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