1. Principles of Treatment

2. Educate, educate, educate Explore family’s explanatory model Respectfully challenge misconceptions Focus on positive coping strategies If parents have ADHD encourage them to seek help Emphasize collaborative teamwork

3. Establish target symptoms & resources Prioritize modalities to fit symptoms Target meds to specific symptoms Monitor multiple domains of functioning Re-evaluate efficacy at follow-up Is treatment working? Any side-effects? Dose?

4. Is there a need for additional treatment? Parent management training Classroom behavioural intervention Remedial teaching OT, Speech & Language, Physio. Consider treatment of Co-morbid conditions Long term supportive contact

5. Behavioural Intervention Time management Organizational skills – managing the environment Communication skills Resilience Frequent re-inforcement 10 min rule Re-focusing reminders

6. Pharmacological Treatments Primary agents Psychostimulants i.e. Methylphenidate Effect size – IR 0.91 LA 0.95 Atomoxetine Effect size – 0.62

7. Adjunctive agents for co-morbidity Mood stabilizers SSRI’s & SNRI’s Neuroleptics Anxiolytics

8. Psychostimulant guide Explain the concept of a medication trial & need to monitor response Discuss which form of MPH ( IR vs LA vs OROS ) Start at a low dose & titrate up until clinical remission or unacceptable side-effects If MPH ineffective or side-effects switch to another medication

9. Secondary Agents Buproprion Alpha-adrenergic agonists Modafanil Tri-cyclic anti-depressants