What questions should be asked during ADHD follow-ups?

Essential Questions for ADHD Follow-up Visits

During ADHD follow-up visits, clinicians should systematically assess target symptoms, medication effectiveness, side effects, and overall functioning using structured questions about both home and school/work environments to guide treatment decisions.

Core Assessment Areas

1. Symptom Control and Medication Effectiveness

• Specific questions about core ADHD symptoms:
  • "How is your attention/focus during tasks that require concentration?"
  • "How is your ability to complete tasks without getting distracted?"
  • "How well can you control impulsive behaviors?"
  • "Has your hyperactivity level changed since the last visit?"
• Timing of symptom control throughout the day:
  • "When does the medication seem to start working?"
  • "When does it wear off?"
  • "Are there particular times of day when symptoms are worse?"

2. Medication Side Effects Assessment

• Direct questions about common side effects 1:
  • Appetite changes: "How is your eating pattern? Any weight loss?"
  • Sleep disturbances: "How easily do you fall asleep? Do you stay asleep?"
  • Mood changes: "Have you noticed any irritability, social withdrawal, or mood swings?"
  • Physical symptoms: "Any headaches, stomach pain, or dizziness?"
  • Cardiovascular effects: "Any heart racing, chest pain, or shortness of breath?"
• Objective measures:
  • Weight measurement at each visit (document on growth chart for children)
  • Blood pressure and heart rate monitoring
  • Height measurement for growing children/adolescents

3. Functional Assessment

• School/work performance:
  • "How are your grades/work performance since our last visit?"
  • "Are you completing assignments/tasks on time?"
  • "Any feedback from teachers/supervisors?"
• Social functioning:
  • "How are your relationships with peers/colleagues?"
  • "Any improvements or difficulties in social situations?"
• Home functioning:
  • "How are things at home? Any changes in behavior or family dynamics?"
  • "Are you able to complete household responsibilities?"

4. Treatment Adherence

• Medication use patterns:
  • "Have you been taking your medication as prescribed?"
  • "Have you missed any doses? If so, why?"
  • "Are there any difficulties with the medication schedule?"
• For adolescents/adults: "Have you used the medication in any way other than prescribed?" 1
• For adolescents: "Has anyone asked you to share or sell your medication?" 1

5. Need for Dose Adjustments

• "Is the current dose providing adequate symptom control?"
• "Are there breakthrough symptoms at specific times?"
• "Has the effectiveness of the medication changed since our last visit?"

Special Considerations by Age Group

For Children (6-11 years)

• Obtain teacher reports before or at each visit 1
• Ask about classroom behavior and academic performance
• Assess growth parameters carefully at each visit
• Consider parent rating scales to track symptoms objectively

For Adolescents (12-17 years)

• Include self-ratings from the adolescent 1
• Assess for signs of medication diversion or misuse 1
• Monitor driving safety if applicable 1
• Screen for substance use at follow-up visits 1
• Assess for emergence of comorbid conditions (anxiety, depression)

For Adults

• Focus on functional impairment in work and relationships
• Obtain collateral information from significant others when possible 1
• Monitor for comorbid conditions that may emerge or worsen

Follow-up Schedule

• During initial titration phase: Weekly contact (can be by phone) 1
• After dose stabilization: Monthly visits until symptoms are well-controlled 1
• Maintenance phase: Follow-up frequency based on:
  • Stability of response
  • Presence of side effects
  • Comorbid conditions
  • Need for psychosocial interventions

Medication-Free Assessment Periods

• Consider periodic medication discontinuation trials to assess continued need 1
• Best timing for these trials:
  • During school/work breaks
  • When demands for sustained attention are lower
  • When monitoring can be consistent

Use of Rating Scales

• Consider using standardized rating scales at follow-up visits:
  • Adult ADHD Self-Report Scale (ASRS) for adults 2
  • Age-appropriate rating scales for children/adolescents
  • Global Assessment of Functioning (GAF) to track overall improvement 2

Promoting Patient Engagement

• Encourage patients (especially youth) to prepare questions before visits 3
• Consider using question prompt lists to facilitate discussion
• Provide education about ADHD and its treatment at follow-up visits

Common Pitfalls to Avoid

• Focusing only on medication effects without assessing overall functioning
• Failing to obtain input from multiple settings (home, school, work)
• Not systematically assessing for side effects at each visit
• Assuming continued benefit without periodic reassessment
• Overlooking the emergence of comorbid conditions

By systematically addressing these areas during ADHD follow-up visits, clinicians can optimize treatment outcomes, minimize adverse effects, and improve long-term functioning for patients with ADHD.