From the Guidelines
Assessment Protocol for ADHD in Physical Medicine and Rehabilitation
The physical medicine and rehabilitation assessment protocol for a child with Attention Deficit Hyperactivity Disorder (ADHD) should include a comprehensive evaluation of the child's medical history, current symptoms, and treatment regimen 1.
Key Components of the Assessment
- The assessment should document the child's current medication, such as methylphenidate (Ritalin) or atomoxetine (Strattera), as well as any previous medications and their durations 1.
- Objective measures such as the Conners' Rating Scales and the Vanderbilt Assessment Scale should be used to assess the child's ADHD symptoms and functional abilities 1.
- The assessment should also include a process to screen for comorbid conditions, including emotional or behavioral conditions, developmental conditions, and physical conditions 1.
Treatment Recommendations
- For preschool-aged children (4-5 years), evidence-based parent- and/or teacher-administered behavior therapy should be prescribed as the first line of treatment, with methylphenidate considered if behavioral interventions do not provide significant improvement 1.
- For elementary school-aged children (6-11 years), US Food and Drug Administration-approved medications for ADHD and/or evidence-based behavior therapy should be prescribed, preferably both 1.
- For adolescents (12-18 years), FDA-approved medications for ADHD should be prescribed with the assent of the adolescent, and behavior therapy may be prescribed as treatment for ADHD 1.
Management of ADHD
- ADHD should be recognized as a chronic condition, and children and adolescents with ADHD should be managed as children and youth with special health care needs, following the principles of the chronic care model and the medical home 1.
From the FDA Drug Label
In 2 identical, 9-week, acute, randomized, double-blind, placebo-controlled studies of children aged 7 to 13 (Study 3, N=147; Study 4, N=144), atomoxetine hydrochloride and methylphenidate were compared with placebo Examination of population subsets based on gender and age (<12 and 12 to 17) did not reveal any differential responsiveness on the basis of these subgroupings Maintenance Study - The effectiveness of atomoxetine hydrochloride in the maintenance treatment of ADHD was established in an outpatient study of children and adolescents (ages 6 to 15 years)
The assessment protocol for a child with Attention Deficit Hyperactivity Disorder (ADHD) in physical medicine and rehabilitation is not explicitly stated in the provided drug label. The label discusses the treatment of ADHD with atomoxetine hydrochloride, but it does not provide information on the assessment protocol in physical medicine and rehabilitation. 2
From the Research
Assessment Protocol for ADHD in Physical Medicine and Rehabilitation
The assessment protocol for a child with Attention Deficit Hyperactivity Disorder (ADHD) in physical medicine and rehabilitation involves a comprehensive evaluation of multiple domains, informants, methods, and settings 3. The following components are essential in the assessment process:
- Clinical interview of the child and family
- Comprehensive medical history and examination
- Psychoeducational tests
- School-related evaluation
- Assessment of social and emotional functioning
- Use of rating scales, tests, and measures to aid in the systematic standardized assessment of deficits associated with ADHD
Key Considerations in Assessment
The assessment protocol should consider the following:
- Evaluation of various organic conditions, functional disorders, developmental status, situational, environmental, and family problems 3
- Identification of coexisting conditions, such as anxiety, learning, mood, or sleep disorders 4
- Assessment of functional impairment across multiple settings (home, school, peers, community) 5
- Use of validated assessment tools with observers from several settings (home, school, community) and self-observation, if possible 4
School-Based Assessment
School-based assessment is crucial in evaluating ADHD, as it provides information relevant to the assessment and treatment of ADHD across a variety of tasks, settings, and observers 6. The following school-based assessment procedures are recommended:
- Teacher rating measures
- Direct observations in classrooms and on playgrounds
- Peer rating and sociometric measures
- Permanent product measures, such as academic performance
- Concurrent use of multiple measures to assess adequately the wide variety of symptoms associated with ADHD 6
Comprehensive Assessment
A comprehensive assessment involving various domains of functioning (academic, social, emotional, physical, and familial) provides not only a more accurate diagnosis but also directions as to what difficulties exist and what multifaceted treatment plan is needed to produce current improvement and long-term positive outcome 3.