ADHD across the lifespan — assessment and multimodal management (MEQ)

(i) Assessment priorities. Multi-informant history (child, parents, school) covering inattention and hyperactivity-impulsivity symptoms, onset before age 12, multi-setting presence, and functional impairment. Review report cards/prior assessments. Screen comorbidity: ODD, learning disorder, anxiety, mood, tics, sleep, substances (energy drinks as gateway curiosity). Developmental and family history (father ADHD). Baseline before medication: height, weight, BP, HR, cardiac history and family sudden death; consider ECG if indicated by history/exam. Hearing/vision and sleep history. Consider psychoeducational testing if learning disorder suspected. Shared decision-making and consent with parents and developmentally with the child. Local prescribing authority requirements for stimulants.^[4]

(ii) Working diagnosis and differentials. Working diagnosis: ADHD combined presentation, moderate-severe, with mild oppositional features; rule out/formulate learning disorder contribution. Anxiety: worry-linked inattention without lifelong multi-setting developmental pattern. Learning disorder: skill-specific underachievement with relatively preserved attention elsewhere. Bipolar: episodic elevated mood, decreased need for sleep, grandiosity — not chronic from early school years. Substance-induced symptoms: currently low-level; still counsel. Medical mimics only if red flags (sleep apnoea, thyroid, hearing).^[4]

(iii) Multimodal plan. Psychoeducation; behavioural parent training; classroom strategies (seating, chunked tasks, daily report card). For moderate-severe impairment, first-line stimulant example: long-acting methylphenidate product-specific morning dosing with weekly titration to response/tolerability (IR alternatives if needed), monitoring height/weight, BP, HR, appetite, sleep, mood/tics, adherence and school function. Alternative non-stimulant: atomoxetine start ~0.5 mg/kg/day then toward ~1.2 mg/kg/day (max ~1.4 mg/kg or 100 mg per many labels) with delayed onset counselling; or guanfacine XR from 1 mg with BP/HR/sedation monitoring if preferred/adjunct pathway. Review response with rating scales and teacher feedback.^[2][3][4]

(iv) MTA logic. At 14 months, carefully managed medication and combined treatment were superior to behavioural treatment alone and community care for core ADHD symptoms; combination may help non-ADHD domains. Behavioural interventions remain important for broader function and parent skills even when medication is used.^[1]

(v) Substance and driving counselling. ADHD elevates lifetime SUD risk; early open discussion about diversion, peers, cannabis/alcohol, and safe storage of stimulants. Looking ahead to adolescence: elevated relative road traffic risk; counsel distraction/impulsivity, sleep, substances, medication timing; document advice; licensing/reporting is jurisdiction-specific.^[5][6]