Accepted
at 5:19 a.m. Nov, 12, 2025
by
julian_stevenson
Author:
kcro9559
Type of change:
Other
Rationale for change
yes/no question to better question
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Personal Notes
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Missed Questions
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eTG Complete
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Talley & O'Connor
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Additional Resources
ADHD Management
Pharmacological management
Stimulants in ADHD
Atomoxetine is used if:
Guanfacine is used if:
Clonidine
Monitoring drug treatment in ADHD
Review child regularly: monthly in early stages then a few times a year. Monitor the following:
Duration of pharmacotherapy in ADHD
- First-line: Nonpharmacological: Social and organisational skills, cognitive training, parent behaviour training, classroom management measures, relationship with staff
- Routine dietary modification is not indicated
Pharmacological management
- Individualized, multimodal management plan
- Prescribed by clinician with expertise in using psychotropics in children
- Take baseline measurements before starting: height, weight, heart rate, blood pressure
- Stimulants are first-line
Stimulants in ADHD
- Improve attention, reduce hyperactivity and impulsiveness
- Do not use in children younger than 6 years
- Drugs and formulations distinguished based on duration of effect
- For individual variability in dosing, titrate according to response and tolerability e.g. more frequent dosing, switching from short- to long-acting, combining both
- If no improvement despite optimal and maximal dosing for 1 month, try another stimulant, review diagnosis, or consider alternative pharmacotherapy
- Given at or immediately after meals. Late evening doses avoided.
- When optimal dose of immediate-release methylphenidate has been established, consider switching to long-acting
- Stimulants can cause hypertension
Atomoxetine is used if:
- Tx with stimulants is not suitable or tolerated
- Risk of misuse of stimulants by guardian or child
- Comorbid motor tics, Tourette syndrome, or a severe anxiety disorder
Guanfacine is used if:
- Tx with stimulants or atomoxetine is not tolerated (e.g. sleep disturbance)
- As adjunctive tx to stimulant with inadequate response
- Comorbid tic disorder (Tourettes)
- Can cause hypotension and, when withdrawn, rebound hypertension
Clonidine
- Similar role to guanfacine
- Limited by short half-life, takes weeks to act
- Does not affect inattention Sx
- May cause depression
- Can cause hypotension and, when withdrawn, rebound hypertension
Monitoring drug treatment in ADHD
Review child regularly: monthly in early stages then a few times a year. Monitor the following:
- Symptoms: Determine titration. Social withdrawal and tearfulness indicate excessive dose
- Height and weight
- BP and HR: If clinically significant, further investigate (e.g. ECG)
- Adverse effects: Children usually become tolerant. Adjust dose or change if not.
- Comorbid conditions, including substance abuse
- Adherence
Duration of pharmacotherapy in ADHD
- Review the need for Tx at least once a year. Consider: patient preference, adverse effects, benefits, impact of Tx or no Tx on other aspects of life
- Stimulants can be stopped abruptly but if close or at maximum dose => reduce gradually
- Atomoxetine can be stopped abruptly
- Clonidine reduced gradually over at least 7 days
- Guanfacine reduced gradually by no more than 1 mg every 3 to 7 days
Additional Resources (Synced)
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Source
Therapeutic Guidelines Accessed August 29, 2025
One by one
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