Mary is a healthy 12-year old girl who recently started 1st year of secondary school. Her teacher reports that she often daydreams in class. Parents also report that completing her homework is a daily struggle and she does not do well in school examinations. 

She was referred to the paediatric neurology service for assessment, her EEG ("electroencephalography") was normal and no other abnormality was found physically. Mary was then referred to paediatric services for further assessment. She was subsequently diagnosed with attention-deficit/hyperactivity disorder (“ADHD”). 

(a) Why was she given EEG at the neurology clinic? (2 marks) 

(b) Mary does not have any symptoms of hyperactivity. What other examples of attention deficit symptoms are frequently experienced by children with ADHD? (2 marks) 

Parents are not keen for Mary to start stimulants and prefer non-stimulant treatment. 

(c) What is the first-line stimulant treatment in Hong Kong and what are the pharmacological actions of stimulants? (3 marks) 

(d) What pharmacological treatment would you recommend? Explain the pharmacology, pharmacokinetic profile, efficacy and safety profile as requested by her parents so that they can discuss this further with the paediatric team. (13 marks)