Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Follow-up
- Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD more...
Further Outpatient Care
Follow-up for attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), varies and depends on the patient's profile, the clinician's experience, and the access to healthcare providers.
After the patient's condition is stabilized, a follow-up frequency of every 6-12 weeks is often appropriate for the first year.
After that, patients whose conditions are stable may do best with visits every 4 months to assess their medications.
Psychotherapy may need to be continued for months to years.
Coexisting neuropsychiatric disorders and learning disorders can complicate the diagnosis and treatment of ADHD (ADD). See History.
The prognosis for patients with ADHD (ADD) is excellent if the following conditions are present:
- The patient has no major comorbidity.
- Medication management takes into account minor comorbidities and the great range of individual responses.
- Patients and caregivers receive appropriate education about ADHD (ADD) and ADHD (ADD) management.
- Adherence to therapy continues.
- Any and all coexisting learning disabilities are diagnosed, and remediation is scheduled and undertaken.
- Any and all coexisting emotional problems are investigated and treated appropriately by a primary care provider or the patient is referred to a mental health professional.
Provide information about the pathophysiology in lay terms.
Provide information about complementary therapeutic approaches to medication (eg, involvement of education specialists, counseling or coaching, school accommodations, parent training).
Provide clinical medication information.
Include appropriate follow-up parameters.
Attend to administrative issues related to medication (eg, prescription writing and safety, compliance with state laws).
Provide emergency information.
Seek school accommodations.
Provide contact information for local and national support organizations.
Provide literature or written resources (eg, books, periodicals).
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|Medication||Initial Pediatric Dose||Pediatric Dosage Range and Maximum Dose*||Common Pediatric Dose*||Preparations|
|Methylphenidate immediate release (IR) (Ritalin, Methylin, generic)||2.5-5 mg||0.1-0.8 mg/kg/dose PO qd to 5 times/d; not to exceed 60 mg/d||0.3-0.5 mg/kg/dose PO tid/qid||All preparations available as 5-mg, 10-mg, or 20-mg scored tabs; Methylin also available as 2.5-mg, 5-mg, or 10-mg chewable tab and PO solution (5 mg/5 mL and 10 mg/mL)|
|Methylphenidate sustained-release (SR) (Ritalin LA, Metadate CD)||Convert from IR or use 10 mg.||0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d||0.6-1 mg/kg/dose PO qd/bid||10-mg, 20-mg, 30-mg, or 40-mg tabs (Metadate also has 50-mg and 60-mg tabs.); can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Methylphenidate extended release (ER)‡ (Ritalin SR, Methylin ER, Metadate ER, Quillivant XR, generic SR)||Convert from IR|
May initiate treatment with Quillivant XR
|0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d|
Quillivant XR: Once daily dosing
|0.6-1 mg/kg/dose PO qd/bid||20-mg Spansules (Do not cut, crush, or chew)|
Quillivant XR 5 mg/mL suspension
|Methylphenidate OROS tablets (Concerta)||Convert from IR or use 18 mg.||0.3-2 mg/kg PO qd; not to exceed 54 mg/d||0.8-1.6 mg/kg PO qd||18-mg, 27-mg, 36-mg, and 54-mg tabs (Do not cut, crush, or chew.)|
