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Attention-Deficit/Hyperactivity Disorder (ADHD) Clinical Pathway, Primary Care – Comorbid Neurologic Conditions

Attention-Deficit/Hyperactivity Disorder (ADHD) Clinical Pathway — Primary Care

ADHD and Comorbid Neurologic Conditions

Tics
  • Neurology referral is not required for clearance before treatment with stimulants.
  • A referral to neurology may be indicated if the provider is not clear if movements of concern are tics, or management is complex.
  • Tics emerge at similar age at which stimulants are prescribed, do not assume tics are secondary to stimulant.
  • Not a contraindication for using stimulant medication for treatment of ADHD:
  • Naturally wax and wane; emergence of tics with starting/changing ADHD medications may be coincidental. Likely tics will wane without discontinuation of ADHD medication.
  • Frequency and severity can change with ADHD medications, but are not caused by the medication.
  • Comorbid tics and ADHD may benefit from alpha-agonist medications.
    • e.g., guanfacine and clonidine
Epilepsy
  • 30-40% of children with epilepsy have ADHD.
  • Stimulant medication for ADHD is not contraindicated in those with epilepsy
  • There is some evidence that seizures may worsen with stimulant treatment in those with intractable epilepsy.
  • Some evidence for anti-seizure medications impacting attention, usually through sedation effects.
  • Stimulant medication for ADHD is not contraindicated in febrile seizure.

 

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