The Texas Children's Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder.
OBJECTIVE
In 1998, the Texas Department of Mental Health and Mental Retardation developed algorithms for medication treatment of attention-deficit/hyperactivity disorder (ADHD). Advances in the psychopharmacology of ADHD and results of a feasibility study of algorithm use in community mental health centers caused the algorithm to be modified and updated.


METHODS
We convened a consensus conference of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families to revise the algorithms for the pharmacotherapy of ADHD itself as well as ADHD with specific comorbid disorders. New research was reviewed by national experts, and rationales were provided for proposed changes and additions to the algorithms. The changes to the algorithms were discussed and approved both by the national experts and experienced clinicians from the Texas public mental health system.


RESULTS
The panel developed consensually agreed-upon algorithms for ADHD with and without comorbid disorders. The major changes included elimination of pemoline as a treatment option, adding atomoxetine to the algorithm, and refining guidelines for treating ADHD with comorbid depression, aggressive behaviors, and tic disorders.


CONCLUSIONS
Medication algorithms for ADHD can be modified to keep abreast of developments in the field. Although these evidence- and consensus-based treatment recommendations may be a useful approach to guide the treatment of ADHD in children, additional research is needed to determine how these algorithms can be used to maximally benefit child outcomes.
Pliszka
Steven R
SR
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin. Electronic address: pliszka@uthscsa.edu.
Crismon
M Lynn
ML
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
Hughes
Carroll W
CW
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
Corners
C Keith
CK
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
Emslie
Graham J
GJ
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
Jensen
Peter S
PS
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
McCRACKEN
James T
JT
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
Swanson
James M
JM
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
Lopez
Molly
M
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Hughes is with the Department of Psychology and Dr. Emslie is with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Conners is with the Department of Psychiatric & Behavioral Science, Duke University, Durham, NC; Dr. Jensen is with Columbia University, New York State Psychiatric Institute, New York; Dr. McCracken is with the UCLA Neuropsychiatric Institute, Los Angeles; Dr. Swanson is with the Department of Psychiatry, University of California at Irvine; and Dr. Lopez is with the Texas Department of State Health Services, Austin.
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000465:Algorithms; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D003155:Community Mental Health Centers; D006801:Humans; D017410:Practice Guidelines as Topic; D011437:Propylamines / Q000627:therapeutic use*; D011600:Psychopharmacology; D013781:Texas; D014481:United States
D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride