©FYNDLAY 2024/2025 ALL RIGHTS RESERVED 2:49PM A+
Treatment of ADHD, Anxiety, and
Depression in Children and Adolescents.
Exam Questions And Answers |Latest 2025 |
Guaranteed Pass.
MTA study of ADHD - Answer✔4 groups, 600 children studied, ages 7-9:
1) Algorithmic medication treatment alone. Methylphenidate TID adjusted for the best dose,
augmentation as needed.
2)Psychosocial treatment alone: Parent training, structured teacher consultation, an 8 week full
time summer treatment program, a 12 week half time classroom behavioral specialist
--1/4th received medication due to lack of benefit
3) Combination of algorithmic medication management and psychosocial treatment
4) Community treatment (included some but lower stimulant use and less frequent follow-up)
MTA results - Answer✔All 4 groups showed reduced symptoms at 14 months
Those that received algorithmic med management did better than those who didn't
Behavioral treatment alone was not significantly more improved than community controls
When moderator of comorbid anxiety was isolated behavioral treatment surpassed community
care but less than med management group in parent symptom report
1
, ©FYNDLAY 2024/2025 ALL RIGHTS RESERVED 2:49PM A+
Medication plus psychosocial was equal to medication only (later studies argue this)
Meaning:
-Algorithmic medication treatment is most effective
-Psychosocial treatment is a reasonable option
What doesn't work for ADHD - Answer✔-Cognitive behavioral therapy (works when Depression
involved)
-Dietary modification
-EEG feedback
-Formal social skills training
General stimulant facts - Answer✔Methylphenidate or amphetamine are equally good, 44%
respond better to one
Better compliance with long acting, consider short acting in small children
Increase every 1-3 weeks until no more symptoms--you should hit side effects or hit max dosing
Consider low doses in children <6, ASD, IDD as they metabolize differently and slower so more
SE
Non-stimulant medications approved for ADHD - Answer✔-Atomoxetine - 0.62 effect size, may
be helpful for comorbid anxiety.
-Clonidine (ER only) and guanfacine (ER only) have FDA approval.
What to do if treatment not working? - Answer✔1) Review the diagnosis
2) Consider external factors that could influence our anxiety
2
, ©FYNDLAY 2024/2025 ALL RIGHTS RESERVED 2:49PM A+
3) Consider going to behavioral interventional
4) Consider 3rd tier options like Wellbutrin, TCAs
Stimulant side effects to watch for and treatment - Answer✔Insomnia - Melatonin, clonidine,
trazodone (talk about priapism)
Tics - switch agent or try non stimulant. Add alpha2agnoist if needed.
Decreased appetite - switch agents or use cyproheptadine (antidote to serotonin syndrome,
increases appetite)
Side Effects: Aggression, Cardiovascular - Answer✔"Rebounding" - the sense that behavior
worsens in the evening, although this is more likely already present ADHD symptoms that are
just easier to see when morning behaviors have improved. Can use afternoon IR stimulant.
Emergent-- If aggression or psychosis not seen at baseline comes out with stimulant use, best
option is likely to discontinue the stimulant. Do not attempt to treat it with other medications
like SGA's.
Cardiovascular - sudden death - this is not really an issue, rate is around 0.2 per 100,000 patient
years for patients on stimulants. But if there is preexisting cardiovascular disease then should
refer to cardiology first.
If stable on medication, then what? - Answer✔Then treatment with medication alone is
satisfactory
If less than optimal response to medication? - Answer✔If a Patient With ADHD Has a Less Than
Optimal Response to Medication, Has a Comorbid Disorder, or Experiences Stressors in Family
Life:
Psychosocial treatment + Medication
When do you reassess? - Answer✔Patients should be reassess periodically
3
Treatment of ADHD, Anxiety, and
Depression in Children and Adolescents.
Exam Questions And Answers |Latest 2025 |
Guaranteed Pass.
MTA study of ADHD - Answer✔4 groups, 600 children studied, ages 7-9:
1) Algorithmic medication treatment alone. Methylphenidate TID adjusted for the best dose,
augmentation as needed.
2)Psychosocial treatment alone: Parent training, structured teacher consultation, an 8 week full
time summer treatment program, a 12 week half time classroom behavioral specialist
--1/4th received medication due to lack of benefit
3) Combination of algorithmic medication management and psychosocial treatment
4) Community treatment (included some but lower stimulant use and less frequent follow-up)
MTA results - Answer✔All 4 groups showed reduced symptoms at 14 months
Those that received algorithmic med management did better than those who didn't
Behavioral treatment alone was not significantly more improved than community controls
When moderator of comorbid anxiety was isolated behavioral treatment surpassed community
care but less than med management group in parent symptom report
1
, ©FYNDLAY 2024/2025 ALL RIGHTS RESERVED 2:49PM A+
Medication plus psychosocial was equal to medication only (later studies argue this)
Meaning:
-Algorithmic medication treatment is most effective
-Psychosocial treatment is a reasonable option
What doesn't work for ADHD - Answer✔-Cognitive behavioral therapy (works when Depression
involved)
-Dietary modification
-EEG feedback
-Formal social skills training
General stimulant facts - Answer✔Methylphenidate or amphetamine are equally good, 44%
respond better to one
Better compliance with long acting, consider short acting in small children
Increase every 1-3 weeks until no more symptoms--you should hit side effects or hit max dosing
Consider low doses in children <6, ASD, IDD as they metabolize differently and slower so more
SE
Non-stimulant medications approved for ADHD - Answer✔-Atomoxetine - 0.62 effect size, may
be helpful for comorbid anxiety.
-Clonidine (ER only) and guanfacine (ER only) have FDA approval.
What to do if treatment not working? - Answer✔1) Review the diagnosis
2) Consider external factors that could influence our anxiety
2
, ©FYNDLAY 2024/2025 ALL RIGHTS RESERVED 2:49PM A+
3) Consider going to behavioral interventional
4) Consider 3rd tier options like Wellbutrin, TCAs
Stimulant side effects to watch for and treatment - Answer✔Insomnia - Melatonin, clonidine,
trazodone (talk about priapism)
Tics - switch agent or try non stimulant. Add alpha2agnoist if needed.
Decreased appetite - switch agents or use cyproheptadine (antidote to serotonin syndrome,
increases appetite)
Side Effects: Aggression, Cardiovascular - Answer✔"Rebounding" - the sense that behavior
worsens in the evening, although this is more likely already present ADHD symptoms that are
just easier to see when morning behaviors have improved. Can use afternoon IR stimulant.
Emergent-- If aggression or psychosis not seen at baseline comes out with stimulant use, best
option is likely to discontinue the stimulant. Do not attempt to treat it with other medications
like SGA's.
Cardiovascular - sudden death - this is not really an issue, rate is around 0.2 per 100,000 patient
years for patients on stimulants. But if there is preexisting cardiovascular disease then should
refer to cardiology first.
If stable on medication, then what? - Answer✔Then treatment with medication alone is
satisfactory
If less than optimal response to medication? - Answer✔If a Patient With ADHD Has a Less Than
Optimal Response to Medication, Has a Comorbid Disorder, or Experiences Stressors in Family
Life:
Psychosocial treatment + Medication
When do you reassess? - Answer✔Patients should be reassess periodically
3
