The clinical guidelines for treating Attention Deficit Hyperactivity Disorder (ADHD) encompass a comprehensive approach that includes diagnostic criteria, pharmacological interventions, non-pharmacological interventions, and specific considerations for adult patients.
Diagnostic criteria
- ADHD should be diagnosed according to the DSM-5 criteria, which includes documentation of symptoms and impairment in one or more major settings (social, academic, or occupational). Information should be primarily drawn from reports from parents or guardians, teachers, other school personnel, and mental health clinicians involved in the patient's care. Any alternative cause should be ruled out
Pharmacological interventions
- For adolescent patients aged 12–18 years, US FDA-approved medications should be offered
- In adult patients, stimulants are recommended as first-line pharmacotherapy . Other options for pharmacologic treatment include non-stimulants and antidepressants
- Doses of medications should be titrated to achieve maximum benefit with tolerable side effects
- In patients with stimulant use disorder, certain agents such as topiramate combined with extended-release mixed amphetamine salts, long-acting amphetamine formulation psychostimulants, and long-acting methylphenidate formulations should be considered
Non-pharmacological interventions
- Structured physical exercise should be considered to improve motor skills and functioning, including attention and executive functioning, and reduce anxiety and problem behaviors in pediatric and adolescent patients
- Psychosocial interventions focused on social, cognitive, and organizational skills should be considered to improve development and functioning in pediatric and adolescent patients
- In adult patients, cognitive behavioral therapy, mindfulness, dialectical behavior therapy, and hypnotherapy should be considered
Specific considerations for adult patients
- In adult patients, validated diagnostic tools and history should be used to confirm DSM-5 criteria for ADHD
- Cognitive behavioral therapy (CBT) should be considered as an adjunct to pharmacotherapy
- Neuropsychological testing should be considered to increase the diagnostic accuracy of adult ADHD when collateral information such as childhood history and observer reports is lacking, malingering is suspected, or confounding mental comorbidities are present
- Adult patients with ADHD should be monitored for signs of diversion and misuse of stimulant medication, especially young adults
In conclusion, the clinical guidelines for treating ADHD involve a multimodal approach that includes a comprehensive diagnostic process, pharmacological and non-pharmacological interventions, and specific considerations for adult patients.