Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder

The clinician with specialized training or expertise should initiate a comprehensive assessment and develop an interprofessional, multimodal treatment plan for any child or adolescent through age 18 years with suspected or diagnosed complex attention-deficit/hyperactivity disorder (ADHD) upon referral from a primary care clinician.

In the evaluation of a child or adolescent with complex ADHD, the clinician should verify any previous diagnoses and assess for coexisting conditions, employing an evidence-based approach that is developmentally appropriate, culturally sensitive, and inclusive of data from multiple settings and sources (home, school, community). The evaluation should include an appropriate, comprehensive medical history and physical examination, and psychological assessment based on the child’s presenting problems and their severity, functional impairments, cognitive/developmental level, and the judgment of the treating clinician.

Psychoeducation about ADHD and its coexisting conditions and evidence-based behavioral and educational interventions are foundational for the treatment of complex ADHD and should be implemented at the outset of treatment whenever possible. Evidence-based behavioral and educational interventions (e.g., behavioral parent training, behavioral classroom management, behavioral peer interventions, and, for older children, organizational skills training) should be provided to all children and adolescents with complex ADHD. These approaches address key functional domains (behavioral, educational, social) in home, school, and peer settings that are associated with long-term outcomes.

Treatment of complex ADHD should include evidence-based approaches that address ADHD and account for coexisting conditions while respecting family background and preferences. Although behavioral and educational approaches serve as the foundation for intervention, it is often necessary to combine these approaches with pharmacological treatments. Treatment should focus on areas of functional impairment, not just symptom reduction, by incorporating developmentally appropriate strategies for self-management, skill building, and prevention of adverse outcomes (e.g., substance use, conduct problems, depression/anxiety, suicidal ideation, educational failure).

Given that ADHD is a chronic condition that often persists into adulthood, treatment of complex ADHD should include ongoing, scheduled monitoring of patients throughout the lifespan, commensurate with the individual patient’s needs and profile, with particular emphasis on preparing for key developmental transitions (preschool to school, elementary to middle school, middle to high school, and high school to postsecondary education or employment).