Methylphenidate and amphetamines, preferably in extended release formulations, are the recommended first choice in children, adolescents, and adults with ADHD, including those with comorbid disruptive behavior. In cases of history of substance abuse, the use of nonstimulants or LDX maybe preferred. Medications for ADHD are chronically administered over years, and require sometimes subtle adjustments in dosing, timing, and adjuncts. Establishing and maintaining a therapeutic alliance with adolescents remains one of the greatest challenges of providing psychopharmacological care for ADHD.

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