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cont. from.
SUBCOMMITTEE ON ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
James M. Perrin, MD, Cochairperson
Martin T. Stein, MD, Cochairperson
Robert W. Amler, MD
Thomas A. Blondis, MD
Heidi M. Feldman, MD, PhD
Bruce P. Meyer, MD
Bennett A. Shaywitz, MD
Mark L. Wolraich, MD
CONSULTANTS
Anthony DeSpirito, MD
Charles J. Homer, MD, MPH
Esther Wender, MD LIAISON
REPRESENTATIVES
Ronald T. Brown, PhD Society for
Pediatric Psychology
Theodore G. Ganiats, MD American Academy of Family
Physicians
Brian Grabert, MD Child Neurology Society
Karen Pierce, MD American
Academy of Child and Adolescent Psychiatry
STAFF
Carla T. Herrerias, BS, MPH
COMMITTEE ON QUALITY IMPROVEMENT
Charles J. Homer, MD, MPH, Chairperson
Richard
D. Baltz, MD
Gerald B. Hickson, MD
Paul V. Miles, MD
Thomas B. Newman, MD, MPH
Joan E. Shook, MD
William M. Zurhellen, MD
LIAISON REPRESENTATIVES
Betty A.
Lowe, MD National Association of Children's Hospitals and Related Institutions
Ellen Schwalenstocker, MBA National Association of Children's Hospitals and
Related Institutions
Michael J. Goldberg, MD Council on Sections
Richard Shiffman, MD Section on Computers and Other Technologies
Jan Ellen Berger, MD
Committee on Medical Liability
F. Lane France, MD Committee on Practice and
Ambulatory Medicine
ACKNOWLEDGMENTS
The subcommittee wishes to acknowledge the numerous people and groups that
made development of this clinical practice guideline possible. The subcommittee
would like to thank the Agency for Healthcare Research and Quality and the
McMaster University Evidence-based Practice Center for its work in developing
the evidence report, and William E. Pelham, Jr, PhD, and Peter Jensen, MD, for
their continuous input and insight into the evidence about
treatment of ADHD.
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Fig 1. Algorithm for the
treatment of the school-aged child with Attention-Deficit/Hyperactivity
Disorder.
Click to enlarge
TABLE 1 Medications Used in the Treatment of Attention-Deficit/Hyperactivity
Disorder
| Generic Class (Brand
Name) |
Daily Dosage Schedule |
Duration |
Prescribing Schedule |
| Stimulants
(First-Line Treatment) |
| Methylphenidate |
| Short-acting
(Ritalin, Methylin) |
Twice a day (BID) to
3 times a day (TID) |
3-5 hr |
5-20 mg BID to TID |
Intermediate-acting (Ritalin SR,
Metadate ER, Methylin ER) |
Once a day (QD) to
BID |
3-8 hr |
20-40 mg QD or 40 mg
in the morning and 20 early afternoon |
Long-acting (Concerta,
Metadate
CD, Ritalin LA*) |
QD |
8-12 hr |
18-72 mg QD |
| Amphetamine |
| Short-acting
(Dexedrine, Dextrostat) |
BID to TID |
4-6 hr |
5-15 mg BID or 5-10
mg TID |
Intermediate-acting (Adderall,
Dexedrine spansule) |
QD to BID |
6-8 hr |
5-30 mg QD or 5-15 mg
BID |
| Long-acting (Adderall-XR*) |
QD |
|
10-30 mg QD |
| Antidepressants
(Second-Line Treatment) |
| Tricyclics (TCAs) |
BID to TID |
|
2-5 mg/kg/day† |
| Imipramine,
Desipramine |
| Bupropion |
| (Wellbutrin) |
QD to TID |
|
50-100 mg TID |
| (Wellbutrin
SR) |
BID |
|
100-150 mg BID |
* Not FDA approved at time of publication. † Prescribing and monitoring
information in Physicians' Desk Reference.
TABLE 2 Effective Behavioral Techniques for Children With
Attention-Deficit/Hyperactivity Disorder
| Technique |
Description |
Example |
| Positive reinforcement |
Providing rewards or privileges contingent on the child's
performance. |
Child completes an assignment and is permitted to play on the
computer. |
| Time-out |
Removing access to positive reinforcement contingent on performance
of unwanted or problem behavior. |
Child hits sibling impulsively and is required to sit for 5 minutes
in the corner of the room. |
| Response cost |
Withdrawing rewards or privileges contingent on the performance of
unwanted or problem behavior. |
Child loses free time privileges for not completing homework. |
| Token economy |
Combining positive reinforcement and response cost. The child earns
rewards and privileges contingent on performing desired behaviors and
loses the rewards and privileges based on undesirable behavior. |
Child earns stars for completing assignments and loses stars for
getting out of seat. The child cashes in the sum of stars at the end of
the week for a prize. |
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