On April 6, 2006, the FDA announced the approval of Daytrana, a transdermal patch version of Ritalin (methylphenidate). While you wouldn’t know it by the gushy promotional copy on Daytrana’s website (www.daytrana.com), the Ritalin patch just barely squeaked through the FDA approval process.

Rarely has a 7-year old with a rash caused the stock price of a major corporation to gyrate so dramatically.

Mr. H., now 49, was first diagnosed with ADHD at the age of 40, when he was evaluated at the suggestion of an old friend, a psychologist who had known him in grade school.

Dr. Diller, as a behavioral pediatrician you certainly prescribe stimulants and other psychiatric medications to children, but at the same time you have spent much of your career speaking and writing about some the potential negative consequences of the excessive use of stimulants. You’ve also studied the history of stimulant use, and have thought about how this can inform our decisions now.

Dopamine is the new serotonin: everyone is talking about it. Depending on what authority you read, dopamine is central to schizophrenia, ADHD, depression, sexuality, and cognition.

There are now no fewer than 14 FDA-approved psychostimulants… and counting. This does not include the many generics, the new non-stimulant Straterra or the off-label ADHD meds Wellbutrin (bupropion) and desipramine.

The Eli Lilly reps are almost delirious about their new ADHD “miracle drug”, Straterra (atomoxetine). This is not surprising.

They have been flooding into your office: grown-ups who believe that they have ADHD.

Dr. Prince, you have done innumerable evaluations of children and adults with ADHD. These days, psychiatrists in the community are besieged by patients wanting treatment for ADHD, and the pressure is on to come up with a diagnosis and treatment during a single 45 minute session. Is this possible?

David Sorenson, M.D., is medical director of the Anna Jaques Hospital Child Psychiatry Inpatient Unit in Amesbury, Massachusetts. His experiences with patients misusing ADHD medications should give us pause.