Duration of pharmacotherapy for attention deficit hyperactivity disorder in children

The optimal duration of pharmacotherapy for attention deficit hyperactivity disorder (ADHD) is unclear. Review the need for treatment at least once a year. Consider factors such as:

• patient preference
• adverse effects
• benefits of treatment
• impact of treatment, or no treatment, on social and other aspects of life.

If it is deemed appropriate, a trial without pharmacotherapy may be attempted. Preferably the trial should occur at a time likely to cause the least disruption (eg during school holidays).

Consider the following when stopping a drug for ADHD:

• stimulants can be stopped abruptly; however, if the dose is close to or at the maximum dose, reduce the dose gradually
• atomoxetine can be stopped abruptly without a gradual reduction
• clonidine should be gradually reduced over at least 7 days; stopping abruptly can cause severe withdrawal symptoms (eg rapid rise in blood pressure, headache, flushing, sweating, insomnia, agitation, tremor)
• guanfacine should be gradually reduced by no more than 1 mg every 3 to 7 days; adverse drug withdrawal effects include an increase in blood pressure.

If symptoms re-emerge when treatment for ADHD is stopped, and cause distress or functional impairment, restart the drug. When restarting the drug, restart at the lowest starting dose and gradually increase according to response (rather than starting at the dose previously taken).