ADHD Follow-Up Tools
Use the ADHD Rating Scale-IV (ADHDRS) or Vanderbilt ADHD Rating Scales to monitor treatment response, obtaining ratings from both parents and teachers for children/adolescents, or the Adult ADHD Self-Report Scale (ASRS) for adults. These validated, symptom-specific instruments directly map to DSM criteria and provide quantitative tracking of treatment efficacy over time.
Recommended Follow-Up Tools by Age Group
Children and Adolescents (Ages 6-18)
The ADHD Rating Scale-IV-Parent Version (ADHDRS) is the primary outcome measure used in FDA approval studies, with each item mapping directly to one DSM symptom criterion for ADHD, including separate hyperactive/impulsive and inattentive subscales 1.
The Vanderbilt ADHD Rating Scales provide comprehensive assessment for ages 6-12, incorporating both parent and teacher ratings to document functional impairment across multiple settings 2.
Teacher ratings using validated, age- and sex-normed instruments are essential for monitoring symptoms in the school setting, as ADHD diagnosis requires documentation of impairment in more than one major setting 2.
Rating scales quantify ADHD symptoms using Likert scales (typically 0-3), making them particularly useful for following disease course quantitatively during medication titration and long-term management 3.
Adults (Ages 18+)
The Adult ADHD Self-Report Scale (ASRS) serves as the primary screening and monitoring tool, with Part B completed by the patient and Part A ideally completed by someone who knows the patient well 2.
The Conners Adult ADHD Rating Scales (CAARS) provide both self-report and observer forms, allowing comprehensive assessment from multiple perspectives 3.
The Current Symptoms Scale (CSS) by Barkley and Murphy focuses on DSM-IV criteria and includes both self-report and other-report versions for ongoing monitoring 3.
Monitoring Schedule and Parameters
Initial Titration Phase
Schedule weekly contact during medication titration to assess symptom response, side effects, and need for dose adjustments 4.
Stimulant medications can be effectively titrated on a 3-to-7-day basis due to their immediate effects, allowing rapid optimization of dosing 5.
Obtain weekly symptom ratings during dose adjustment, specifically asking about focus, task completion, and any side effects like insomnia or appetite suppression 4.
Maintenance Monitoring
Monthly follow-up visits are recommended during maintenance treatment after achieving optimal symptom control 4.
Monitor blood pressure and pulse at baseline and regularly during treatment with any ADHD medication, particularly stimulants 4.
Track height and weight regularly, especially in younger patients, as growth deceleration may occur during the first 2 years of stimulant treatment 5.
Monitor for sleep disturbances and appetite changes as common adverse effects requiring potential dose or timing adjustments 4.
Screen for suicidality and clinical worsening, particularly when using atomoxetine or in patients with comorbid depression 4.
Critical Implementation Points
Multi-Informant Approach
Gather collateral information from multiple settings (home, school, work) using standardized rating scales rather than relying solely on patient self-report 2.
Rating scales serve to systematically collect symptom information but do not diagnose ADHD by themselves—the diagnosis remains fundamentally clinical 2.
Functional Impairment Assessment
Document functional impairment in at least two settings through information from parents, teachers, and other observers, not just symptom counts 2.
The American Academy of Pediatrics identifies the need for reliable instruments to assess functional impairment and monitor improvement over time as a key area requiring further research 5.
Common Pitfalls to Avoid
Do not rely solely on computerized test results (like QB tests) for diagnosis or monitoring—these serve only as adjuncts to clinical assessment 2.
Avoid assuming current symptoms alone are sufficient—retrospective assessment of childhood ADHD symptoms is required for adult diagnosis using tools like the Wender-Utah Rating Scale (WURS) 3.
Do not delay systematic monitoring while pursuing additional testing in patients with documented significant impairment, as this worsens outcomes 2.
Recognize that rating scales are subject to rater errors and should be interpreted within the full clinical context rather than as standalone diagnostic tools 6.