The Journal for Nurse Practitioners xxx (xxxx) xxx

Contents lists available at ScienceDirect

The Journal for Nurse Practitioners

journal homepage: www.npjournal.org

The Chronic Care Model and Attention-Deficit/Hyperactivity Disorder:

A Novel Approach to Improving the Transition to Postsecondary
Education
Cindy Parsons

a b s t r a c t
Keywords: The transition from high school to further education is challenging. Current studies support that young adults
attention-deficit/hyperactivity disorder with attention-deficit/hyperactivity disorder (ADHD) may be at higher than average risk for academic un-
Chronic Care Model
derachievement. Currently, the management of ADHD follows a medical model emphasizing episodic care
patient centered
self-management
rather than a holistic, longitudinal approach befitting the chronic nature of the disorder. The symptoms and
transitions effects of ADHD are pervasive and require a concerted effort from a variety of disciplines to effectively di-
agnose and treat the disorder. The Chronic Care Model (CCM) offers a novel approach to the management of
ADHD and through adaptation has the potential to improve treatment adherence and patient outcomes. The
CCM is currently being successfully implemented in patients living with chronic illnesses such as diabetes,
depression, and asthma. The CCM is a team approach deemed to be quite successful, especially for patients
less likely to adhere to treatment, such as patients with ADHD. The CCM includes 6 components: health
systems or organizations, delivery system, clinical information system, decision support, community re-
sources and policy, and self-management support. The focus on patient-centered, coordinated care with an
emphasis on self-management offers a novel approach to improving the outcomes for those with ADHD in
their transition to college.
© 2020 Elsevier Inc. All rights reserved.

Attention-deficit/hyperactivity disorder (ADHD) is a neuro-
behavioral disorder commonly diagnosed during childhood. Once
believed to be a disorder limited to childhood, studies show about
two thirds will continue to experience symptoms into adulthood.1,2
ADHD is now recognized as a chronic health condition. The effects
of ADHD can be pervasive, creating problems in academic, social,
and occupational functioning for the affected individual. Many
adolescents are faced with the choice of pursuing a vocation or
college as they transition through adolescence. For young adults
with ADHD, the challenges they face as they consider the option of
postsecondary education are multiple. Nurse practitioners (NPs) in
primary care are well positioned to help their patients navigate this
transition.
Diagnosing ADHD
ADHD is defined as a “persistent pattern of inattention and/or
hyperactivity-impulsivity that is more frequent and severe than is
typically observed in individuals at comparable levels of develop-
ment.”3 The diagnosis of ADHD is based on criteria from the
American Psychiatric Association’s Diagnostic and Statistical Manual
of Mental Disorders (Fifth Edition).3 Symptoms must be evident in a
variety of settings and interfere with academic, social, or occupa-
tional functioning and activities of daily living. Additionally, several
of the inattentive or hyperactive impulse symptoms must have
been evident before age 12 and persisted for greater than 6
months.3 To date, there are no laboratory, genetic, or neuroimaging
tests that can be used to definitively establish the diagnosis of
ADHD. Diagnosis remains subjective, and clinicians rely heavily on
information from patients, parents, teachers, or other adults
involved with the patient and the use of structured interviews.4,5
When evaluating a patient for ADHD, it is important to use data
from multiple sources to confirm the diagnosis.4,5 The assessment
should consider symptom patterns, onset, pervasiveness, severity
of symptoms, and the impact on the patient’s normal daily func-
tioning and relationships. A physical assessment will rule out any
potential sensory, metabolic, or organic factors that could be pro-
ducing symptoms. A psychosocial assessment identifies factors that
may have triggered or are contributing to behavioral symptoms,
such as parental conflict, parenting inconsistency, abuse or neglect,
recent losses, or changes in economic or living conditions. The
complete psychiatric assessment should include a structured

