Assessment Questions for Concerta 18 mg Follow-Up
At today's follow-up, you should systematically assess ADHD symptom control, medication adherence, side effects, growth parameters, and signs of misuse or diversion 1.
Core ADHD Symptom Assessment
Ask specific questions about target symptoms in multiple settings:
- School/work performance: "How is your attention during class/work? Can you complete assignments? Are you staying on task?" 1
- Home functioning: "How are things going with homework? Following instructions? Completing chores?" 1
- Social relationships: "How are interactions with peers? Any improvements in friendships or conflicts?" 1
Obtain collateral information from teachers using standardized rating scales (e.g., ADHD rating scales, validated and age/sex-normed) 1. Parent ratings should also be collected systematically 1.
For adolescents and adults, obtain self-ratings in addition to parent/teacher reports 1.
Medication Adherence and Administration
- "Are you taking the medication every morning? Any missed doses?"
- "Are you swallowing the pill whole, or crushing/chewing it?" (Concerta must be swallowed whole) 2
- "What time do you take it each day?"
- "Do you take it with or without food?" (either is acceptable) 2
Side Effect Monitoring
Systematically ask about known side effects by name 1:
Common Side Effects
- Appetite: "How is your appetite? Are you eating breakfast, lunch, and dinner?" 1
- Sleep: "Any trouble falling asleep? What time do you fall asleep?" Distinguish medication effect from oppositional behavior or anxiety 1
- Headaches: "Any headaches since starting medication?" 1
- Stomach problems: "Any stomachaches or nausea?" 1
- Mood changes: "Any sadness, irritability, or mood swings? When do these occur?" (timing helps distinguish peak effects vs. rebound) 1
- Tics: "Any new repetitive movements or sounds?" 1
Timing-Specific Questions
- Morning/peak effects (1-6 hours post-dose): Jitteriness, anxiety, sadness 1
- Afternoon/evening (12+ hours): Behavioral rebound, irritability 1
Growth Monitoring
Weigh the patient at each visit to objectively assess appetite effects 1. Height should also be measured periodically, though significant growth effects are uncommon with stimulants 1.
Efficacy Assessment Across the Day
Since Concerta 18 mg provides coverage for approximately 12 hours 2, 3, ask about symptom control at different times:
- Morning (1-4 hours post-dose): "How is focus in the first few classes?"
- Midday (4-8 hours): "What about after lunch through the end of school?"
- Afternoon/evening (8-12 hours): "How is homework time? Evening activities?" 3, 4
The 18 mg dose may provide insufficient coverage—this is the lowest starting dose, equivalent to methylphenidate 5 mg three times daily 2. If symptom control is inadequate, dose increases in 18 mg increments at weekly intervals should be considered, up to 54 mg/day for children or 72 mg/day for adolescents 2.
Special Considerations for Adolescents
If the patient is an adolescent, screen for substance use and medication diversion 5:
- "Has anyone asked you for your medication or to buy/trade pills?"
- "Are you using any alcohol, marijuana, or other substances?"
- "Is anyone else in your household taking your medication?" 1
Ask about driving if applicable: "Do you feel the medication is working when you drive? Any concerns about focus while driving?" 5
Dose Optimization Decision
If symptoms are not adequately controlled on 18 mg, increase the dose by 18 mg weekly 1, 2. The current dose (18 mg) is at the low end of the therapeutic range—most patients require higher doses for optimal symptom control 1, 6.
Follow-up schedule: During dose titration, maintain weekly contact (by phone or visit). Once stable, follow-up should be at least monthly until symptoms are fully stabilized 1.
Documentation
Record:
- Specific target symptoms and their severity in different settings
- Weight (and height periodically)
- Blood pressure and pulse 1
- Side effects with timing
- Teacher/parent rating scale scores if obtained
- Adherence patterns
- Any signs of misuse/diversion (especially in adolescents)