Outcome evaluation

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (a) family and social relationships, (b) disruptive behavior, (c) completing required tasks, (d) self-motivation, (e) appearance, and (f) self-esteem. It is very important to elicit evaluations of the patient's behavior from family, school, and social environments in order to assess these outcomes. Using standardized rating scales (e.g., Conners Rating Scales—Revised, Brown Attention-Deficit Disorder Scale, and Inattentive-Overactive With Aggression

[IOWA] Conners Scale) in both children and adults with ADHD helps to minimize

variability in evaluation. After initiation of therapy, evaluate every 2 to 4 weeks to determine efficacy of treatment and potential effects on height, weight, pulse, and blood pressure. Use physical examinations or liver function tests as appropriate to monitor for adverse effects. In children being considered for ADHD pharmacotherapy, obtain baseline ECGs when known or suspected cardiac disease exists or the clinician judges it necessary.34-36 Typically, therapeutic benefits will be seen within days of initiating stimulants and within a month or two of starting bupropion and atomoxet-ine. Once a maintenance dose has been achieved, schedule follow-up visits every 3 months. At these visits, assess height and weight, and screen for possible adverse drug effects. If a patient has failed to respond to multiple agents, reevaluate for other possible causes of behavior dysfunction. Counsel patients and their families that treatment generally is long term. Typically, appropriately treated patients learn to better control their ADHD symptoms as adults.

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