What is the treatment for inattentive type Attention Deficit Hyperactivity Disorder (ADHD) symptoms?

Treatment for Inattentive Type ADHD

For inattentive type ADHD, FDA-approved medications are the first-line treatment, with stimulants being the most effective option, followed by behavior therapy as an important adjunctive treatment. 1

Medication Options

First-Line: Stimulant Medications

• Methylphenidate-based medications

  • Starting dose: 5 mg twice daily
  • Can be administered as a single daily dose in the morning or divided doses
  • Extended-release formulations may provide better coverage throughout the day

• Amphetamine-based medications

  • Starting dose: 2.5 mg once or twice daily
  • Available in immediate and extended-release formulations

Stimulants have an effect size of approximately 1.0, making them the most effective pharmacological intervention for ADHD symptoms 1.

Second-Line: Non-Stimulant Medications

• Atomoxetine (Strattera)

  • For children/adolescents <70 kg: Start at 0.5 mg/kg/day, target dose 1.2 mg/kg/day
  • For individuals >70 kg: Start at 40 mg/day, target dose 80 mg/day (maximum 100 mg)
  • Can be taken as a single morning dose or divided doses 2
  • Effect size approximately 0.7 (slightly less effective than stimulants) 1
  • May be particularly beneficial for patients with comorbid depression or anxiety 3
  • Preferred for patients with substance use concerns due to low abuse potential 3

• Extended-release guanfacine and clonidine

  • Effect size approximately 0.7
  • Not approved for preschool-aged children 1

Special Considerations

Age-Specific Recommendations

• Children and adolescents: Strong recommendation for FDA-approved medications with behavior therapy as an adjunct 1
• Preschool-aged children: Behavior therapy is recommended as first-line treatment; medication can be added if behavior therapy alone is insufficient 1
• Adolescents: Special attention to medication coverage while driving; longer-acting or late-afternoon short-acting medications may be helpful 1

Comorbid Conditions

• For ADHD with depression: Consider atomoxetine or bupropion, which may address both conditions 3
• For ADHD with anxiety: Atomoxetine may be beneficial 3
• For substance use concerns: Non-stimulant medications (atomoxetine, extended-release guanfacine, extended-release clonidine) are preferred due to lower abuse potential 1, 3

Behavior Therapy

Behavior therapy represents a broad set of specific interventions aimed at modifying the physical and social environment to alter behavior 1. Key components include:

• Parent training in specific techniques to modify and shape child's behavior
• Classroom management strategies
• Peer interventions
• Skills to provide effective rewards for desired behaviors
• Techniques for planned ignoring of certain behaviors
• Appropriate consequences when goals aren't met

For inattentive symptoms specifically, behavioral interventions should focus on:

• Developing organizational skills
• Improving task initiation and completion
• Enhancing time management
• Strengthening working memory strategies

Monitoring and Follow-Up

• Schedule follow-up visits within 2-4 weeks after medication changes 3
• Monitor vital signs, particularly blood pressure and heart rate with stimulants
• Assess for side effects: insomnia, appetite changes, mood effects
• Evaluate improvement in core symptoms of inattention
• For long-term treatment, periodically reevaluate the continued need for medication 2

Common Pitfalls and Caveats

1. Misdiagnosis: Ensure symptoms meet DSM criteria for inattentive type ADHD (at least 6 symptoms of inattention persisting for at least 6 months) 2

2. Overlooking comorbidities: Screen for and address common comorbid conditions like anxiety, depression, and learning disorders

3. Inadequate dosing: Titrate medication to optimal dose rather than settling for partial response

4. Medication timing issues: For inattentive symptoms that affect academic or work performance, ensure medication coverage during these critical periods

5. Discontinuing treatment prematurely: ADHD often requires long-term management; the benefit of maintaining treatment has been demonstrated in controlled trials 2

6. Neglecting behavioral interventions: Medication alone may not address all functional impairments; behavioral strategies are essential components of comprehensive treatment

Remember that medication is not appropriate for children whose symptoms do not meet diagnostic criteria for ADHD, though behavioral interventions may still be beneficial in these cases 1.