ent Algorithm
Psychosocial (behavior) Therapy
>> Consider as an initial treatment if:
`` Patient���s ADHD symptoms are mild with minimal impairment
`` Uncertainty of ADHD diagnosis
`` Marked disagreement about ADHD diagnosis between parents or parents
and teachers
`` Preference of family
`` Use when presence of comorbid disorder or problem responsive to psychological
treatment (eg, CD, ODD, anxiety, depression, substance use disorder)
>> Address family dysfunction (eg, parental depression, substance abuse, marital
problems)
>> Treat any ADHD-affected parent
Monitoring Side Effects
>> More common: decreased appetite, weight loss, insomnia, headache
>> Less common: tics, emotional lability/irritability
>> Adversity of side effect vs. efficacy of medication
`` Reduce medication (may affect efficacy)
`` Trial of different stimulant/medication class
`` Adjunctive medication for side effect
`` Trial of nonstimulant medication
>> If aggressiveness or emotional lability increases or psychotic symptoms appear, select
different medication.
If patient fails to respond to trials of stimulants, review diagnosis of ADHD:
>> Accuracy of patient���s history
>> Presence of undetected comorbid conditions (eg, affective, anxiety, subtle
developmental disorders) as primary problems impairing attention and impulse
control
>> Consider conjoint trial of psychosocial (behavior) therapy before trial of other
medication
>> Consider referral to child and adolescent psychiatrist
Results
>> Psychopharmacological treatment alone is satisfactory if:
`` Robust response to medication
`` Normative functioning in academic, family, and social domains
>> Psychosocial (behavior) therapy in conjunction with psychopharmacological treatment if:
`` Less than optimal response to medication
`` Presence of comorbid disorder
`` Dysfunction/stressors in family life
>> Periodic assessment and follow-up of patient to determine if:
`` Medication effective
`` Dosage optimal
`` Side effects present and clinically significant
`` Appropriate growth and weight across major percentiles
>> Treatment should continue as long as symptoms remain present and cause impairment
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