Pharmacological management of attention-deficit/hyperactivity disorder in adolescents: an update

The aim of this paper is to provide an update to a previously published selective review of the recent literature on the pharmacology of attention-deficit/hyperactivity disorder (ADHD) in adolescents. About one half of children medicated for ADHD will continue to experience sufficient impairment during adolescence to warrant the continuation of their treatment. A smaller number of people with ADHD may require treatment for the first time in adolescence. The academic and social demands of adolescence can exaggerate the impairment caused by attentional problems. Adolescents, more so than children, have activities in the afternoon and evening that will tax their attentional abilities. Stimulant and non-stimulant medications are likely to be as effective for adolescent patients as they are for younger children, provided treatment adherence is satisfactory. Long-acting medications are preferred over immediate release compounds as they provide better coverage of symptoms throughout the day. Patterns of comorbidity with ADHD change from childhood to adolescence and may require a shift in treatment strategy. Picking a time to discontinue treatment should be a decision shared by the clinician and the patient. A negotiated trial off treatment followed by a review can avert premature discontinuation of treatment.