Selecting a Treatment Regimen
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ADHD Treatment Algorithm
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 A DHD 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 aer 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
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 A DHD 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 A DHD
` Includes psychopharmacological and/or behavior therapy options
` Provides systematic monitoring/review/follow-up
