Risks and benefits of drugs used in the management of the hyperactive child.

Childhood hyperactivity is a common behavioural complaint. The therapeutic options for physicians caring for children with hyperactivity are considerable and varied; current recommendations call for a multidisciplinary approach, including when necessary the use of drug therapy. Central nervous system stimulants are the primary agents used in the therapy of hyperactivity. The majority of children with hyperactivity diagnosed using careful clinical criteria will demonstrate short term benefits in cognitive and behavioural terms, but long term efficacy remains controversial. There appears to be a subset of patients who do not demonstrate a beneficial response to stimulants, although there is controversy as to whether this may be dose dependent. The adverse effects of most concern are suppression of growth, the development of tics and the potential for abuse. Antidepressants and clonidine are useful agents for the therapy of patients resistant to stimulant therapy. Although the most frequent adverse events of antidepressant therapy are associated with the anticholinergic activity of these agents, the most common serious adverse events are associated with antidepressant overdose. Concern has been expressed because of case reports describing an association between antidepressant therapy for hyperactivity and sudden death. A number of other therapies have been used for hyperactivity. Although these therapies may be effective in subsets of patients with hyperactivity, there is little research detailing how to identify patients who might be expected to respond to such treatment.