What are the diagnostic steps and treatment options for Attention Deficit Hyperactivity Disorder (ADHD) according to the Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDERA)?

From the Guidelines

ADHD diagnosis according to CADDRA involves a comprehensive assessment process that typically begins with screening questionnaires and a detailed clinical interview covering developmental history, symptoms, and functional impairment, as recommended by the most recent guidelines 1. This is followed by a thorough evaluation of ADHD symptoms using standardized rating scales completed by multiple informants (patient, family members, teachers), medical examination to rule out other conditions, and assessment of comorbidities. Some key points to consider in the diagnostic process include:

• The use of the Adult ADHD Self-Report Scale (ASRS-V1.1) to screen for symptoms of inattention and hyperactivity-impulsivity 1
• The importance of assessing symptoms in multiple settings, such as home and work or school 1
• The need to rule out other conditions that may be contributing to symptoms, such as oppositional behavior or other mental disorders 1 Treatment recommendations follow a multimodal approach, starting with psychoeducation about ADHD for patients and families. Medication is often a first-line treatment, with stimulants like methylphenidate (Ritalin, Concerta) at 18-72 mg daily or amphetamine-based medications (Adderall, Vyvanse) at 20-70 mg daily being most effective, as supported by recent studies 1. Non-stimulant options include atomoxetine (Strattera) at 40-100 mg daily, guanfacine XR (Intuniv XR) at 1-4 mg daily, or clonidine. Behavioral interventions are equally important, including cognitive behavioral therapy, parent training, organizational skills coaching, and educational accommodations. Regular follow-up is essential to monitor treatment effectiveness, adjust medications as needed, and address emerging issues, as emphasized by clinical guidelines 1. This comprehensive approach recognizes ADHD as a neurodevelopmental disorder affecting executive functioning that requires individualized, ongoing management addressing multiple life domains.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Diagnostic Steps for Attention Deficit Hyperactivity Disorder (ADHD)

• A comprehensive assessment is necessary to determine whether the subject has ADHD or another disorder, involving multiple domains, informants, methods, and settings 2, 3, 4.
• The clinical interview of the child and family is one of the cornerstones of the assessment process, along with a comprehensive medical history and examination, psychoeducational tests, and school-related evaluation 2, 4.
• A wide array of rating scales, tests, and measures have been developed to aid in the systematic standardized assessment of the various deficits associated with ADHD, but none of these tests is definitive 2.
• Assessment of neuropsychological functions is important to understand the symptom patterns and to develop targeted treatment programs 3.

Treatment Options for ADHD

• The first-line treatment options for ADHD include behavioral therapy, pharmacotherapy with stimulants or both 5, 4.
• Methylphenidate and amphetamine salts are the stimulant drugs of choice for ADHD treatment, acting by increasing presynaptic release of dopamine and other biogenic amines in the brain 5.
• Atomoxetine, a selective norepinephrine reuptake inhibitor, is an alternative, non-stimulant drug for ADHD, but it is less efficacious than stimulants 5, 4.
• Behavioral treatments are recommended for preschool-aged children and may be helpful at older ages, including parent training, classroom management, and peer interventions 4.
• Medications are recommended as first-line therapy for older children, with psychostimulants being the most effective for the treatment of core ADHD symptoms 4.