When is discharge from an outpatient ADHD clinic appropriate, including criteria such as stable symptom control on a well‑tolerated medication regimen for 3–6 months, consistent improvement on standardized rating scales, independent medication management, resolved or controlled comorbidities, established psychosocial supports, and a documented follow‑up plan?

Discharge Criteria from Outpatient ADHD Clinic

Discharge from an outpatient ADHD clinic is appropriate when a patient demonstrates stable symptom control on a well-tolerated medication regimen for 3–6 months, with consistent improvement on standardized rating scales, independent medication management, resolved or controlled comorbidities, established psychosocial supports, and a documented follow-up plan with primary care. 1

Core Discharge Criteria

Medication Stability and Symptom Control

• Stable medication regimen maintained for 3–6 months without dose adjustments, with the patient demonstrating consistent adherence and no dose-limiting side effects 1
• Optimal symptom reduction approaching levels of individuals without ADHD, not merely "some improvement," as documented by standardized ADHD rating scales from multiple informants (patient, family, workplace/school) 1, 2
• Consistent improvement on standardized rating scales obtained at regular intervals, demonstrating sustained therapeutic benefit across home, work/school, and social settings 1

Independent Medication Management

• Patient demonstrates reliable self-administration of medication without supervision, including appropriate timing of doses and understanding of when to take medication 1
• Patient can identify and report side effects accurately and knows when to contact their provider for concerning symptoms 1
• No evidence of medication misuse, diversion, or dose escalation beyond prescribed amounts, particularly critical for stimulant medications 1, 2

Comorbidity Management

• All comorbid psychiatric conditions are resolved or adequately controlled with stable treatment, including mood disorders, anxiety disorders, and substance use disorders 1, 3
• No new psychiatric symptoms have emerged during the stabilization period that would require ongoing specialty monitoring 1
• Substance use disorders, if previously present, are in sustained remission with appropriate supports in place 4

Psychosocial Supports and Functional Improvement

• Established psychosocial interventions such as cognitive-behavioral therapy, parent training (for pediatric patients), or workplace accommodations are in place and functioning effectively 1, 2
• Documented functional improvement across multiple domains including academic/occupational performance, social relationships, and family functioning 1, 5
• Patient has developed effective coping strategies and compensation mechanisms for residual ADHD-related challenges 5

Monitoring Schedule Prior to Discharge

Stabilization Phase Requirements

• Monthly visits during initial stabilization (first 3–6 months) to ensure consistent symptom control and medication tolerability 1
• Quarterly visits once stable for patients with uncomplicated ADHD and no comorbidities, with systematic assessment of symptoms, side effects, and functional outcomes 1
• More frequent monitoring (monthly) for complex cases with multiple comorbidities or history of medication non-adherence until stability is clearly established 1

Required Assessments Before Discharge

• Cardiovascular parameters (blood pressure and pulse) documented as stable and within acceptable ranges 1, 2
• Growth parameters (height and weight) tracked and showing appropriate trajectory, particularly in pediatric and adolescent patients 1, 2
• Systematic assessment of common side effects including sleep quality, appetite, mood stability, and any tics or motor symptoms 1

Documented Follow-Up Plan

Primary Care Transition

• Explicit transfer of care to primary care provider with detailed summary including diagnosis, medication history, optimal dose, monitoring requirements, and management of common side effects 1
• Primary care provider agrees to assume ongoing management and has capacity to prescribe controlled substances if stimulants are being used 1
• Clear instructions for when to re-refer to specialty care, including emergence of new psychiatric symptoms, medication failure, or significant functional decline 1

Ongoing Monitoring Requirements

• Annual medication discontinuation trials may be considered to assess continuing need for treatment, though this should be timed to avoid important academic or occupational demands 1
• Regular monitoring of cardiovascular parameters should continue in primary care, particularly for patients on stimulant medications 1, 2
• Periodic reassessment using standardized rating scales to detect any symptom recurrence or functional decline 1

Special Populations Requiring Extended Specialty Care

Patients Who Should NOT Be Discharged

• Active substance use disorder or recent relapse requiring ongoing addiction medicine involvement 4
• Unstable comorbid bipolar disorder requiring mood stabilizer optimization before or during stimulant therapy 3, 6
• Severe treatment-resistant ADHD requiring multiple medication trials or complex polypharmacy 1
• Ongoing medication diversion concerns or documented non-adherence requiring structured monitoring 1, 2
• Pregnant or breastfeeding patients on ADHD medications requiring specialized risk-benefit counseling 2

Adolescents Transitioning to Adult Care

• Adolescents (12-18 years) should have established self-management skills before discharge, including understanding of their diagnosis, medication effects, and when to seek help 1, 2
• Substance abuse screening should be documented as negative before discharge, given elevated risk in this population 1, 2
• Driving safety considerations addressed with medication coverage during driving hours if applicable 1, 2

Common Pitfalls to Avoid

• Do not discharge patients who are underdosed simply because they report "some improvement"—the MTA study demonstrated that community treatment with lower doses and less frequent monitoring produces inferior outcomes compared to optimal medication management 1
• Do not assume stability after only 1–2 months of unchanged medication—a minimum of 3 months of documented stability is required to ensure sustained benefit 1
• Do not discharge without confirming primary care capacity to prescribe controlled substances and monitor for side effects, as this leads to treatment discontinuation and symptom recurrence 1
• Do not discharge patients with unresolved comorbidities even if ADHD symptoms are controlled, as functional impairment will persist 1, 5