Key Points
����ADHD is a clinical diagnosis requiring evaluation of behavior across
multiple settings (eg, family, academic, social). There is no laboratory
���test��� for ADHD.
����ADHD is a chronic condition that may persist into adulthood, extends across
developmental phases, and presents different challenges during each phase.
����Clinician interviews and rating scales of parents/caregiver/teachers are the
core of ADHD assessment process.
����Therapeutic alliance with patient/parents/caregiver/teachers is crucial to
treatment planning/implementation.
����Important role of educational system in patient treatment/monitoring
distinguishes ADHD from many other chronic conditions.
����Key to effective long-term management of patient with ADHD is continuity of
care with a clinician experienced in treatment of ADHD.
����Treatment plans should:
>> Be individualized
>> Consider patient strengths and target symptoms identified in assessment process
>> Include psychoeducation of parents and patient about ADHD
>> Provide periodic, systematized follow-up focused on targeted outcomes and adverse
effects based on input from parents, teachers, and patient
>> Anticipate long-term therapeutic planning and monitoring
����Treatment goals should be realistic, attainable, and measurable:
>> Improved relationships with parents, siblings, teachers, peers
>> Decreased disruptive/setting-inappropriate behaviors
>> Improved academic performance
>> Increased independence by self-monitoring and completion of assigned activities
>> Improved self-esteem
����Decision to treat with medication should be based on persistent target
symptoms sufficiently severe to cause functional impairment in home,
school, work, or peer-related activities, on continuing efficacy of
medication, and on family/parent preference.
����Patients treated pharmacologically should have their height and weight
monitored throughout treatment.
����Limitations in pharmacologic and behavioral treatments arise from lack
of maintenance if treatment discontinued and/or failure in settings where
treatment has not been well applied.
����Medication should be reinstituted when target symptoms re-emerge if
medication is discontinued and when ratio of therapeutic benefit to side
effects is acceptable.
����Psychosocial treatments may be useful for ADHD with comorbid disorders
or other problems responsive to such nonmedication treatments.
