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Child & Youth Mental Health Algorithm - GPSC

Child & Youth Mental Health Algorithm - GPSC

PSP

PSP Child and Youth Mental Health –Initiating and Monitoring Dextroamphetamine treatment for Children/ YouthUse PST andWRP throughoutthe treatmentprocess.Use SNAP-IV everyweek for dosetitrationADHD Diagnosis(DSM-IV-TR criteria)Initiate PST for at least 3 visits.SNAP-IV (18 items)> 18, symptoms continue causingdistress and CFA/TeFA or WFIRS-P/WFIRS-S showsdecrease or no change in function.Time to start medication!Begin at 2.5mg – 5mg of dextroamphetamine in themorning and 2.5mg – 5mg at noon for 1 week.- Children (6-12)- Adolescent (>12)Measurefunctioning usingCFA/TeFA orWFIRS-P/WFIRSandside effectsusing KESA atevery visit.If insufficient effect, tolerable and no significant sideeffects increase to 5mg – 10mg in the morning and2.5mg – 5mg at noon for 1 week.If insufficient effect, tolerable and no significant sideeffects increase to 5mg – 10mg in the morning and 5mg– 10mg at noon for 1 week.If insufficient effect, tolerable and no significant sideeffects, increase to 5mg – 10mg in the morning, 5mg –10mg at noon and 2.5mg – 5mg at 4pm for 1 week.If substantial side effects occur continue the dose andincrease the time between dosages*Doses suggested byDr. Margaret WeissIf symptoms have not improved after the initial 4 weeksof treatment, titrate by 2.5mg – 5mg/dose weekly, to amaximum total daily dose of 20mg - 40 mg/day.If you have reached the maximum doses and symptomscontinue to cause distress and dysfunction, change tomethylpneidate (i.e. Ritaline – if not tried yet) orconsider referral to a mental health specialist orpaediatrician.If symptoms havesubstantially improved,switch to a long-actingdextroamphetamine(i.e spansule) or dextro-amphetamine basedproducts long-actingmedication (i.e. AderallXR).BC Pharmacare requires patients to start on short-acting ADHD medications for the special authorityrequest exemption. CADDRA recommends initiating on long-acting for patients that are insured.CYMH_PSP_Dextroamphetamine_algorithm final 1 of 1

PSP Child and Youth Mental Health –Initiating and Monitoring Methylphenidate treatment for Children/ YouthUse PST andWRP throughoutthe treatmentprocess.Use SNAP-IV everyweek for dosetitrationADHD Diagnosis(DSM‐IV‐TR criteria)Initiate PST for at least 3 visits.SNAP‐IV (18 items)> 18, symptoms continue causingdistress and CFA/TeFA or WFIRS‐P/WFIRS‐S showsdecrease or no change in function.Time to start medication!Begin at 2.5mg – 5mg of methylphenidate in themorning and 2.5mg – 5mg at noon for 1 week.‐ Children (6‐12)‐ Adolescent (>12)Measurefunctioning usingCFA/TeFA orWFIRS‐P/WFIRSandside effectsusing KESA atevery visit.If insufficient effect, tolerable and no significant sideeffects increase to 5mg – 10mg in the morning and2.5mg – 5mg at noon for 1 week.If insufficient effect, tolerable and no significant sideeffects increase to 5mg – 10mg in the morning and 5mg– 10mg at noon for 1 week.If insufficient effect, tolerable and no significant sideeffects, increase to 5mg – 10mg in the morning, 5mg –10mg at noon and 2.5mg – 5mg at 4pm for 1 week.If substantial side effects occur continue the dose andincrease the time between dosagesIf symptoms have not improved after the initial 4 weeksof treatment, titrate by 2.5mg – 5mg/dose weekly, to amaximum of 2mg/kg total daily dose, not to exceed 60mg/day.If you have reached the maximum doses and symptomscontinue to cause distress and dysfunction, change todextromphetamine (i.e. Dexedrine) or consider referralto a mental health specialist or paediatrician.If symptoms havesubstantially improved,switch to a long actingmethylphenidate (i.e.Concerta, PMS)*Doses suggested byDr. Margaret WeissBC Pharmacare requires patients to start on short-acting ADHD medications for the special authorityrequest exemption. CADDRA recommends initiating on long-acting for patients that are insured.26.2_CYMH_PSP_Medication_Algorithm_ADHD_Methylphenidate ‐ FINAL[1] 1 of 1

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