Key Questions for Initial Intake of Adolescents with Established ADHD Diagnosis
The initial intake for a teenager with previously diagnosed ADHD should focus on comprehensive symptom assessment across multiple settings, medication history and response, functional impairment evaluation, and screening for comorbidities using validated rating scales from multiple sources. 1
Core Assessment Areas
Current Symptom Profile
- Severity and persistence of inattention, hyperactivity, and impulsivity symptoms
- Age of symptom onset and developmental trajectory
- Symptom manifestation across different settings (home, school, social)
- Use of validated DSM-5 based rating scales from at least two sources (parents/caregivers and self-report) 1
Previous Diagnosis and Treatment History
- Documentation of previous diagnostic process and criteria used
- Prior medication trials and responses:
- Specific medications (stimulants vs. non-stimulants)
- Dosing history and titration schedule
- Effectiveness for target symptoms
- Side effects experienced (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) 2
- Current medication regimen and adherence patterns
- Previous non-pharmacological interventions and their effectiveness
Functional Impairment Assessment
- Academic performance and classroom behavior
- Organizational skills and homework completion
- Social functioning and peer relationships
- Family relationships and home functioning
- Impact on self-esteem and emotional well-being
Comorbidity Screening
- Mood disorders (depression, anxiety)
- Behavioral disorders (oppositional defiant disorder, conduct disorder)
- Learning disabilities
- Substance use (particularly important in adolescents) 2
- Sleep disorders
Special Considerations for Adolescents
Substance Use Assessment
- Screen for current substance use before initiating or continuing medication
- Assess risk for medication diversion or misuse 2
- Consider medications with lower abuse potential if diversion is a concern:
- Non-stimulants (atomoxetine, extended-release guanfacine, extended-release clonidine)
- Stimulants with lower abuse potential (lisdexamfetamine, dermal methylphenidate, OROS methylphenidate) 2
Driving Safety
- Assess impact of ADHD symptoms on driving abilities
- Evaluate medication coverage during typical driving times
- Document any history of traffic violations or accidents 1
Medication Management Questions
- Current dosing schedule and timing relative to daily activities
- Medication coverage for afternoon/evening activities and homework
- Weekend and holiday medication use patterns
- Medication adherence challenges
- Side effect monitoring (weight, height, blood pressure, sleep patterns) 2
Academic and Organizational Support
- Current school accommodations and their effectiveness
- Need for additional educational interventions
- Use of organizational systems and external reminders 1
Implementation Tips
- Collect information from multiple sources (adolescent, parents, teachers)
- Use standardized rating scales to quantify symptoms
- Establish clear follow-up schedule based on symptom stability:
- Monthly visits until symptoms stabilized 2
- Adjust frequency based on medication response, side effects, and comorbidities
- Document baseline measurements (weight, vital signs) for ongoing monitoring
- Assess need for psychosocial interventions alongside medication management
Common Pitfalls to Avoid
- Relying solely on self-report from the adolescent
- Failing to assess substance use before continuing stimulant treatment
- Not addressing potential for medication diversion
- Overlooking the impact of ADHD on driving safety
- Insufficient attention to medication coverage for afternoon/evening activities
- Neglecting to screen for common comorbidities
- Assuming previous diagnosis was comprehensive and accurate
By systematically addressing these areas during the initial intake, clinicians can establish an appropriate treatment plan that addresses the unique needs of adolescents with ADHD while ensuring medication safety and effectiveness.