Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Follow-up

  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Apr 07, 2016
 

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.

Next

Complications

Coexisting neuropsychiatric disorders and learning disorders can complicate the diagnosis and treatment of ADHD (ADD). See History.

Previous
Next

Prognosis

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.
Previous
Next

Patient Education

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).

For excellent patient education resources, visit eMedicineHealth's Mental Health Center. Also, see eMedicineHealth's patient education article Attention Deficit Hyperactivity Disorder.

Previous
 
Contributor Information and Disclosures
Author

Maggie A Wilkes, MD Resident Physician, Department of Psychiatry, Medical University of South Carolina College of Medicine

Maggie A Wilkes, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Eve G Spratt, MD, MSc Professor of Pediatrics and Psychiatry, Division of Developmental Pediatrics, Medical University of South Carolina; Director, Pediatric Consultation Liaison Psychiatry, Medical University of South Carolina Children's Hospital at Charleston

Eve G Spratt, MD, MSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Stacey M Cobb, MD Fellow in Developmental and Behavioral Pediatrics, Clinical Instructor, Department of Pediatrics, Medical University of South Carolina College of Medicine

Stacey M Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Society for Developmental and Behavioral Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Zainab P Contractor, MD Medical Director, The Affinity Center

Disclosure: Nothing to disclose.

Chet Johnson, MD Professor and Chair of Pediatrics, Associate Director, Developmental Pediatrician, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas School of Medicine; LEND Director, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Christine A Mayhall, PhD Clinical Psychologist, The Affinity Center

Christine A Mayhall, PhD is a member of the following medical societies: American Psychological Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.

  2. Brown TE. Brown ADD Scales. San Antonio, TX: Psychological Corp; 1996:5-6.

  3. Daley D, van der Oord S, Ferrin M, et al, for the European ADHD Guidelines Group. Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry. 2014 Aug. 53(8):835-847.e5. [Medline].

  4. Brauser D. Behavioral interventions effective for ADHD. Medscape Medical News. July 31, 2014. [Full Text].

  5. Spinelli S, Joel S, Nelson TE, Vasa RA, Pekar JJ, Mostofsky SH. Different neural patterns are associated with trials preceding inhibitory errors in children with and without attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2011 Jul. 50(7):705-715.e3. [Medline].

  6. Ducharme S, Hudziak JJ, Botteron KN, Albaugh MD, Nguyen TV, Karama S, et al. Decreased regional cortical thickness and thinning rate are associated with inattention symptoms in healthy children. J Am Acad Child Adolesc Psychiatry. 2012 Jan. 51(1):18-27.e2. [Medline]. [Full Text].

  7. FDA. FDA Permits Marketing of First Brain Wave Test To Help Assess Children and Teens for ADHD. US Food and Drug Administration. Jul 15 2013. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm360811.htm.

  8. Lowes R. First Brain-Wave Test for ADHD Approved by FDA. Medscape Medical News. Jul 15 2013. [Full Text].

  9. Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan. 51(1):86-97.e8. [Medline].

  10. Melville N. ADHD Meds May Double Cardiovascular Event Risk in Kids. Medscape Medical News. Available at http://www.medscape.com/viewarticle/827747.. Accessed: July 6, 2014.

  11. Dalsgaard S, Kvist AP, Leckman JF, Nielsen HS, Simonsen M. Cardiovascular Safety of Stimulants in Children with Attention-Deficit/Hyperactivity Disorder: A Nationwide Prospective Cohort Study. J Child Adolesc Psychopharmacol. 2014 Jun 23. [Medline].

  12. Cassels C. ADHD Meds Linked to Priapism, Prompts FDA Warning, Label Change. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/817936. Accessed: December 21, 2013.

  13. Pfizer. Pfizer Receives U.S. FDA Approval of New QuilliChew ER™ (methylphenidate hydrochloride) extended-release chewable tablets CII. Available at http://www.pfizer.com/news/press-release/press-release-detail/pfizer_receives_u_s_fda_approval_of_new_quillichew_er_methylphenidate_hydrochloride_extended_release_chewable_tablets_cii?linkId=19384409. December 7, 2015; Accessed: December 7, 2015.

  14. Brauser, D. FDA approves ADHD drug for maintenance treatment in kids. Medscape Medical News. May 2, 2013. Available at http://www.medscape.com/viewarticle/803516. Accessed: May 13, 2013.

  15. Blader JC, Schooler NR, Jensen PS, Pliszka SR, Kafantaris V. Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy. Am J Psychiatry. 2009 Dec. 166(12):1392-401. [Medline]. [Full Text].

  16. Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA. 2011 Dec 28. 306(24):2673-83. [Medline]. [Full Text].

  17. Wilens TE, Bukstein O, Brams M, Cutler AJ, Childress A, Rugino T, et al. A controlled trial of extended-release guanfacine and psychostimulants for attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2012 Jan. 51(1):74-85.e2. [Medline].

  18. Doyle K. Methylphenidate Reduces Injuries in Kids With ADHD. Medscape Medical News. Available at http://www.medscape.com/viewarticle/836933. Accessed: December 20, 2014.

  19. Man KK, Chan EW, Coghill D, Douglas I, Ip P, Leung LP, et al. Methylphenidate and the Risk of Trauma. Pediatrics. 2014 Dec 15. [Medline].

  20. Elia J, Ambrosini PJ, Rapoport JL. Treatment of attention-deficit-hyperactivity disorder. N Engl J Med. 1999 Mar 11. 340(10):780-8. [Medline].

  21. Adisetiyo V, Jensen JH, Tabesh A, Deardorff RL, Fieremans E, Di Martino A, et al. Multimodal MR Imaging of Brain Iron in Attention Deficit Hyperactivity Disorder: A Noninvasive Biomarker That Responds to Psychostimulant Treatment?. Radiology. 2014 Jun 17. 140047. [Medline].

