Diagnosing Complex Pediatric Attention-Deficit/Hyperactivity Disorder

In this podcast, Psych Congress Steering Committee member Vladimir Maletic, MD, MS, Clinical Professor of Psychiatry, University of South Carolina School of Medicine, Greenville, discusses the concept of complex attention-deficit/hyperactivity disorder (ADHD), how it is defined, and how clinicians should respond to it.

Dr Maletic presented "Trees or the Forest? Advances in Neurobiological Understanding of ADHD and Novel Treatments," at the 2021 Psych Congress Regionals meeting series.

Read the transcript:

Complex ADHD has emerged in treatment guidelines that have been composed by the Society for Developmental & Behavioral Pediatrics. They make several pertinent points. One of them is that ADHD is not a very simple diagnosis.

If the individual does not have sufficient expertise and experience in evaluating children and adolescents with ADHD, it may be a good idea to engage somebody who does have that kind of clinical background.

So, what are some defining features of complex ADHD?

• If a clinician either identifies or suspects presence of coexisting disorders, it would meet one of the criteria for complex ADHD, so either suspected or identified presence of a comorbid condition.

• It is associated with moderate to severe functional impairment, so greater degree of impairment.

• Inadequate response to treatment, that standard treatments have been tried and don't work very well.

• Lastly, atypical onset. It is ADHD that has onset before age 4 or after age 12.

In all these circumstances, again, unless clinician feels comfortable and has sufficient expertise to address these comorbidities and complexities, it may be a good idea to refer the patient to a specialist.

Vladimir Maletic, MD, MS, is a clinical professor of psychiatry and behavioral science at the University of South Carolina School of Medicine in Greenville, and a consulting associate in the Division of Child and Adolescent Psychiatry, Department of Psychiatry, at Duke University in Durham, North Carolina. Dr. Maletic received his medical degree in 1981 and his master’s degree in neurobiology in 1985, both from the University of Belgrade in Yugoslavia. He went on to complete a residency in psychiatry at the Medical College of Wisconsin in Milwaukee, followed by a residency in child and adolescent psychiatry at Duke University.