https://doi.org/10.1016/j.nurpra.2020.11.024
1555-4155/© 2020 Elsevier Inc. All rights reserved.
2 C. Parsons / The Journal for Nurse Practitioners xxx (xxxx) xxx
Table
Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scales Commonly Used
Scale Age Administration Details
Range
Conner’s Rating Scale for 3-17 Parent: 80 items/27 Assesses ADHD symptoms and executive functioning,
Parents and Teacher for short form defiance/aggression, and peer/family relations
Teacher: 59 items/
28 for short form
National Institute for 6-12 Parent: 43 items Assesses ADHD symptoms as well as comorbid anxiety and 4-point frequency with higher scores indicating
Children’s Health Quality Teacher: 55 items oppositional symptoms and teacher assessment of
Vanderbilt Assessment academic performance and classroom behavior
Scale
ADHD Rating Scale IV 5-18 Self-report 18-item scale that corresponds to the DSM diagnostic
(ADHD-RS-IV) semistructured criteria
parent and teacher
complete
SNAP-IV 5-11 Separate parent and 90 items, includes items for internalizing and externalizing Scored on a 0- to 3-point scale; scores are totaled
teacher versions behaviors and other DSM-IV
disorders
DSM ¼ Diagnostic and Statistical Manual of Mental Disorders.
diagnostic interview; mental status examination; use of valid
clinical rating scales; and physical, psychosocial, and observational
data. The Table includes commonly used ADHD rating scales. Dif-
ferential diagnoses must be considered because many conditions
either exist comorbidly or produce symptoms that mimic those in
ADHD. These include but are not limited to learning disabilities,
Tourette syndrome, conduct disorder, oppositional defiant disorder,
depression, or anxiety.5 Neuropsychological testing also serves a
useful role in the diagnostic assessment.5 A broader range of
cognitive functioning such as intelligence, problem-solving skills,
and memory are assessed with this testing, providing diagnostic
clarity and the ability to create comprehensive treatment plans.
Finally, data on classroom performance, academic progression or
failures, special education services, academic modifications, and
teacher observations provide valuable information on the patient’s
functioning and performance. Treatment must be comprehensive
and include management of comorbid disorders.
Although there is a wealth of research available on childhood
ADHD, less is known about its manifestation in adulthood. Current
studies suggest that a significant proportion of those with ADHD
continue to demonstrate active symptoms into adulthood.1 The
symptoms of ADHD change as a child matures into adulthood.
Hyperactivity wanes and becomes internal restlessness or fidgety
behavior. These individuals have difficulty concentrating,
completing projects, relaxing, or engaging in sedentary activities.
Impulsivity causes problems with executive functioning, which is
one’s ability to plan, organize, delay gratification, have self-control,
and divide and focus attention to sources simultaneously.6 Inat-
tentiveness yields poor organizational skills, forgetfulness, missed
deadlines, and frequent difficulties with social and occupational
relationships. Outcomes of these symptoms can be procrastination
in important tasks such as assignments or projects, mental rest-
lessness, and disorganization. Establishing the diagnosis of ADHD
in adults is difficult because academic, occupational, or relationship
difficulties can be a result of other or comorbid psychiatric
disorders.1,5
Prevalence in the College-Aged Population
Although adolescents with ADHD and learning disabilities are
less likely to attend college, there has been an increase in the
number of students with ADHD pursuing postsecondary educa-
tion.2 ADHD diagnostic criteria were designed to be applied to
children; therefore, they may not adequately capture the disorder
as it presents in adolescents or adults.1 Fleming and McMahon2
Scoring
4-point frequency with higher scores indicating
greater frequency of symptoms
greater frequency of symptoms.
4-point frequency with higher scores indicating
greater frequency of symptoms
and divided by 9 for an average, which will be used
to correlate with diagnostic criteria
studied the prevalence of ADHD in college-aged students, finding
that approximately 2% to 8% of students self-report clinically sig-
nificant symptoms, and at least 25% of college students with dis-
abilities are diagnosed with ADHD. The actual prevalence rates may
vary because many studies used only student self-reports and did
not include reports from parents or significant others. It is difficult
to determine accurate numbers because students with disabilities
are not required to self-identify or register their disability unless
they are requesting accommodations. A significant percentage of
