What is the recommended schedule and components for routine reassessment of patients receiving medication for attention‑deficit/hyperactivity disorder?

Routine Reassessment for Patients on ADHD Medication

Patients receiving ADHD medication should be monitored monthly until symptoms stabilize, then at least every 3 months during maintenance, with systematic assessment of target symptoms, side effects, cardiovascular parameters, and functional outcomes at each visit. 1

Initial Titration Phase Monitoring (First 2–4 Weeks)

During dose adjustment, maintain weekly contact to optimize medication response and detect emerging problems early. 1

Weekly Assessment Components

• ADHD symptom ratings from multiple informants (parent, teacher, and self-report for adolescents/adults) using standardized scales 1
• Blood pressure and pulse at each dose adjustment visit 1
• Specific side effect inquiry including insomnia, appetite suppression, headaches, social withdrawal, tics, and weight loss 1
• Weight measurement at each visit to objectively track appetite effects 1
• Sleep quality and timing to detect stimulant-related insomnia 1

Titration Schedule

• Increase methylphenidate by 5–10 mg per dose weekly or dexamphetamine by 2.5–5 mg weekly until optimal response or dose-limiting side effects occur 1
• Stimulants can be titrated on a 3–7 day basis because effects manifest quickly 1
• Continue titration until ADHD symptoms are controlled across all settings or maximum recommended doses are reached 1

Maintenance Phase Monitoring (After Stabilization)

Once the patient achieves stable symptom control on a consistent dose, transition to monthly visits initially, then extend to quarterly (every 3 months) for ongoing maintenance. 1

Monthly to Quarterly Visit Components

Core assessments at every maintenance visit:

• Target ADHD symptoms assessed via parent and teacher reports (and self-ratings for adolescents/adults) 1
• Blood pressure and pulse measurement 1
• Height and weight tracking, particularly in children and adolescents, to monitor growth effects 1
• Systematic side effect screening by asking specific questions about known adverse effects 1
• Functional impairment across home, school/work, and social settings 1

Additional monitoring parameters:

• Cardiovascular symptoms including chest pain, palpitations, syncope, or exercise intolerance 1
• Sleep disturbances and their impact on daytime functioning 1
• Appetite changes and nutritional adequacy 1
• Mood symptoms including irritability, anxiety, or depressive symptoms 1
• Suicidal ideation particularly when using atomoxetine or in patients with comorbid depression 1
• Substance use screening, especially in adolescents and adults 1

Frequency Adjustments

Increase visit frequency (more than monthly) when: 1

• Significant side effects emerge
• Comorbid psychiatric disorders cause additional impairment
• Adherence problems develop
• Dose adjustments are needed
• Psychoeducation or psychosocial interventions require coordination

The response and severity of symptoms determine appointment frequency, not arbitrary time intervals. 1

Chronic Care Model Approach

ADHD should be managed as a chronic condition following medical home principles, with the primary care clinician coordinating comprehensive, continuous care. 1

Long-Term Management Components

• Bidirectional communication with teachers and school personnel to monitor academic functioning 1
• Coordination with mental health clinicians involved in the patient's care 1
• Regular reassessment of treatment necessity, as discontinuation places patients at higher risk for motor vehicle crashes, criminality, depression, and other adverse outcomes 1
• Monitoring for treatment discontinuation, which is common and associated with worse long-term outcomes including increased psychiatric comorbidity, substance use disorders, lower educational achievement, and increased incarceration rates 1

Age-Specific Considerations

Children (Ages 6–12)

• Obtain teacher reports before or at each visit to assess school functioning 1
• Monitor growth parameters (height and weight) at every visit due to stimulant effects on growth 1
• Assess academic performance and peer relationships 1

Adolescents (Ages 12–18)

• Include self-ratings of ADHD symptoms in addition to parent/teacher reports 1
• Screen for substance use, anxiety, depression, and learning disabilities at minimum 1
• Monitor for suicidal ideation, particularly with atomoxetine or SSRIs 1
• Assess driving safety and risk-taking behaviors 1

Adults

• Obtain self-ratings as primary symptom measure 1
• Monitor occupational functioning and interpersonal relationships 1
• Screen for substance use disorders and comorbid psychiatric conditions 1
• Assess cardiovascular risk factors more carefully than in children 1, 2

Common Pitfalls to Avoid

Do not assume stable dosing means infrequent monitoring is acceptable—quarterly visits remain necessary even when symptoms are well-controlled to detect emerging problems, monitor growth, and assess continued treatment necessity. 1

Do not rely solely on parent reports in children—teacher input is essential because ADHD symptoms manifest differently across settings, and school impairment is a core diagnostic criterion. 1

Do not skip cardiovascular monitoring—blood pressure and pulse should be checked at every visit, as stimulants cause modest but consistent increases that require tracking. 1

Do not overlook functional outcomes—symptom reduction alone is insufficient; assess whether treatment improves academic performance, social relationships, and quality of life. 1

Do not continue medication indefinitely without periodic reassessment—while ADHD is chronic, treatment needs may change, and medication holidays or discontinuation trials can clarify ongoing necessity. 1