Management of treatment refractory attention-deficit/hyperactivity disorder in children and adolescents.

Psychostimulants are the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. A minimum of two psychostimulant trials should be instituted before a child's symptoms of ADHD are considered treatment refractory. Clinical issues of diagnostic accuracy, comorbid disorders, psychosocial factors, medication compliance, symptoms across settings, and behavioral treatment should be addressed before initiating alternative medication trials. With the exception of tricyclic antidepressants, there is a paucity of controlled studies with adequate sample size to support the efficacy and safety of nonstimulant medications for the treatment of childhood ADHD. In this article, data on medications for treatment refractory ADHD in children and adolescents are presented and treatment strategies are discussed.