Journal of the American Academy of Child & Adolescent Psychiatry
Volume 45, Issue 6 , Pages 642-657, June 2006

The Texas Children's Medication Algorithm Project: Revision of the Algorithm for Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder

Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin

Accepted 14 December 2004.

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.

Key Words:  attention-deficit/hyperactivity disorder , algorithm , psychopharmacology , practice parameters

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 Disclosure: Dr. Pliszka serves a consultant for and is a member of the speakers' bureau for Shire Pharmaceuticals and MacNeil Specialty and Consumer Products; he has received research support from Eli Lilly, Cephalon, and AstraZeneca. Dr. Crismon has received research grants or unrestricted grant funding (through the University of Texas at Austin) from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, Pfizer, and Shire; at present or during the past 3 years, he has served on the speaker's bureau or has been sponsored for lecturing or developing continuing education materials by AstraZeneca, Eli Lilly, Forest Laboratories, and Pfizer; and he has served as a consultant to or on advisory boards for Janssen, Pfizer, Eli Lilly, Bristol-Myers Squibb, AstraZeneca, and McNeil Specialty and Consumer Products. Dr. Hughes has received research support from GlaxoSmithKline. Dr. Conners has served as a consultant to or been a member of the speakers' bureau for Novartis, Eli Lilly, McNeill Specialty and Consumer Products, Shire, and GlaxoSmithKline; he is also on advisory committees for Shire and Eli Lilly. Dr. Emslie receives research support form Eli Lilly, Organon, and Forest Laboratories. He is a consultant to or a member of the speakers' bureau for Eli Lilly, GlaxoSmithKline, Forest Laboratories, Pfizer, Wyeth-Ayerst, and McNeil Specialty and Consumer Products. Dr. Jensen receives research support from Janssen, McNeil Specialty and Consumer Products, Pfizer, Eli Lilly; he has served on the speakers' bureau for Janssen, UCB Pharma, and Novartis; and he holds stock in Lilly Pharmaceuticals. Dr. McCracken receives research support from Eli Lilly, Shire, and Bristol-Myers Squibb. He is a consultant to or has received honoraria from Shire, Eli Lilly, McNeil Specialty and Consumer Products, Janssen, Cephalon, Abbott, and UCB Pharma. Dr. Swanson has received research support from, had an advisory board membership in, and participated in speakers' bureaus for McNeil Specialty and Consumer Products, Cephalon, UCB Pharma, Shire, Novartis/Celgene, Eli Lilly, and Abbott. Dr. Lopez has no financial relationships to disclose.

PII: S0890-8567(09)61222-3

doi:10.1097/01.chi.0000215326.51175.eb

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 45, Issue 6 , Pages 642-657, June 2006

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