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ADHD Treatment 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
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
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
