David Rabiner, Ph.D.Research Professor Emeritus, Duke University 08/28/2025
| Regardless of how a child’s ADHD is being treated, establishing an ongoing plan to monitor how well that treatment is working is very important. This is because children’s response to ADHD treatment often changes over time, and a strong initial treatment response offers no guarantee that treatment benefits will persist.. Core ADHD symptoms of inattention and hyperactivity-impulsivity that are well-controlled at one time may subsequently reemerge and create difficulties. A child’s success with school work, meeting behavioral expectations at school, and getting along with peers can also ebb and flow.For this reason, ADHD treatment guidelines from the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry highlight the necessity of sustained, systematic treatment monitoring so that adjustments to treatment can be made as needed. Having a strong monitoring plan in place is thus an integral component of high quality ADHD treatment. The absence of treatment monitoring in community settings Despite the importance of sustained and systematic treatment monitoring, results from multiple studies suggest that this is rarely done. In fact, one study (1) reported that collecting any systematic behavior ratings from parents and/or teachers – even a single time – seems to happen for only about 10% of children. And, the average amount of time between initiating treatment and collecting any such ratings was roughly one year. Another study (2) found that rating scales to assess ongoing treatment response to medication treatment were administered in fewer than 3% of visits. Because of this, it is likely that many children were maintained on a treatment program that was far from optimal. What can parents do? Parents who recognize the importance of treatment monitoring can speak with their child’s health care provider to make sure that a treatment monitoring plan is in place for their child.One reasonable approach would be to obtain monthly feedback from teachers on the intensity of core ADHD symptoms, and how well the child is doing overall in their academic, social, and behavioral functioning. Teacher ratings would be supplemented by ratings from parents based on their observations of their child at home. When medication is part of a child’s treatment, monitoring for emergent side effects would also be recommended. When teacher and/or parent ratings reflect important difficulties, decisions about possible changes/adjustments to the current treatment plan can be made in consultation with parents. Without such information, making a well-informed decision about the adequacy of a child’s current treatment is not possible. The ADHD Monitoring System You can dowload a simple treatment monitoring system that I developed at https://helpforadd.com/wp-content/uploads/2023/04/monitor.pdf If you feel this tool could be useful in your work, you are welcome to use it and to modify it as you wish to best meet your needs.. References 1. Epstein, J.N., et al., (2014). Variability in ADHD care in community-based pediatrics.Pediatrics, 134, 1136-1143.2. Rosenau, P.T. et al. (2023). Adherence to Clinical Guidelines for Dose Finding and Monitoring Methylphenidate Use: A Medical Record Audit in Child and Adolescent Mental Health Care and Pediatric Settings. Journal of Child and Adolescent Psychopharmacology.===================================== Information presented in Attention Research Update is for informational purposes only, and is not a substitute for professional medical advice. |
 |
| David Rabiner, Ph.D.Research Professor EmeritusDuke University |
| Copyright © 2025 by David Rabiner |
- Dr. Rabiner’s work focuses on violence prevention, ADHD, and interventions to improve academic performance in children with attention difficulties. In the violence prevention area, he is currently working on the GREAT Schools and Families project, a multi-site violence prevention study for middle school students that is funded by the Centers for Disease Control. Other projects include a study of two different computerized interventions for elementary school students with attention difficulties and a study of the misuse and abuse of ADHD medications among college students. He also has long standing interests in improving the quality of care received by children with ADHD and in the relationship between children’s social experience and their social cognitive functioning.