Initial Treatment Approach for Teenagers Newly Diagnosed with ADHD
For adolescents (12-18 years of age) with ADHD, the primary care clinician should prescribe FDA-approved medications for ADHD with the assent of the adolescent, and may also prescribe behavior therapy as treatment, preferably both. 1
Medication Management
First-Line Medication Options
- Stimulant medications are the first-line pharmacological treatment with strongest evidence:
Second-Line Medication Options
- Non-stimulants if stimulants are ineffective, poorly tolerated, or contraindicated:
Behavioral Interventions
- Implement evidence-based behavioral interventions alongside medication 1
- For adolescents, focus on:
- Self-monitoring strategies
- Organizational skills training
- Time management techniques
- Academic support and accommodations
Initial Assessment Questions for New Intake
Core ADHD Symptom Assessment
- Duration, severity, and impact of inattention symptoms
- Duration, severity, and impact of hyperactivity/impulsivity symptoms
- Age of symptom onset and progression over time
- Impairment across multiple settings (home, school, social environments)
Comorbidity Screening
- Screen for common comorbid conditions 1:
- Anxiety disorders (worry, nervousness, social anxiety)
- Mood disorders (depressive symptoms, irritability)
- Disruptive behavior disorders (oppositional behaviors, conduct problems)
- Substance use (particularly important in adolescents)
- Learning disabilities and academic performance
- Sleep disorders
Functional Assessment
- Academic performance and challenges
- Social functioning and peer relationships
- Family functioning and relationships
- Daily life skills and self-care abilities
- Risk-taking behaviors (particularly relevant for adolescents)
Treatment History and Preferences
- Previous evaluations or treatments for ADHD or related concerns
- Adolescent's understanding and perspective on ADHD diagnosis
- Treatment preferences and concerns from both adolescent and parents
- Willingness to try medication and/or behavioral interventions
Educational Interventions
- Educational interventions are a necessary part of any treatment plan 1
- Often include an Individualized Education Program (IEP) or rehabilitation plan (504 plan)
- Focus on:
- School environment adjustments
- Class placement considerations
- Instructional accommodations
- Behavioral supports in the academic setting
Follow-Up and Monitoring
- Recognize ADHD as a chronic condition requiring ongoing management 1
- Schedule regular follow-up visits to:
- Monitor medication effectiveness and side effects
- Adjust treatment as needed
- Assess for emerging comorbidities
- Evaluate functional improvement across settings
Important Considerations
- Medication titration: Doses should be carefully titrated to achieve maximum benefit with minimum side effects 1
- Comorbidity management: If comorbid conditions are detected, treatment may need to be modified or referral to specialists may be necessary 1
- Adolescent assent: Obtaining the adolescent's agreement to treatment is crucial for adherence and effectiveness 1
- Treatment discontinuation risks: Untreated ADHD in adolescents is associated with increased risk for poor educational outcomes, substance use, driving accidents, and other negative outcomes 1
By implementing this comprehensive approach to ADHD treatment in adolescents, clinicians can effectively address symptoms while improving long-term outcomes related to morbidity, mortality, and quality of life.