daniel smith is a 44-year-old man who was diagnosed with adhd-inattentive subtype in college, but has not taken medication for the last several years. he is seeking treatment now because of declining work performance following a promotion 7 months ago. specifically, he complains of difficulty finishing papers and staying focused during meetings and fears that his boss is losing confidence in him. assessment confirms a diagnosis of adhd-inattentive subtype. after 2 months treatment on a therapeutic dose of a long-acting stimulant, he states that his focus, sustained attention, and distractibility are much better, but that he still can't get organized and that it takes him longer to complete tasks than it should. would it be appropriate for the pmhnp to raise the dose of the stimulant to address his residual symptoms?

A 44-year-old man has ADHD-inattentive subtype from college, but has not taken medication for several years. It would not be appropriate to raise the dose of the stimulant to address his residual symptoms.

Why would it not be appropriate to raise the dose of stimuli for residual symptoms?

Dose response studies of stimulant medications suggests that optimal dose varies across individuals and depends on the domain of function. Higher doses may lead to greater improvement of some domains but not executive function.

If medication dose is high enough to diminish symptoms of inattention and distractibility, then executive function needs to be addressed independently and will not response to higher dose.

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