It is important to do a careful history and mental status examination before starting an adult or child on stimulant medication. We often get outside data such as relatives reports or school checklists to help verify the diagnosis. Inattention is a fairly non-specific phenomenon. It may be caused by anxiety, depression or medical illness. In the past, children often got medication coverage only for the hours they were in school.
Some clinicians still use stimulants only for school or work situations.
We prefer a more individualized approach. Such an individual might take a short acting stimulant only to cover school or difficult work situations. Even in these situations, three doses of methylphenidate are often better than two larger doses. Other individuals benefit from broader stimulant coverage. Impulsivity can be problematic in the evenings and on the weekends.