Selecting a Treatment Regimen
>>
ADHD Treatme
Clinician/parents/teachers (as appropriate):
>> Identify targeted behavior symptom(s)
>> Collect any previous treatment data:
`` Targeted behavior, patient response, follow-up/monitoring
`` Medication (eg, dosage, duration, side effects/adverse events)
`` Duration and acceptability of treatment
>> Develop treatment plan that:
`` Recognizes ADHD as a chronic disorder
`` Defines targeted behavior
`` Advocates therapeutic alliance of clinician/patient/parents/teachers and linkage
���with community supports
`` Includes parental and patient psychoeducation about ADHD
`` Includes psychopharmacological and/or behavior therapy options
`` Provides systematic monitoring/review/follow-up
Psychoeducation
Perform in context of medication management:
>> Educating parents and patient about ADHD
`` Helping parents anticipate developmental challenges difficult for ADHD patients
>> Providing advice to parents and patient to help improve patient���s academic and
behavioral functioning
Psychopharmacological Treatment
>> Each patient���s treatment must be individualized
>> Initiate trial with medication approved by FDA for ADHD (Table 3):
`` Amphetamines
`` Methylphenidate
`` Atomoxetine
>> Selection of agent is sole choice of family and clinician, but may be influenced by
nature of patient���s comorbid disorder(s)
>> After selection of starting dose, titrate upward every 1���3 weeks until whichever
occurs first:
`` Maximum dose reached
`` Symptoms of ADHD remit
`` Side effects become unacceptable
>> Obtain parent and teacher rating scales after patient observed on selected dose for at
least 1 week
Schedule office visit after first month of treatment plan to:
>> Review overall progress
>> Determine if trial stimulant was successful; if not, repeat trials with other stimulants
>> Decide if long-term maintenance with stimulant should begin
CD, compulsive disorder; FDA, US Food and Drug Administration; ODD, oppositional defiant disorder
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