Key Points
Î ADHD is a clinical diagnosis requiring evaluation of behavior across
multiple settings (eg, family, academic, social). There is no laboratory
"test" for ADHD.
Î ADHD is a chronic condition that may persist into adulthood, extends across
developmental phases, and presents different challenges during each phase.
Î Clinician interviews and rating scales of parents/caregiver/teachers are the
core of ADHD assessment process.
Î Therapeutic alliance with patient/parents/caregiver/teachers is crucial to
treatment planning/implementation.
Î Important role of educational system in patient treatment/monitoring
distinguishes ADHD from many other chronic conditions.
Î Key to effective long-term management of patient with ADHD is continuity of
care with a clinician experienced in treatment of ADHD.
Î 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
Î 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
Î 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.
Î Patients treated pharmacologically should have their height and weight
monitored throughout treatment.
Î 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.
Î Medication should be reinstituted when target symptoms re-emerge if
medication is discontinued and when ratio of therapeutic benefit to side
effects is acceptable.
Î Psychosocial treatments may be useful for ADHD with comorbid disorders
or other problems responsive to such nonmedication treatments.