TABLE 8

KAS 5c: For adolescents (age 12 years to the 18th birthday) with ADHD, the PCC should prescribe FDA-approved medications for ADHD with the adolescent’s assent (grade A: strong recommendation). The PCC is encouraged to prescribe evidence-based training interventions and/or behavioral interventions as treatment of ADHD, if available. Educational interventions and individualized instructional supports, including school environment, class placement, instructional placement, and behavioral supports, are a necessary part of any treatment plan and often include an IEP or a rehabilitation plan (504 plan). (Grade A: strong recommendation.)

Aggregate evidence qualityGrade A for Medications; Grade A for Training and Behavioral Therapy
BenefitsTraining interventions, behavioral therapy, and FDA-approved medications have been demonstrated to reduce behaviors associated with ADHD and to improve function.
Risks, harm, costBoth therapies increase the cost of care. Psychosocial therapy requires a high level of family and/or school involvement and may lead to unintended increased family conflict, especially if treatment is not successfully completed. FDA-approved medications may have some adverse effects, and discontinuation of medication is common among adolescents.
Benefit-harm assessmentGiven the risks of untreated ADHD, the benefits outweigh the risks.
Intentional vaguenessNone.
Role of patient preferencesFamily preference, including patient preference, is likely to predict engagement and persistence with a treatment.
ExclusionsNone.
StrengthStrong recommendation.
Key referencesEvans et al25; Webster-Stratton et al87; Evans et al95; Fabiano et al93; Sibley and Graziano et al94; Langberg et al96; Schultz et al97; Brown and Bishop104; Kambeitz et al105; Bruxel et al106; Froehlich et al108; Joensen et al109