The Texas Children's Medication Algorithm Project: Revision of the Algorithm for Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder
Abstract
Objective In 1998, the Texas Department of Mental Health and Mental Retardation developed algorithms for medication treatment of attention-deficit/hyperactivity disorder (ADHD). Advances in the psychopharmacology of ADHD and results of a feasibility study of algorithm use in community mental health centers caused the algorithm to be modified and updated.Method We convened a consensus conference of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families to revise the algorithms for the pharmacotherapy of ADHD itself as well as ADHD with specific comorbid disorders. New research was reviewed by national experts, and rationales were provided for proposed changes and additions to the algorithms. The changes to the algorithms were discussed and approved both by the national experts and experienced clinicians from the Texas public mental health system.Results The panel developed consensually agreed-upon algorithms for ADHD with and without comorbid disorders. The major changes included elimination of pemoline as a treatment option, adding atomoxetine to the algorithm, and refining guidelines for treating ADHD with comorbid depression, aggressive behaviors, and tic disorders.Conclusions Medication algorithms for ADHD can be modified to keep abreast of developments in the field. Although these evidence- and consensus-based treatment recommendations may be a useful approach to guide the treatment of ADHD in children, additional research is needed to determine how these algorithms can be used to maximally benefit child outcomes.
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Stimulants are the mainstay of pharmacotherapy for ADHD, and their safety and efficacy have been well documented.
“Stimulants are the mainstay of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD). Their safety and efficacy have been well documented [1-3].”
From A 13-hour laboratory school study of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder (2009) · cites this paper as [1]
In some cases, treatment of ADHD may resolve the comorbid condition, for example, improvement in coexisting aggression and/or oppositional defiant, depressive, or anxiety symptoms.
“In some cases, treatment of the ADHD may resolve the comorbid condition. For example, treatment of ADHD may lead to improvement in coexisting aggression and/or oppositional defiant, depressive, or anxiety symptoms.150,151”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [150]
AAP guidelines note that if the diagnosis of ADHD is confirmed, appropriate treatment of ADHD can result in the resolution of comorbid symptoms such as anxiety.
“If the diagnosis of ADHD is confirmed, the AAP guidelines note that appropriate treatment of ADHD can result in the resolution of comorbid symptoms such as anxiety [54].”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [54]
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- Authors
- PLISZKA, S. R., CRISMON, M. L., HUGHES, C. W., CORNERS, C. K., EMSLIE, G. J., JENSEN, P. S., McCRACKEN, J. T., SWANSON, J. M., & LOPEZ, M.
- Affiliations
- Texas Department of State Health Services (US)
- Corresponding author
- PLISZKA, STEVEN R.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2006-06
- Volume
- 45
- Issue
- 6
- Pages
- 642-657
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2167062019
- Cited by
- 442
- References
- 54
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 11 · 2023: 4 · 2022: 11 · 2021: 10 · 2020: 14 · 2019: 10 · 2018: 17 · 2017: 19 · 2016: 28 · 2015: 24 · 2014: 23 · 2013: 26 · 2012: 39
- FWCI
- 26.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, ADHD medication, medication algorithm, consensus conference, atomoxetine, pemoline, comorbid depression, aggression, tic disorders, children, community mental health centers, treatment guidelines
- MeSH terms
- Atomoxetine Hydrochloride, Algorithms, Attention Deficit Disorder with Hyperactivity, Child, Community Mental Health Centers, Humans, Propylamines, Psychopharmacology, Texas, United States, Practice Guidelines as Topic, Adrenergic Uptake Inhibitors
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