DSM 5 Shorthand Descriptions of Diagnosis:
Attention Deficit Disorder-Hyperactivity Disorder (ADHD): developmentally inappropriate and persistent difficulty with inattention and/or hyperactivity with symptoms present in multiple settings.
Diagnosing ADHD in Adults: ADHD often lasts into adulthood. To diagnose ADHD in adults and adolescents age 17 years or older, only 5 symptoms are needed instead of the 6 needed for younger children. Symptoms might look different at older ages. For example, in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.
-Common Child Disorders DSM-5 Criteria
Plan of Care (Steps for Treating ADHD)
Side note: private practice or other clinics may not require these considerations but this post is primarily for treating ADHD in community settings:
- Consider formal testing but it’s not mandatory: an ADHD diagnosis can include formal psychological testing because it may rule out other learning delays or issues. It should be covered by insurance for kids but if not, using rating scales or more affordable options are equally as important to not hinder further treatment. Some psych settings you can print/write a prescription for psychological testing e.g., F.90.1 psychological testing for IQ r/o ADHD. Other facilities may have referral paperwork or use other methods to do testing. However, obtaining a prescription monitoring report helps with the past history of care, prevent/reduce misusage, and in many states it is MANDATORY prior to prescribing.
- Insurance and Costs: these medications can be expensive, and need prior authorization particularly if the medication isn’t generic or the starting dose is too high, etc. Try using generic medications first, such as bupropion, atomoxetine, mixed salts, etc. and start at the lowest dosage…
- “Start Low and Go Slow” Approach: For children, especially younger ones (before puberty), providers should start with non-stimulants (e.g., guanfacine or clonidine) to minimize side effects like sleep and growth/appetite issues. Consider stimulant/medication breaks during non-school days to also help reduce side-effects.
- Medication Selection: Amphetamines (e.g., Adderall) are standard for high acuity patients, but can be too harsh for young or small patients, so methylphenidate or non-stimulants may be preferable. Prioritize sleep, and consider med breaks or low doses when using stimulants.
- Managing Side Effects and Cautions: providers should rule out or monitor heart conditions, potential side effects like tics, and consider stimulant use carefully. Drug testing, although important, can be challenging in practice, but records from external sources like PCP, inpatient/hospitals records can also be useful.
- Targeting Other Factors: Educate families on proper eating, activity, and especially since sleep that can worsen ADHD symptoms and mood issues. The quality of sleep or simply asking questions should be discussed in sessions, e.g. problems falling/staying asleep, nightmares, etc. Educate about avoiding triggering/harmful content.
- Address the MOOD: ADHD treatment can improve the poor behaviors by simply having the kid finally paying attention to directions, instructions, and improving the learning capabilities. However, if issues like the impulsivities and aggressions doesn’t improve, risperidone or aripiprazole are good alternatives for low-dose treatment in children. Genetic testing during the intake process is also important to help tailor medication choices and avoid adverse reactions.
- Consider Genetic Testing: Lastly, this can easily lead to a child having multiple medications prescribed and increase risks for side-effects. Genetic testing can guide better treatment decisions, avoiding repeated trial-and-error medication adjustments, and help families who have doubts and worries due to past medication failures.. Sidebar: genetic testing is also favorable with certain demographics that usually respond adversely with Western medicines, e.g. Asians, Blacks, Hispanics, etc.
About (Non) Stimulants
What are Stimulants? As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration (National Institute on Drug Abuse, 2014). Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD.
Stimulants used to treat ADHD include from NIH:
Note: In 2002, the FDA approved the non-stimulant medication atomoxetine for use as a treatment for ADHD. Two other non-stimulant antihypertensive medications, clonidine, and guanfacine are also approved for the treatment of ADHD in children and adolescents. One of these non-stimulant medications is often tried first in a young person with ADHD, and if the response is insufficient, then a stimulant is prescribed.
Stimulants are also prescribed to treat other health conditions, including narcolepsy, and occasionally depression (especially in older or chronically medically ill people and in those who have not responded to other treatments).
How do people respond to stimulants?
Prescription stimulants have a calming and “focusing” effect on individuals with ADHD. Stimulant medications are safe when given under a doctor’s supervision. Some children taking them may feel slightly different or “funny.”
Some parents worry that stimulant medications may lead to drug abuse or dependence, but there is little evidence of this when they are used properly as prescribed. Additionally, research shows that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications.
What are the possible side effects of stimulants?
Stimulants may cause side effects. Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include:
- Difficulty falling asleep or staying asleep
- Loss of appetite
- Stomach pain
- Headache
Less common side effects include:
- Motor tics or verbal tics (sudden, repetitive movements or sounds)
- Personality changes, such as appearing “flat” or without emotion
Stimulants may cause other side effects that are not included in the list above. To report any serious adverse effects associated with the use of stimulants, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects of each medication, please see Drugs@FDA.
–Read More About Common Medications
Additional Resources & Organizations
- American Academy of Child and Adolescent Psychiatry (AACAP)
- Attention Deficit Disorder Association (ADDA)
- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
- Learning Disabilities Association of America (LDA)
