Organizing and delivering treatment for ADHD

Following diagnosis, all children with ADHD will require some form of intervention and most will require treatment over a relatively prolonged period of time. Before embarking on medicating a child for ADHD it is important that both the treating doctor and parent (carer) have a good understanding of the child’s ADHD; a full history which includes environmental exposures and stress in pregnancy and early childhood; exclusion of conditions that may mimic ADHD (although can often be associated with ADHD), a through assessment with includes information from several sources, and an assessment of comorbidities associated with ADHD. Managing ADHD can be a complex journey where good communication with your patient, family and other allied professionals will greatly enrich this journey. We review potential modes of action of ADHD medications which explain (i) why careful dose titration of stimulant and psychotropic medications is essential; (ii) why combination of stimulants and an SSRI can be effective in enhancing emotional regulation – given that 5HT plays a key role in OFC function; (iii) why combination of stimulants and antipsychotic can reduce emotionality, anxity, agitation and aggression – given that stimulants target D1 and alpha2A receptors, while anti-psychotics target D2 receptors; (iv) why guanfacine and clonidine – alpha 2A agonists - have a role in ADHD management as a monotherapy or combination therapy; and (v) the relevance of pharmacokinetics.