Attention deficit/hyperactivity disorder: complexities and controversies.

PURPOSE OF REVIEW: Attention deficit/hyperactivity disorder continues to be a prevalent childhood behavioral disorder, with significant clinical and media interest. Providers must be current with research findings that impact the evolving understanding of this complex entity. This article summarizes recent progress in our view of attention deficit/hyperactivity disorder, with emphasis on controversies around diagnosis and treatment, and future management directions. RECENT FINDINGS: Literature about attention deficit/hyperactivity disorder in 2005 further enhanced our understanding of the genetic contribution to the expression of attention deficit/hyperactivity disorder, with exploration of sophisticated genetic models and their dynamic interaction with exposures and experiences. Previous literature focuses on conventional treatment; new developments in pharmacological/alternative options add to treatment choices, but have brought well publicized controversies. Furthermore, optimal management continues to gain evidence-based support. SUMMARY: Attention deficit/hyperactivity disorder is a subject of great interest to families, providers, researchers, and public forums. Scientific investigation supports a primary genetic contribution, but the relationship of molecular bases and environmental exposures appears intricate and complex. With increased awareness of this disorder, diagnostic dilemmas and medication side effects are more widely understood, topics particularly important to clinicians. Stimulant treatment remains the mainstay of intervention, but new delivery forms and nonstimulant options are potential therapies as well.

Predicting length of stay on an acute care medical psychiatric inpatient service.

The goal of this study was to identify variables associated with length of stay (LOS) and to incorporate into the authors' routine preadmission assessment the measurement of these variables. A retrospective study of 80 discharged patients explored the association of 25 variables reflecting a mixture of patient/demographic variables, illness variables, and treatment variables with LOS. Multivariate analysis revealed that 10 variables independently accounted for 62% of the variance in LOS. The information used was obtained primarily in the preadmission screening. The predictive power of the variables shrank in the prospective study. However, fewer individual variables were significantly associated with LOS; the summed score of the variables predicted 17% of the LOS variance. Results indicated that factors important for estimating LOS are available at the time of admission, and these variables can be systematically assessed and incorporated into clinical decision making.