Recommended Treatment for Attention Deficit Hyperactivity Disorder (ADHD)
The recommended first-line treatment for ADHD is a comprehensive approach combining FDA-approved medications (stimulants as first choice) with behavioral therapy and educational interventions, tailored to the patient's age and specific ADHD presentation. 1
Pharmacological Treatment
First-Line Medications
- Stimulants are the first-line pharmacotherapy for ADHD:
- Methylphenidate formulations: Recommended for children/adolescents
- Amphetamine formulations: Particularly effective for adults
- Both are effective in 70-80% of people with ADHD 1
Dosing Guidelines
Children and adolescents <70 kg:
Children and adolescents >70 kg and adults:
- Start at 40 mg daily and increase after 3 days to target dose of 80 mg
- May increase to maximum 100 mg after 2-4 weeks if needed 2
Non-Stimulant Options
- Atomoxetine: Alternative when stimulants are contraindicated or ineffective
- Children <70 kg: Start at 0.5 mg/kg/day; target dose 1.2 mg/kg/day
- Children >70 kg and adults: Start at 40 mg/day; target dose 80 mg/day 2
- Other non-stimulant options: bupropion, guanfacine, clonidine, and viloxazine 1
Psychosocial Interventions
Cognitive Behavioral Therapy (CBT)
- Most extensively studied and effective psychotherapy for ADHD
- Focuses on developing executive functioning skills:
- Time management
- Organization and planning
- Emotional self-regulation
- Stress management
- Impulse control 1
- Most effective when combined with medication 1
Parent Training Behavioral Management (PTBM)
- Essential for managing ADHD in children
- Teaches parents techniques for:
- Providing positive reinforcement for desired behaviors
- Using planned ignoring as an active strategy
- Applying appropriate consequences 1
Mindfulness-Based Approaches
- Mindfulness-Based Cognitive Therapy (MBCT)
- Mindfulness-Based Stress Reduction (MBSR)
- Help with inattention symptoms, emotion regulation, and executive function 1
Age-Specific Treatment Recommendations
Preschool Children
- Behavioral parent training as first-line treatment
- Medication only if behavioral interventions are insufficient and symptoms cause significant impairment 1
School-Age Children
- Combination of behavioral interventions and medication
- Educational accommodations (504 plans or IEPs) 1
Adolescents
- FDA-approved medications with adolescent assent
- Evidence-based training interventions
- Educational accommodations
- Transition planning to adult care starting at age 14 1
Adults
- Combination of medication and CBT
- Workplace accommodations 1
Educational and Workplace Accommodations
- Preferential seating
- Modified work assignments
- Test modifications
- Behavior plans
- Extended time to complete tasks
- Reduced workload demands
- Written instructions and meeting notes
- Structured work environment with clear expectations
- Permission for short breaks to improve focus 1
Treatment Monitoring
- Regular assessment of symptom control using validated ADHD-specific rating scales
- Monitoring for side effects, particularly cardiovascular or psychiatric symptoms
- Regular assessment of vital signs, height, and weight
- Periodic reevaluation of treatment effectiveness 1
Common Pitfalls to Avoid
- Discontinuing medication prematurely
- Inadequate dose titration
- Focusing solely on medication without behavioral interventions
- Neglecting to monitor for side effects
- Failing to address comorbid conditions
- Not screening for bipolar disorder before starting treatment 1, 2
- Not recognizing the chronic nature of ADHD requiring ongoing management 1