Brams M, Cutler AJ, Childress A, Rugino T, et al. A controlled trial of extended-release guanfacine and psychostimulants for attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. Jan 2012;51(1):74-85.e2. [Medline].
Elia J, Ambrosini PJ, Rapoport JL. Treatment of attention-deficit-hyperactivity disorder. N Engl J Med. Mar 11 1999;340(10):780-8. [Medline].
Hunt RD, Paguin A, Payton K. An update on assessment and treatment of complex attention-deficit hyperactivity disorder. Pediatr Ann. Mar 2001;30(3):162-72. [Medline].
Johnson TM. Evaluating the hyperactive child in your office: is it ADHD?. Am Fam Physician. Jul 1997;56(1):155-60, 168-70. [Medline].
Millichap JG. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. Feb 2008;121(2):e358-65. [Medline].
Nadeau KG, Littman E, Quinn P. Understanding Girls With AD/HD. Springfield, MD: Advantage Books; 2000.
Ramchandani P, Joughin C, Zwi M. Attention deficit hyperactivity disorder in children. Clin Evid. Jun 2002;262-71. [Medline].
Rappley MD. Clinical practice. Attention deficit-hyperactivity disorder. N Engl J Med. Jan 13 2005;352(2):165-73. [Medline].
Reeves G, Schweitzer J. Pharmacological management of attention-deficit hyperactivity disorder. Expert Opin Pharmacother. Jun 2004;5(6):1313-20. [Medline].
Spencer TJ, Biederman J, Wilen T. Pharmacotherapy of ADHD with antidepressants. In: Barkley RS, ed. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. New York, NY: Guilford Press; 1998:552-63.
Wolraich ML, ed. The Classification of Child and Adolescent Mental Diagnoses in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child. Elk Grove, IL: American Academy of Pediatrics; 1996.
Wilens TE. Straight Talk about Psychiatric Medications for Kids. New York, NY: Guilford Press; 2002.
| Medication | Initial Pediatric Dose | Pediatric Dosage Range and Maximum Dose* | Common Pediatric Dose* | Preparations |
| Methylphenidate immediate release (IR) (Ritalin, Methylin, generic) | 2.5-5 mg | 0.1-0.8 mg/kg/dose PO qd to 5 times/d; not to exceed 60 mg/d | 0.3-0.5 mg/kg/dose PO tid/qid | All preparations available as 5-mg, 10-mg, or 20-mg scored tabs; Methylin also available as 2.5-mg, 5-mg, or 10-mg chewable tab and PO solution (5 mg/5 mL and 10 mg/mL) |
| Methylphenidate sustained-release (SR) (Ritalin LA, Metadate CD) | Convert from IR or use 10 mg. | 0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d | 0.6-1 mg/kg/dose PO qd/bid | 10-mg, 20-mg, 30-mg, or 40-mg tabs (Metadate also has 50-mg and 60-mg tabs.); can be sprinkled into soft food (Do not cut, crush, or chew.) |
| Methylphenidate extended release (ER)‡ (Ritalin SR, Methylin ER, Metadate ER, generic SR) | Convert from IR. | 0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d | 0.6-1 mg/kg/dose PO qd/bid | 20-mg Spansules (Do not cut, crush, or chew.) |
| Methylphenidate OROS tablets (Concerta) | Convert from IR or use 18 mg. | 0.3-2 mg/kg PO qd; not to exceed 54 mg/d | 0.8-1.6 mg/kg PO qd | 18-mg, 27-mg, 36-mg, and 54-mg tabs (Do not cut, crush, or chew.) |
| Methylphenidate transdermal patch (Daytrana)† | Convert from IR or use 10 mg (12.5 cm2 patch) released over 9 h and titrate up prn. | 0.3-2 mg/kg released over 9 h; not to exceed one 30-mg patch | 10-30 mg released over 9 h | 10-mg, 15-mg, 20-mg, 30-mg patches, applied to the hip |
| Dexmethylphenidate IR (Focalin) | 2.5-5-mg | 0.1-0.5 mg/kg/dose PO qd to qid; not to exceed 20 mg/d | 0.2-0.3 mg/kg/dose PO bid/tid | 2.5-mg, 5-mg, or 10-mg scored tabs (Do not cut, crush, or chew.) |
| Dexmethylphenidate extended release (Focalin-XR) | 5-10-mg | 0.2-1 mg/kg/dose PO qd to bid; not to exceed 20 mg/d | 0.4-0.6 mg/kg/dose PO qd/bid | 5-mg, 10-mg, or 20-mg scored tabs; can be sprinkled into soft food (Do not cut, crush, or chew.) |
| Dextroamphetamine (Dexedrine, Dextrostat) | 2.5-5 mg | 0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 60 mg/d | 0.3-0.5 mg/kg/dose PO qd/tid | Dexedrine: 5-mg scored tabs; Dextrostat: 5-mg and 10-mg scored tabs |
| Dextroamphetamine Spansules (Dexedrine CR) | 5 mg | 0.1-0.75 mg/kg/dose PO qd/bid; not to exceed 60 mg/d | 0.3-0.6 mg/kg/dose PO qd/bid | 5-mg, 10-mg, or 15-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.) |
| Mixed amphetamine salts IR (Adderall, generic) | 2.5-5 mg | 0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 40 mg/d | 0.3-0.5 mg/kg/dose PO tid/qid | 5-mg, 7.5-mg, 10-mg, 12.5-mg, 15-mg, 20-mg, or 30-mg scored tabs |
| Mixed amphetamine salt XR (Adderall-XR) | Convert from IR or use 5-10 mg | 0.2-1.4 mg/kg/dose PO qd/tid Not to exceed 30 mg/d | 0.6-1 mg/kg/dose PO qd/bid | 5-mg, 10-mg, 15-mg, 20-mg, 25-mg, or 30-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.) |
| Lisdexamfetamine (Vyvanse) | 30 mg PO qam | 30-70 mg PO qam | Data limited (too early to tell) | 20-mg, 30-mg, 40-mg, 50-mg, 60-mg, or 70-mg caps (Swallow cap whole, sprinkle into soft food, or dissolve contents in glass of water and drink immediately.) |
| Note. In general, when the terms methylphenidate, Dexedrine, and Ritalin are used without abbreviations for extended-release preparations (eg, continuous release [CR], SR, osmotic-release oral system [OROS]), a short-acting, IR preparation is implied. * Maximum pediatric dose suggested by the US Food and Drug Administration (FDA). Although some children benefit greatly from doses greater than these, benefit from use of either the lowest and highest ends of the dose range is uncommon. †The methylphenidate patch contains a different total methylphenidate dose than the name implies because it is designed to last 12 hours (eg, 10-mg patch [patch size 12.5 cm2] delivers about 10 mg over 9 h [estimated delivery rate is 1.1 mg/h for this particular patch]). Delivery rate varies depending on patch size. ‡Many patients describe their experience with methylphenidate SR preparations as erratic and uncomfortable. | ||||
Print