adults diagnosed with ADHD as children receive treatment into
adolescence, but as they transition into adulthood, it often is not
continued.7 The reasons for low rates of treatment in the college-
aged student are varied. Some may discontinue treatment
because they did not experience improvement in symptoms or
experienced intolerable adverse effects. Others may have never
received an accurate diagnosis or had parents who were reluctant
to place their child on stimulant medications, leaving both groups
undertreated or untreated.7,8
ADHD and Academic and Social Functioning
Academic Problems
Adolescents with a history of ADHD who have completed their
secondary education and gained acceptance into postsecondary
education are likely to have better adaptive and cognitive abilities.9
However, they still face difficulties related to changes in the aca-
demic environment, the increased rigor of classes, and increased
performance expectations. The structure of high school, the pre-
dictability of academic schedules, manageable reading assign-
ments, and few projects or assignments requiring independent
planning and coordination may contribute to the challenges of
transitioning.1,6 Several studies suggest that the mean grade point
average (GPA) for non-ADHD graduating seniors was higher
compared with the GPAs of graduating seniors with ADHD.9,10
Students with ADHD appear to be at higher risk for academic
underachievement. Studies of college students with ADHD have
identified higher rates of academic problems such as lower GPAs,
increased rates of academic probation, disorganization, inadequate
study habits, poor time management, procrastination, and deficient
test-taking skills.9 Studies also suggest that they will have trouble
selecting a major and perform lower in areas of grammar, writing,
spelling, and foreign languages.6,7,9,10 In addition to academic dif-
ficulties, they experience a higher degree of restlessness and more
intrusive thoughts and report a lower quality of life. The underlying
 C. Parsons / The Journal for Nurse Practitioners xxx (xxxx) xxx
pathology that contributes to academic difficulties is not under-
stood but is likely related to deficits in executive and cognitive
functioning, inattention, and impulsivity.10 It is important to note
that these results may not generalize to all postsecondary educa-
tion students with ADHD.
Social Problems
Social relationships gain significance as students transition to
greater independence and away from the security of their re-
lationships with family, friends, and their peer groups. This can
result in decreased adaptability to change, social skills, and overall
self-esteem.9 The impulsivity associated with ADHD can impede
the development of new relationships. ADHD behaviors can include
interrupting others, being disorganized, not remembering dates or
forgetting appointments, not following through on commitments,
or engaging in high-risk behaviors.10 Those with ADHD also tend to
have difficulties structuring and organizing their lives and have
problems with interpersonal boundaries and reading social cues.
These behaviors individually can create stress in relationships, but
for those with ADHD, clusters of these symptoms exist. In addition,
young adults with untreated ADHD may be at higher risk for sub-
stance use and financial difficulties and have higher rates of legal
problems.2
Mood and Self-Esteem
The transition to postsecondary education is difficult for stu-
dents who attend college not in proximity to their home, their
familiar sources of support and resources have changed. The
prevalence of mental health problems in college students has
increased over the years. A survey of university counseling centers
reported a 92% increase in students seeking assistance for mental
health issues.11 The most common symptoms reported were feel-
ings of loneliness, being overwhelmed, and feeling so depressed it
was difficult to function.11,12 Among college students, low general
self-esteem significantly impacts academic success. Self-esteem
and mood appear to be significantly affected in patients with
ADHD. This may stem from the “stress resulting from symptom-
related behaviors and frequent failure often resulting in low self-
esteem in the adult ADHD population.”12 Students with ADHD are
also at an increased risk for psychological disturbances such as
depression, substance abuse, aggressiveness, smoking, and less
ability to adapt to stress.9 ADHD along with being a first-year un-
dergraduate student significantly increases the risk of low self-
esteem.10,12
A leading cause of death among college students is suicide.12
Providers need to be aware of the effect of ADHD on mood, self-
esteem, and the potential risk for suicidal ideation. In students
with untreated ADHD, this risk is further increased; therefore, this
