Psychiatry Medical News about Attention Deficit Disorder with Hyperactivity

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Taking the stress out of individualizing ADHD drug therapy
Canadian Family Physician, 09/16/09

McLeod M et al. – This case illustrates that psychostimulants administered once daily in a long–acting formulation can offer some advantages, particularly in school–aged children. However, as with all medication, adherence to ADHD medication regimens can decrease over time. It is essential, therefore, that strategies are employed to improve adherence. Other strategies that have been effective for improving adherence included the following:

Educate patients and parents about anticipated results, benefits, and possible adverse effects.
Provide frequent follow–up early in treatment, especially during dose titration.
Strive for dose optimization.
Identify and treat comorbid conditions.

Individualizing therapy. What if...

early–morning symptoms are not well controlled?
- Add 1 dose of immediate–release methylphenidate at breakfast or switch to a long–acting agent with a higher ratio of immediate release (such as Biphentin or Adderall XR)
the patient develops reduced appetite or weight loss?
- Give drug with meals; give high–calorie meals when stimulant effects are low (eg, breakfast, bedtime)
- Engage child in meal selection and preparation Consider nonstimulant treatment (eg, atomoxetine)
the patient has swallowing problems?
- Adderall XR, Biphentin, and Dexedrine Spansules can be opened up and sprinkled onto food
the patient also develops comorbid aggression?
- Reduce or discontinue stimulant; consider behavioural therapy; possibly consider atypical antipsychotics or clonidine