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Criteria for initiation of pharmacotherapy in children with ADHD

Criteria for initiation of pharmacotherapy in children with ADHD
Diagnostic assessment is complete and confirms diagnosis of ADHD
Child is age 4 years or older*
Caregivers accept medication as a contribution to management
School will cooperate in administration and monitoring
No previous sensitivity to the chosen medication
Child has normal heart rate and blood pressure
Child has no known cardiac risk factors
Child does not have a significant comorbid condition such as seizures, tics, depression, or anxietyΔ
Substance abuse and stimulant misuse/diversion among household members are not a concern (for children who will be treated with immediate-release stimulants)

ADHD: attention deficit hyperactivity disorder.

* Primary care clinicians may wish to consult a specialist for medication management of children age 4 to 5 years.

¶ It is not safe to permit the child or adolescent to take their own medication to school.

Δ Primary care clinicians may wish to consult with a specialist for management of children with ADHD complicated by comorbid conditions.

◊ Nonstimulants, osmotic release methylphenidate, the methylphenidate patch, and prodrug stimulant formulations are alternatives to immediate-release or more easily abusable stimulant preparations for children who live in households where substance abuse, diversion, and misuse are a concern.

Adapted from: Hill T, Taylor E. An auditable protocol for treating attention deficit/hyperactivity disorder. Arch Dis Child 2001; 84:404.

Updated with information from:
  1. Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2019; 144: e20192528.
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