ADHD
DH is a 10-year-old boy diagnosed 2 years ago with ADHD and is currently being treated with Adderall XR 20 mg every morning. At a parent-teacher meeting, DH's mother was informed that his behavior is well controlled; however, at home, she has difficulty getting him to complete any afternoon tasks or school homework. Rules set for DH at home include no playtime activities until his homework is complete. Instead of focusing on homework, he insists on video games. He is sometimes careless with toys and has exhibited impulsive and reckless behavior when interacting with his younger brother. Although the medication he is on seemed to be working, the behaviors have progressively gotten worse. His mother is afraid that these afternoon behaviors will have serious consequences on DH's daytime behavior and grades.
PMH
• Asthma x 3 yr
• ADHD x 2 yr
• Tonsillectomy (s/p 1 yr)
• Vaccines up to date
FH
• Father and uncle have a history of hyperactivity and are receiving treatment as adults
MEDS
• Adderall XR 20 mg qam
• Albuterol MDI ii puffs q 4-6 h prn
• Singulair 5 mg po qd
ROS
• PE was difficult as he could not sit still for more than 30 sec; asthma appears controlled
VS
• BP 110/72
• Wt 50 kg
• P 82
• Ht 5'2''
• RR 25
• T 37.50 C
CV
• RRR
NEURO
• A&O x 3, no tics noted
LABS
• WNL
Questions
1. Are there any problems to consider (concurrent conditions, medications, history etc.) prior to making any changes in this patient?
2. The patient has a diagnosis of ADHD in the past as consistent with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria for ADHD. Provide a list of symptoms (or suspected symptoms based on HPI and ROS) that meet these criteria in DH.
3. What are the goals of treatment (pharmacotherapy and nonpharmacotherapy) for a patient diagnosed with ADHD?
4. What pharmacotherapeutic stimulant and nonstimulant dosage formulations are available for the treatment of ADHD (provide some information on each e.g., special characteristics, onset, duration, etc.)?
5. What drug, dosage form, dose, schedule, and duration of therapy are best for this patient?
6. What therapeutic alternatives would be appropriate if the patient fails to respond to stimulant therapy or cannot tolerate it (include appropriate dosing)?
7. What clinical and laboratory parameters are necessary to evaluate the therapy for achievement of the desired therapeutic outcome and to detect or prevent adverse effects?