A clinician's guide for navigating the world of attention deficit hyperactivity disorder medications

Abstract

Our knowledge and understanding of the underlying neurobiology and symptomatic expression of ADHD has advanced dramatically over the past decade. Associated with these advances has been a similar explosion of new formulations for individualization of treatment based on our patient’s needs. Optimized treatment is enhanced by measuring and tracking ADHD symptoms with the goal of treating to symptomatic remission with minimal functional impairment. Individual clinical presentation and patient response guide a clinician’s choice between chemical classes of medications: methylphenidate, amphetamine, or non-stimulant. Within both classes of stimulant, we now have delivery systems that tailor the release kinetics to each individual patient with immediate-release, 8-hour sustained-release, 12 hour sustained-release, and 13 to 16 hour sustained-release. In addition, we now have an evening dosed DR/ER methylphenidate that captures morning symptoms with sustained symptom control throughout the day and into the evening. A deeper understanding of the functional difficulties encountered by ADHD patients throughout their lives, coupled with more consistent use of ADHD rating scales enables clinicians to choose between a wide variety of medication delivery systems in order to optimize the outcome for each of their patients