Primary care plays a key role in the management of
ADHD
Monitoring for adverse effects and response to treatment
Specialist review of progress is usually performed at least six monthly and more frequently during initiation and adjustment of medication. However general practitioners are likely to be involved with ongoing prescriptions, when they see the patient with other conditions, or to discuss side effects.
Methylphenidate and dexamphetamine are started at low dose and increased slowly to allow monitoring of effect and side effects. Common side effects include insomnia, nervousness, headache, decreased appetite, gastrointestinal symptoms and minor cardiovascular effects such as minor increases in blood pressure or pulse rate.
Significant side effects of stimulant medications that should always be reported by families include tics, major mood changes with marked sadness, anxiety or aggression, fainting, symptomatic cardiovascular issues such as tachycardia or palpitations and any bizarre or persecutory thoughts.
A period of five to seven days between dose increases allows adjustment to minor side effects and assessment of response to treatment. Maintenance doses are the lowest doses which produce optimal therapeutic responses without significant side effects.
When response to treatment appears unsatisfactory, checks for side effects, adherence and timing issues are reviewed before dose adjustment is considered.
Stimulants routinely result in appetite and weight loss. Although growth in height is less than expected, most studies show that children with ADHD continue to grow while medicated. These deficits in expected height could be transient maturational delays that are associated with ADHD. Overall height seems to be unaffected if treatment is discontinued in adolescence and several long-term studies suggest that deficits in expected height are reversible even with continued treatment for two to three years, although no attenuation was recorded over two years in one study. Clinicians should continue to monitor growth in children treated with stimulant drugs.5
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