This tool is designed to support primary care providers in screening, diagnosing and implementing treatment for adult patients (≥ 18 years) with attention deficit hyperactivity disorder (ADHD). ADHD in adulthood can be associated with significant impairment in occupational, academic, social and emotional functioning.1,2 The treatment of ADHD involves pharmacological and non-pharmacological interventions.
Adverse Effects 16, 35
Common adverse effects:
Restlessness, irritability, anxiety, insomnia or anorexia, worsening of aggressive behaviour or hostility at the start of treatment
- Paradoxical psychiatric effects such as rebound, restlessness, irritability, and increased aggression may be observed
- Somatic effects such as insomnia, decreased appetite, tics, stomach ache, and headache are all common, especially at the beginning of therapy
- The slower the rate of titration, the less severe the initial side effects
- Many of these psychiatric and somatic side effects will endure throughout treatment, making drug holidays useful to assess impact of relative risk vs. benefit, and necessitating the regular monitoring of growth
Abrupt withdrawal after prolonged use may result in dysphoria, irritability or rebound in symptoms of ADHD, increase in sleep and appetite reported. Consider tapering over several weeks in patients who poorly tolerate discontinuation or have been on medication for longer than 3 months.
If stimulants are taken in conjunction with an antipsychotic, sudden discontinuation may result in the emergence of extrapyramidal symptoms previously masked by the stimulant.
- Monitor patient for suicidal thoughts/ideation; consider a change in treatment if concerns arise.