Did you note some of the key practice points and exam relevant tips from the CADDRA (Canadian ADHD Resource Alliance) Updated ADHD practice guidelines that were released this year? CADDRA has put together a great document for those that want to do a deep-dive into the latest evidence based guidelines for ADHD and some co-morbid conditions – but for the busy resident or practice-eligible physician here are 3 key take-away tips.
DRIVING SAFETY ASSESSMENT
Patients with ADHD are 2-4X as likely to be in a motor vehicle accident compared to age-adjusted peers. Medications are wearing off in the evenings and that’s when teenagers are most likely driving. In order to avoid accidents, ensure your patients are:
Restricting cell phone use
Limiting night/weekend driving
Recommend manual transmission
You can also use the Jerome Driving Questionnaire in order to have a framework for assessment.
At The Review Course in Family Medicine we teach the SNOFLAKE – SAFETY First!
We know that some ADHD medications can cause growth-delay in some patients and appetite suppression. When this happens what can you do to mitigate this?
Maximize intake during periods when appetite-suppression is low (e.g. breakfast/evening)
Reduce portions and increase snack times (mandatory snack time in PM)
Nutritional supplements + meal replacements
Possible dose reduction, change to alternative agent, or drug holidays
2ND CHANCE DATER
First line treatment with stimulants doesn’t always seem to work. So what does CADDRA recommend prior to moving onto the 2nd and 3rd line treatments such as Atomoxetine and Guanfacine? They recommend using the DATER mnemonic to slowly work through some key issues before moving to those 2nd and 3rd line drugs.
Dosage – Try a higher dose, is the duration of effect adequate?
All – Try all 1st line medications (amphetamine, methylphenidate)
Time – Give time for patient response and for any side effects to resolve
Examine – What are the specific targets for treatment and how are you measuring changes?
Review – Are you missing something? Review and assess for comorbidity, psychosocial complications and any lifestyle issues or changes
1. Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD practice guidelines, 4th ed, Toronto ON: CADDRA; 2018. https://www.caddra.ca/canadian-adhd-practice-guidelines/