You may have noticed that a confusing array of new stimulants has been approved in the last few years. Since 2012, there have been five new amphetamines and two new methylphenidates. What are these preparations? Are any of them worth prescribing to your patients?

In this issue we tackle a range of challenges, including differentiating ADHD from bipolar disorder, understanding suicide risk in college students, managing assertions about the safety of weed, and assessing and treating violent behavior in our patients.

Early into the evaluation of a 10-year-old boy, you note the following symptoms: inattention, hyperactivity, impulsivity, sleep problems, racing thoughts, and moodiness. The boy’s parents came to your office convinced that their son has ADHD, but thinking through the case, you recognize that the same symptoms could signal bipolar disorder (BD).

There is still confusion about ADHD, especially the name itself. People with ADHD can pay attention well when they’re interested in what they’re doing. Not knowing this, it’s easy to see why so many people still don’t believe the condition is real.

Prescribing bedtime stimulants sounds like a recipe for a bad night’s sleep. But the FDA recently approved Jornay PM, which is an extended release (ER) formulation of methylphenidate that is, in fact, dosed at night.

In 2015, the FDA approved Dyanavel XR (amphetamine extended release oral suspension), which was the first long-acting liquid version of amphetamine on the market. To provide some context, Quillivant XR, a long-action liquid methylphenidate formulation, was approved in 2012 and appears to be fairly popular for kids who can’t or won’t swallow pills. Seeing a market opportunity, Tris Pharmaceuticals developed Dyanavel XR and funded a placebo-controlled trial that was successful enough to gain FDA approval. Recently, this study was published, and some readers might be curious to look at the quality of the data.

Medications are the first-line treatment for adult ADHD, and the efficacy of psychosocial therapies is less well-defined. Mindfulness-based therapy showed promise for adult ADHD in a recent meta-analysis, but there were flaws and significant differences between the included studies.

You are evaluating a 16-year-old boy referred for mandated substance use treatment by his high school, where he was found drinking alcohol and smoking cannabis with a friend in the restroom.

When parents bring in their kids for concentration, attention, and learning issues, it’s common to assume a provisional diagnosis of ADHD. In many children, however, anxiety can be the real cause of these problems.

Some studies have indicated that patients with ADHD may be at an increased risk of suicide. While these studies have shown associations between methylphenidate use and suicide, it is not clear whether the stimulant actually causes suicidality or whether patients taking stimulants are suicidal for other reasons.