population should be screened, and risk factors carefully exam-
ined.13 Substance use disorders typically begin in adolescence or
early adulthood and affect about 30% of the United States popula-
tion. Current studies support that early and consistent treatment of
ADHD reduces the risk in this population.13,14
ADHD and the Chronic Care Model
Currently, the management of ADHD in adolescents and young
adults focuses on acute and episodic treatment, in contrast to the
chronic nature of the disorder. Treatment typically follows the
medical model emphasizing pharmacologic management of
symptoms. The chronicity of ADHD has been well established, and
care of these patients should include a multimodal effort
throughout the life span. The Chronic Care Model (CCM) is a team
3
approach designed for patients less likely to adhere to treatment,
such as patients with ADHD. The CCM has been successfully
implemented in patients with chronic illnesses such as diabetes,
depression, and asthma.15 The CCM offers a novel approach to the
management of ADHD and through adaptation (Figure) has the
potential to improve treatment adherence and patient outcomes.
In applying the CCM, it is necessary to shift from a provider-
centered model to one of partnership between the patient and
health care provider (HCP), creating a patient-centered approach.
The health system organization includes all the systems involved in
the management and care of the patient. These would include the
HCP, psychologist or licensed counselor, college health center,
student counseling, and the student disabilities services within the
college.
The delivery system requires coordination and communication
among all providers of care.15 When a high school student transi-
tions to postsecondary education, the HCP should be actively
involved in transitioning care from pediatrics to adult care. An
optimal time to start planning this transition is the student’s last 2
years of high school. A needs assessment should be conducted,
including a discussion with the patient and their family regarding
future academic and occupational plans. Before students starting
college, the HCP should assist the patient in finding a new provider
and coordinating the transition to adult health. At this time, the
HCP should provide a summary of the patient’s care to the new
provider, including past medical history, current and past medica-
tion regimen, and psychotherapy treatments. This summary should
be provided to the student health center and the center responsible
for academic accommodations. While the student is at college, the
student health center should be managing much of the patient’s
care. During breaks and upon graduation, the student health center
should provide a summation of patient care to the patient’s HCP for
collaboration and coordination of care.
The clinical information system component involves electronic
medical record (EMR) use. By using an EMR, practitioners can ac-
cess a pertinent database of the individual patient.15 This will allow
the HCP to monitor the patient and assess the progress and stability
of ADHD symptoms through screenings and evaluations. EMRs can
alert providers to needed follow-up, diagnostic tests, prescriptions
refills, and tracking quality improvement data.16 A well-developed
clinical information system should facilitate the exchange of in-
formation between the interprofessional team and patients. It
should include a patient interface that allows patients to look up
laboratory tests, obtain clinical notes, and coordinate care among
their providers.
Because ADHD has long been treated as a childhood disorder,
adult HCPs may feel hesitant about managing the care of adult
ADHD patients and writing psychiatric prescriptions. This is where
the decision support component of the model becomes important.
Decision support includes the use of nationally accepted clinical
guidelines. Currently established guidelines for the management of
ADHD in children can be accessed via the American Association of
Pediatric guidelines.4,17 These guidelines provide an important tool
for HCPs; they should feel empowered in making the diagnosis and
selecting the correct therapy; whether pharmacologic or
nonpharmacologic.
Although there is improved recognition of ADHD, its symp-
tomatology, and the negative impact it can have on an individual’s
functionality, there remains stigma and disbelief among the general
population. A key factor in the academic success of students with
ADHD is having faculty members who are aware of the symptom-
atology of ADHD and accommodations that may be required. With
adequate training, faculty can feel more comfortable about
providing accommodations to provide better support for the
student.
4 C. Parsons / The Journal for Nurse Practitioners xxx (xxxx) xxx

