ADHD treatment: Clinical pearls for primary care providers

Pediatricians play a vital role in the management of attention-deficit/hyperactivity disorder (ADHD).

“You are America’s ADHD providers,” said Rakesh Jain, MD, MPH, clinical professor of psychiatry at Texas Tech University School of Medicine. “I know you didn’t sign up for it, but ADHD is in your practice, and 80% to 90% of all patients with ADHD in America are being taken care of by you.”

Jain highlighted the approval of clonidine hydrochloride (ONYDA XR, Tris Pharma), a new extended-release liquid formulation of clonidine. “We’ve got once-a-day formulation that’s liquid and can be used as a monotherapy in appropriate patients, or if your patient’s currently on a stimulant, we don’t have to settle for suboptimal control of symptoms,” he explained. “We certainly can, in appropriate situations, consider augmentation therapy.”

For pediatricians managing ADHD, Jain emphasized several practical tips to improve outcomes and workflows. He encouraged routine screening for ADHD as early as possible to address symptoms before they escalate. “It’s so much easier to catch ADHD and treat it in its early stages than when it’s catastrophic, meaning the child is being kicked out of school or [they have] failing grades,” he said. Screening tools like the Vanderbilt Assessment Scale remain valuable for identifying cases early.

Jain also recommended gathering input from multiple sources to get a complete picture of a child’s challenges. “Definitely get input from the teachers,” he said. “This triangulation of information is important.”

While medications like stimulants have long been the cornerstone of ADHD treatment, Jain urged pediatricians to consider behavioral therapy first. “Medications are not first line, not immediately,” he said. “If you don’t see what you’re needing for that child’s sake, or the adolescent’s sake, within, say, 6 to 8 weeks of behavioral therapy, then it’s important to consider medications.”

For clinicians, seeing improvements in patients with ADHD can be profoundly rewarding. “When a kid or an adolescent gets better and they see that innate intelligence and abilities flourish, I've got to tell you, that feeling is the reason why I continue being excited about being a clinician,” Jain concluded.

The availability of ONYDA XR offers pediatricians an additional tool to optimize ADHD care, empowering them to tailor treatment to their patients' needs.

Rakesh Jain, MD, MPH

In a previous interview with Contemporary Pediatrics, Jain explained the the once-a-day oral solution's make-up in more detail. Click here to watch.