A 12-Year-Old Boy With Falling Grades and Forgetful Behavior

Stephen Soreff, MD; Foad Afshar, PsyD, EdM

Disclosures

June 25, 2019

Any treatment program for a patient with ADHD rests on 4 pillars. The first is individual psychotherapeutic work with the patient; this can be behavioral, dynamic, educational, or cognitive.[16] Additionally in this realm, numerous alternative approaches and diets are available, although these need more evaluation.[17]

Second, treatment that involves the family includes education, guidelines, instructions, and listening. Third, an individualized education plan in the school should be developed with the patient’s teachers, guidance counselor, and family. The fourth pillar is medication, if the symptoms of ADHD are debilitating and severe and cause impairment in school, at home, or at work. Stimulants (methylphenidate, dextroamphetamine) are first-line therapy, as they are generally the most effective drugs for treating ADHD.[9] More specific, age-related pharmacologic interventions are outlined in guidelines from the US Centers for Disease Control and Prevention (CDC).[8,11] What remains key is that treatment requires all four pillars. Too often, people see medication alone as the basic approach. ADHD can be viewed a dynamic issue within the context of the school and community.

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