Quiz: Monitoring & Long-Term Management

Asha, Age 7

Asha is a 7-year-old girl with ADHD, Combined Presentation, starting her first medication trial. Her pediatrician prescribes methylphenidate extended-release 18 mg daily. The pediatrician plans to see Asha in 4 weeks for the first follow-up.

Q1. Asha's pediatrician plans to see her in 4 weeks for the first follow-up. During the titration phase, what is the recommended contact frequency?

Q2. At week 3, Asha's teacher Vanderbilt shows major improvement. Her mother's form reports 'she's terrible from 4 PM to bedtime, worse than before medication.' What most likely explains this discrepancy?

Q3. You identify Asha's evening deterioration as pharmacokinetic rebound. What is the most appropriate management?

Ronan, Age 10

Ronan is a 10-year-old boy with ADHD, Combined Presentation, who has been on methylphenidate extended-release for 6 months. His pediatrician started him at 18 mg and confirmed improvement at the first follow-up but did not titrate further. His parents bring his most recent Vanderbilt to today's visit. His ADHD Rating Scale (ADHD-RS) total score has dropped 35% from baseline. His teacher reports he is "better but still struggles to complete classwork." His grades have improved from D's to C's.

Q4. Based on Ronan's ADHD-RS score reduction of 35%, what is his current treatment status?

Q5. Ronan's ADHD-RS total score is now 16, meeting the remission benchmark. However, his teacher reports he still 'can't organize anything,' homework completion is 50%, and his WFIRS scores remain elevated in the School and Life Skills domains. What is the most appropriate next step?

Q6. Three months later, Ronan's mother calls: 'The medication stopped working. His behavior is terrible again.' Before changing his prescription, which factor should be assessed first?

Petra, Age 14

Petra is a 14-year-old girl with ADHD, Predominantly Inattentive Presentation, on lisdexamfetamine 50 mg daily for 2 years with good symptom control. At today's visit, her ADHD-RS score has risen 40% from her maintenance baseline. Her mother reports declining grades and increased conflict at home. Petra, interviewed alone, admits she stopped taking her medication 6 weeks ago because "it kills my appetite and my friends think it's weird."

Q7. Petra's ADHD-RS score has risen 40% from her maintenance baseline after 6 weeks without medication. What does this pattern represent?

Q8. Petra will only resume medication if appetite suppression is manageable. Regarding lisdexamfetamine's appetite effects, which statement is most accurate?

Q9. Petra agrees to resume medication but needs coverage for evening study hours. She also drives to school. Which formulation consideration is most important?

Taye, Age 9

Taye is a 9-year-old boy with ADHD, Combined Presentation, who has been on mixed amphetamine salts extended-release 20 mg daily for 2 years with good symptom control. At today's visit, his growth chart shows his height has crossed from the 50th percentile to the 20th percentile since starting medication. His height velocity is 4.2 cm/year. His weight has dropped from the 45th to the 30th percentile.

Q10. Taye's height has dropped from the 50th to the 20th percentile since starting medication. His height velocity is 4.2 cm/year. What is the clinical significance?

Q11. You initiate the growth management hierarchy for Taye. What is the recommended first-line strategy?

Q12. Taye's parents ask whether weekend medication breaks would help his growth. What does the evidence show about weekend holidays?

Rafe, Age 38

Rafe is a 38-year-old software engineer diagnosed with ADHD, Predominantly Inattentive Presentation, at age 35 after his daughter's ADHD diagnosis prompted self-recognition. He has been on lisdexamfetamine 60 mg daily for 3 years with good symptom control. He presents for his annual review. His blood pressure today is 142/90 mmHg, up from 128/82 at baseline three years ago. He has a BMI of 30 and a family history of hypertension.

Q13. Rafe has been on lisdexamfetamine for 3 years. His BP today is 142/90. Regarding long-term cardiovascular risk with ADHD medications, which statement is best supported?

Q14. Rafe's blood pressure is confirmed at 142/90 mmHg. His lisdexamfetamine has provided excellent ADHD symptom control for 3 years. How should you approach the risk-benefit analysis?

Q15. During Rafe's annual comprehensive review, you assess five monitoring domains. Which domain is most commonly omitted in routine practice?

Q16. Rafe asks whether he still needs medication at age 38. Based on the longitudinal evidence, how should you frame the prognosis?

Juno, Age 11

Juno is an 11-year-old boy with ADHD, Combined Presentation, treated with guanfacine extended-release 3 mg nightly and methylphenidate extended-release 36 mg daily. He has been stable for 18 months. His parents want to try stopping medication over the summer to "see if he still needs it."

Q17. Which factor makes Juno the best candidate for a structured discontinuation trial?

Q18. Before starting the discontinuation trial, Juno's pediatrician must address a critical safety concern. Which of his medications requires a mandatory taper?

Q19. During the summer discontinuation trial, Juno's mother reports he is 'absolutely terrible every evening, about an hour after his afternoon activities, but fine the rest of the day.' What is the most likely explanation?

Q20. Juno completes the 4-week discontinuation trial. His ADHD-RS scores have returned to pre-treatment levels. His parents ask about the long-term outlook. What is the strongest argument for resuming medication?