CADDRA Monitoring Frequency After ADHD Medication Adjustment
According to CADDRA-aligned guidelines, patients with ADHD should be monitored weekly during medication titration (typically 2-4 weeks), then at least monthly until symptoms are stabilized, after which monitoring can occur every 3-4 months for stable responders. 1, 2
Initial Titration Phase (First 2-4 Weeks)
- Weekly contact is essential during dose adjustments, either through office visits or telephone follow-up, to assess response and side effects 1
- The titration phase typically requires 2-4 weeks to establish the optimal dose 1
- Obtain ADHD symptom ratings weekly from the patient and collateral sources (family members, teachers for children) during this period 1, 2
- Monitor blood pressure and pulse at each dose adjustment visit 2, 3
Stabilization Phase (Until Symptoms Controlled)
- Schedule appointments at least monthly until the patient's symptoms have been stabilized and a robust response is achieved 1
- Continue systematic assessment of target ADHD symptoms using standardized rating scales 1, 2
- Screen for side effects through specific questioning about sleep, appetite, mood changes, cardiovascular effects, and tics 1, 2
- Track weight at each visit to objectively measure appetite suppression 1, 2
Maintenance Phase (After Stabilization)
- For patients with stable, high-quality response and good adherence, visits can occur as infrequently as every 3-4 months (2-4 times per year) 1, 2
- Continue monitoring growth parameters (height and weight), cardiovascular parameters (blood pressure and pulse), and functional impairment across settings 2
- Assess adherence patterns and barriers to medication compliance 2
Factors Requiring More Frequent Monitoring
Increase visit frequency beyond the standard schedule when:
- Significant side effects emerge requiring dose or timing adjustments 1
- Comorbid psychiatric disorders cause significant impairment 1
- Adherence problems are identified 1
- Psychosocial stressors affect the patient or family 1
- Complex comorbidity is present, which may necessitate monthly visits 2
- The patient is in a high-risk group (e.g., substance abuse history, cardiovascular concerns) 1
Critical Monitoring Components at Each Visit
- ADHD symptom severity using parent/teacher rating scales (for children) or self-report and collateral information (for adults) 1, 2
- Cardiovascular parameters: blood pressure and pulse, including orthostatic measurements when indicated 2, 3
- Growth trajectory: height and weight to detect stimulant-related growth suppression 1, 2
- Side effect screening: systematically ask about insomnia, appetite suppression, headaches, mood changes, tics, and cardiovascular symptoms 1, 2
- Functional improvement across home, school/work, and social settings 2
Common Pitfalls to Avoid
- Do not assume stable patients require only annual visits—even well-controlled patients need monitoring every 3-4 months to detect late-onset side effects like growth trajectory changes 1, 2
- Do not rely solely on patient self-report for symptom assessment; obtain collateral information from family members or teachers, as adults with ADHD are unreliable reporters of their own behaviors 3
- Do not discontinue monitoring after initial stabilization—long-term safety surveillance for cardiovascular effects and growth requires ongoing assessment 2, 3
- Do not use rigid visit schedules—tailor frequency to individual patient needs, comorbidities, and treatment response 1