Selecting a Treatment Regimen > 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
ADHD Treatme
> Develop treatment plan that: ` Recognizes ADHD 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 ADHD ` Includes psychopharmacological and/or behavior therapy options ` Provides systematic monitoring/review/follow-up
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 ADHD 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 aſter 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 6