|Methylphenidate transdermal patch (Daytrana)†||Convert from IR or use 10 mg (12.5 cm2 patch) released over 9 h and titrate up prn.||0.3-2 mg/kg released over 9 h; not to exceed one 30-mg patch||10-30 mg released over 9 h||10-mg, 15-mg, 20-mg, 30-mg patches, applied to the hip|
|Dexmethylphenidate IR (Focalin)||2.5-5-mg||0.1-0.5 mg/kg/dose PO qd to qid; not to exceed 20 mg/d||0.2-0.3 mg/kg/dose PO bid/tid||2.5-mg, 5-mg, or 10-mg scored tabs (Do not cut, crush, or chew.)|
|Dexmethylphenidate extended release (Focalin-XR)||5-10-mg||0.2-1 mg/kg/dose PO qd to bid; not to exceed 20 mg/d||0.4-0.6 mg/kg/dose PO qd/bid||5-mg, 10-mg, or 20-mg scored tabs; can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Dextroamphetamine (Dexedrine, Dextrostat)||2.5-5 mg||0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 60 mg/d||0.3-0.5 mg/kg/dose PO qd/tid||Dexedrine: 5-mg scored tabs; Dextrostat: 5-mg and 10-mg scored tabs|
|Dextroamphetamine Spansules (Dexedrine CR)||5 mg||0.1-0.75 mg/kg/dose PO qd/bid; not to exceed 60 mg/d||0.3-0.6 mg/kg/dose PO qd/bid||5-mg, 10-mg, or 15-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Mixed amphetamine salts IR (Adderall, generic)||2.5-5 mg||0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 40 mg/d||0.3-0.5 mg/kg/dose PO tid/qid||5-mg, 7.5-mg, 10-mg, 12.5-mg, 15-mg, 20-mg, or 30-mg scored tabs|
|Mixed amphetamine salt XR (Adderall-XR)||Convert from IR or use 5-10 mg||0.2-1.4 mg/kg/dose PO qd/tid|
Not to exceed 30 mg/d
|0.6-1 mg/kg/dose PO qd/bid||5-mg, 10-mg, 15-mg, 20-mg, 25-mg, or 30-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.)|
|Lisdexamfetamine (Vyvanse)||30 mg PO qam||30-70 mg PO qam||Data limited||20-mg, 30-mg, 40-mg, 50-mg, 60-mg, or 70-mg caps (Swallow cap whole, sprinkle into soft food, or dissolve contents in glass of water and drink immediately.)Risk of apnea in patients with chronic pulmonary disease; closely monitor these patients, when initiating and titrating therapy; alternatively, consider the use of alternative non-opioid analgesics in these patients (see Black Box Warnings and Contraindications)|
|Amphetamine (Evekeo, Dyanavel XR), Adzenys XR-ODT||Evekeo: 2.5 mg PO BID/TID|
Dyanavel XR: 2.5-5 mg PO once daily
Adzenys XR-ODT: 6.3 mg PO qAM
|Evekeo: 2.5 mg BID/TID; only in rare cases is it necessary to exceed 40 mg/day|
Dyanavel XR: 2.5-5 mg/day; not to exceed 20 mg/day
Adzenys XR-ODT: Not to exceed 18.8 mg/day (aged 6-12 y) or 12.5 mg/day (aged 13-17 y)
|Data limited||Evekeo: 5-mg, 10-mg tablets|
Dyanavel XR: 2.5-mg/mL extended-release oral suspension (do not substitute oral suspension for other amphetamine products on a milligram-per-milligram basis)
Adzenys XR-ODT: 3.1-mg, 6.3-mg, 9.4-mg, 12.5-mg, 15.7-mg, 18.8-mg extended-release oral disintegrating tablets
|Note. In general, when the terms methylphenidate, Dexedrine, and Ritalin are used without abbreviations for extended-release preparations (eg, continuous release [CR], SR, osmotic-release oral system [OROS]), a short-acting, IR preparation is implied.|
* Maximum pediatric dose suggested by the US Food and Drug Administration (FDA). Although some children benefit greatly from doses greater than these, benefit from use of either the lowest and highest ends of the dose range is uncommon.
†The methylphenidate patch contains a different total methylphenidate dose than the name implies because it is designed to last 12 hours (eg, 10-mg patch [patch size 12.5 cm2] delivers about 10 mg over 9 h [estimated delivery rate is 1.1 mg/h for this particular patch]). Delivery rate varies depending on patch size.
‡Many patients describe their experience with methylphenidate SR preparations as erratic and uncomfortable.