  22. Brauser D. Too much TV linked to aggression, inattention in kids. Medscape Medical News. Available at http://www.medscape.com/viewarticle/772099. Accessed: October 15, 2012.

  23. Brooks M. Eye Test May Diagnose ADHD, Predict Treatment Response. Medscape Medical News. Available at http://www.medscape.com/viewarticle/830188. Accessed: August 23, 2014.

  24. Brooks M. More Than Symptoms at Play in Prescribing ADHD Meds to Kids. Medscape Medical News. Oct 17 2014. [Full Text].

  25. Brooks M. Brain Iron Levels a Potential ADHD Biomarker. Available. Medscape Medical News. Available at http://www.medscape.com/viewarticle/826896. Accessed: June 26, 2014.

  26. Fried M, Tsitsiashvili E, Bonneh YS, Sterkin A, Wygnanski-Jaffe T, Epstein T, et al. ADHD subjects fail to suppress eye blinks and microsaccades while anticipating visual stimuli but recover with medication. Vision Res. 2014 Aug. 101:62-72. [Medline].

  27. Galéra C, Pingault JB, Michel G, et al. Clinical and social factors associated with attention-deficit hyperactivity disorder medication use: population-based longitudinal study. Br J Psychiatry. 2014 Oct. 205(4):291-7. [Medline].

  28. Hand L. Stimulants linked to lower smoking risk in kids with ADHD. Medscape Medical News. May 14, 2014. [Full Text].

  29. Hunt RD, Paguin A, Payton K. An update on assessment and treatment of complex attention-deficit hyperactivity disorder. Pediatr Ann. 2001 Mar. 30(3):162-72. [Medline].

  30. Johnson TM. Evaluating the hyperactive child in your office: is it ADHD?. Am Fam Physician. 1997 Jul. 56(1):155-60, 168-70. [Medline].

  31. Millichap JG. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. 2008 Feb. 121(2):e358-65. [Medline].

  32. Nadeau KG, Littman E, Quinn P. Understanding Girls With AD/HD. Springfield, MD: Advantage Books; 2000.

  33. Ramchandani P, Joughin C, Zwi M. Attention deficit hyperactivity disorder in children. Clin Evid. 2002 Jun. 262-71. [Medline].

  34. Rappley MD. Clinical practice. Attention deficit-hyperactivity disorder. N Engl J Med. 2005 Jan 13. 352(2):165-73. [Medline].

  35. Reeves G, Schweitzer J. Pharmacological management of attention-deficit hyperactivity disorder. Expert Opin Pharmacother. 2004 Jun. 5(6):1313-20. [Medline].

  36. Schoenfelder EN, Faraone SV, Kollins SH. Stimulant Treatment of ADHD and Cigarette Smoking: A Meta-Analysis. Pediatrics. 2014 May 12. [Medline].

  37. Spencer TJ, Biederman J, Wilen T. Pharmacotherapy of ADHD with antidepressants. In: Barkley RS, ed. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. New York, NY: Guilford Press; 1998:552-63.

  38. Verlinden M, Tiemeier H, Hudziak JJ, Jaddoe VW, Raat H, Guxens M, et al. Television viewing and externalizing problems in preschool children: the Generation R Study. Arch Pediatr Adolesc Med. 2012 Oct. 166(10):919-25. [Medline].

  39. Wilens TE. Straight Talk about Psychiatric Medications for Kids. New York, NY: Guilford Press; 2002.

  40. Wolraich ML, ed. The Classification of Child and Adolescent Mental Diagnoses in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child. Elk Grove, IL: American Academy of Pediatrics; 1996.

Previous
Next
 
Table 1. Pediatric Dosing of Stimulant Medications
Medication Initial Pediatric Dose Pediatric Dosage Range and Maximum Dose* Common Pediatric Dose* Preparations
Methylphenidate immediate release (IR) (Ritalin, Methylin, generic)2.5-5 mg0.1-0.8 mg/kg/dose PO qd to 5 times/d; not to exceed 60 mg/d0.3-0.5 mg/kg/dose PO tid/qidAll 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/d0.6-1 mg/kg/dose PO qd/bid10-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/bid20-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/d0.8-1.6 mg/kg PO qd18-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 patch10-30 mg released over 9 h10-mg, 15-mg, 20-mg, 30-mg patches, applied to the hip
Dexmethylphenidate IR (Focalin)2.5-5-mg0.1-0.5 mg/kg/dose PO qd to qid; not to exceed 20 mg/d0.2-0.3 mg/kg/dose PO bid/tid2.5-mg, 5-mg, or 10-mg scored tabs (Do not cut, crush, or chew.)
Dexmethylphenidate extended release (Focalin-XR)5-10-mg0.2-1 mg/kg/dose PO qd to bid; not to exceed 20 mg/d0.4-0.6 mg/kg/dose PO qd/bid5-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 mg0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 60 mg/d0.3-0.5 mg/kg/dose PO qd/tidDexedrine: 5-mg scored tabs; Dextrostat: 5-mg and 10-mg scored tabs
Dextroamphetamine Spansules (Dexedrine CR)5 mg0.1-0.75 mg/kg/dose PO qd/bid; not to exceed 60 mg/d0.3-0.6 mg/kg/dose PO qd/bid5-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 mg0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 40 mg/d0.3-0.5 mg/kg/dose PO tid/qid5-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 mg0.2-1.4 mg/kg/dose PO qd/tid



Not to exceed 30 mg/d



0.6-1 mg/kg/dose PO qd/bid5-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 qam30-70 mg PO qamData limited20-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-ODTEvekeo: 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 limitedEvekeo: 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.



Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.