Medication Management of Children with ADHD: Communication Strategies to Improve Safety

BACKGROUND: Attention Deficit and Hyperactivity Disorder (ADHD) is a common neurologic disorder that affects children and adolescents and can persist into adulthood. According to the National Center for Health Statistics, there is an estimated prevalence of 4.4% to 5.2% in the general U.S population, but 7.8% of the school-age population (more than 6 million children in the U.S.). Getting children to follow a treatment regimen can be challenging and medication adherence is an essential determinant of clinical success. Pharmacist-comanaged ADHD programs may provide an improvement in medication management strategies in children. The objective of this study was to systematically review medication management models that provide safe and effective care to children and adolescents with ADHD.

METHODS: A comprehensive and systematic literature search using PubMed from 2013-2023 was performed and included search terms: "Attention Deficit Disorder with Hyperactivity/diagnosis”, "Practice Guideline”, "Attention Deficit Disorder with Hyperactivity/drug therapy", "Stimulant”, "Non-Stimulant”, "Protocols”, "Models”, "Safety”, "Pharmacist”, and "Treatment”. Article abstracts were reviewed and considered for inclusion if they used an appropriate ADHD rating scale to measure efficacy of therapy and evaluated relevant therapy. After reviewing the selected articles each article was graded based on the CEBM levels of evidence. Two authors independently reviewed the titles and abstracts for inclusion of relevant studies. Full text was reviewed to determine final inclusion. If confusion existed regarding article inclusion/exclusion, it was resolved by discussion between two authors. Results were reported according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). A table was developed to record findings from each included article and contained year of publication, author, title, research design, interventions, findings, source, and grade.

RESULTS: A total of 22 articles were included in this review. A variety of guidelines exist regarding ADHD diagnosis. Most follow DSM-V although no clear consensus has been developed. Based on a patient's age, stimulants are a typical first line therapy in treating children and adolescents with ADHD. Stimulants pose a variety of safety concerns including reduced appetite, insomnia, and cardiovascular events. Based on stigma regarding stimulant use, parents have sought nonpharmacologic options to therapy. Characteristics of pharmacist co-managed ADHD programs include a standardized protocol for assessment, referral, and follow-up, psychosocial intervention, titration and monitoring of medications/adverse effects, and a communication plan. Successful programs include medication management provided via in-person as well as telehealth visits and a majority of patients with a current Health Plan membership.

CONCLUSION: Pharmacist co-managed ADHD programs have been shown to be effective in the improvement of safety outcomes for children and adolescents with ADHD. ADHD remains a prevalent and growing topic among parents, teachers, caregivers, and healthcare providers. Further research, including highlighting outcomes associated with combined pharmacological and psychosocial treatments, is warranted to improve safety. Depending on the patient’s current health status, medical history, and use of other medications, parents need to work with their physician and pharmacist to determine the best treatment.