Monitoring
Many children with attention deficit hyperactivity disorder (ADHD) will be treated with medications. Follow-up with the physician should occur at least several times a year and the following parameters should be monitored.[32][91]
Symptoms: parent and teacher rating scales can be particularly helpful in following the level of functioning at home and school. Parents and teachers should be alert for worsening of behaviours, which may indicate need for adjustment of medication (often occurs when the patient grows). Academic failures despite treatment can be a sign of comorbid learning disorder.
Height and weight: use of growth charts to monitor these parameters can demonstrate changes in growth velocity. These parameters should be checked once or twice a year (or more frequently if practical or when results are concerning). A change in height or weight that crosses 2 percentile lines is cause for concern and a dose reduction, medication change, or drug holiday should be considered.
BP and pulse: baseline measures should be obtained at initiation of treatment, when dose is adjusted, and several times annually. Seek specialist advice if drug treatment results in sustained resting tachycardia (>120 bpm), arrhythmia, or systolic blood pressure greater than the 95th percentile (or a clinically significant increase) measured on two occasions, or other significant adverse effects develop.[91]
Adverse effects of medications (including anorexia, insomnia, headache, tics, and irritability): strategies to address adverse effects include further monitoring, dose adjustment, switching medication, or adjunctive medication to treat the adverse effect. Stimulant medications have been associated with cardiovascular side effects, although a 10-year analysis of data from the multimodal treatment study showed no treatment effect on blood pressure.[229] These should be monitored in children with heart conditions.[97]
Assessment for comorbid disorders and medical conditions: careful history and mental status examination can help elicit comorbid disorders including substance use disorders.
Prevention of misuse involves offering developmentally appropriate anticipatory guidance and close monitoring, including educational materials and monitoring pill counts.[109]
Periodic assessment to determine if tapering of medications is indicated. A trial of medications can be initiated if the patient has remained symptom-free for at least 1 year and should occur during a vacation to avoid disruption of school.
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