Figure. Improving outcomes in ADHD. Applying the CCM: a life span approach. (Adapted with permission from Wagner EH. Chronic disease management: what will it take to
improve care for chronic illness? Eff Clin Pract. 1998,1:2-4.)

Community resources, another core component of the CCM,
provide additional support to patients with ADHD. To effectively
link patients to community resources, the care team will need to
educate the patient on the resources available to them such as
tutoring, ADHD self-help groups/forums, or magazines directed
toward patients with ADHD. For instance, Additude is an online
magazine that provides resources for patients, families, and pro-
viders in the treatment and management of ADHD.18 With the CCM,
patients work with multiple providers of care; therefore, it is
essential that someone serve in the coordinator role and assist in
linking the patient to these community resources. The role of case
manager may be the responsibility of the nurse or counselor at a
student health center.
Self-management support, the final element of the CCM, plays a
significant role in successfully managing ADHD.16 Using a patient-
centered approach, patients are empowered to manage their plan
of care and advocate for themselves. First, the provider should
assess the patient’s knowledge of their illness. Do they know what
ADHD is? How has ADHD affected them? What are their core
symptoms, and what improves or exacerbates symptoms? Do they
 C. Parsons / The Journal for Nurse Practitioners xxx (xxxx) xxx
know what medications they are taking and what their role in
symptom management is? Do they know what potential side ef-
fects they may experience? Once the gaps in knowledge are iden-
tified, patients should be educated, and they should become a focus
of care. Patients should be encouraged to continue to use phar-
macologic and nonpharmacologic treatment modalities that work
for them.8,9,19 The patient should be supported in self-advocacy and
helped to guide his or her treatment. Whether it is using earplugs
during tests, using a “to do list” or planner, scheduling study times,
using academic support services, or alternate testing sites, the pa-
tient can incorporate these tools into the plan of care.2,9 For pa-
tients who find side effects distressing or intolerable, they need to
be able to address this with their HCP and advocate for change. An
essential and effective component of patient-centered care and
self-management is the use of substance abuse contracts, which
provides parameters and a clear understanding of the appropriate
use of controlled substances for the management of ADHD.14,15
Contract use does not guarantee that a patient will not misuse his
or her medication, but it provides an agreement between the
provider and the patient, clarifying roles, responsibilities, and
expectations.
While planning for the transition to college, students should
become familiar with the resources that colleges offer, including
the student disability services, student center of academic success,
and writing and tutoring resources.6,19 Patients should work with
their care team to develop a plan of care that identifies the re-
sources and accommodations required and strategies for managing
academics.9 This may be educating patients and working to assure a
manageable first semester course load, rather than a full-time
course load of extremely rigorous courses. Well in advance of
starting classes, they should contact the student disability center to
coordinate academic accommodations, which may include class-
room or testing accommodations. Some students may be hesitant
about requesting accommodations because of perceived stigma.
These feelings should be acknowledged by the provider; however,
patients need to be educated on the importance these accommo-
dations have on their academic success.
As discussed throughout, the transition from high school to
college can be extremely challenging for students with ADHD.
Educating and linking patients to available resources is of great
importance in students’ success. The success of the CCM in ADHD
relies on the use and integration of all 6 components to reach
maximum effectiveness.15
Implications for NPs
NPs work in a variety of primary care settings and are uniquely
positioned to implement this patient-centered approach. Although
not every patient will require all elements to be implemented, the
NP can assess and apply those elements that will improve func-
tionality, compliance, and quality of life for the patient.
In order to support patients with self-management, it is
necessary to identify those students with ADHD symptomology.
Research suggests that a significant portion of young adults who
experience symptoms of ADHD are not adequately treated.7-9 Many
young adults who were being pharmacologically treated discon-
tinue their medications because of a lack of improvement in
symptoms or intolerable side effects.7 Medication discontinuation
may also be the practice of many HCPs who view ADHD as a
childhood disorder of an acute and episodic nature.
Limited adult ADHD diagnostic tools and age of onset criteria
make it difficult to adequately diagnose ADHD in young adults.
Educating HCPs about ADHD, current standards of care and clinical
guidelines, as well as its impact across the life span is the first
5
approach to overcoming this challenge.18 The American Academy of
Family Physicians has created an online resource called the Adult
ADHD Toolkit to provide guidance in assessing, diagnosing, and
treating adults with ADHD.20 HCPs need to reframe their knowl-
edge and perspectives to address the chronicity of the disorder
with a life span approach to treatment, thus guiding newly inde-
pendent college students into continuing treatment through col-
lege and beyond.
Accurate and timely diagnosis is the first step in treating pa-
tients; the identification of postsecondary education students in
need of services can be difficult.19 Students, who are now learning
to navigate life independently, may not self-identify or register
their disability unless they are seeking accommodations. NPs can
conduct needs assessment with patients with a history of ADHD or
those who present with ADHD symptomology to case find.
Other psychosocial challenges such as low self-esteem, poor
academic performance, depression, substance abuse, and other
comorbidities require treatment and services beyond those for
ADHD.5,7 As HCPs increase their knowledge in diagnosing and
treating ADHD, it is necessary to consider that although pharma-
cologic treatment is the gold standard, comprehensive treatment
should include a multidisciplinary team of professionals who offer
additional treatment options and support services. The patient’s
HCP will need to drive this approach in 2 ways. As previously stated,
the patient, now a young adult, needs to assume more ownership
and self-management of his or her disorder. However, the HCP also
needs to support the patient through guidance, education, and
coordination of care to ensure that the patient has the needed tools
and support to self-manage his or her disorder.
The CCM is not a new model and has been successfully used to
improve outcomes for other chronic health conditions, such as
asthma and diabetes.15 The application of the CCM to ADHD is a
new approach and will require a paradigm shift in how HCPs
approach and treat the disorder. As with any significant change, the
process is slow and will require extensive research to support or
invalidate the suggested approach. ADHD is a chronic disorder, and
current acute episodic treatment modalities are not meeting the
needs of the young adult ADHD patient. Any movement toward
chronic care management is likely to improve patient outcomes.
References
1. Sibley MH, Swanson JM, Arnold LE, et al. Defining ADHD symptom persistence
in adulthood optimizing sensitivity and specificity. J Child Psychol Psychiatry.
2016;58(6):655-662. https://doi.org/10.1111/jcpp.12620.
2. Fleming A, McMahon R. Developmental context and treatment principles for
ADHD among college students. Clin Child Fam Psychol Rev. 2012;15:303-329.
https://doi.org/10.1007/s10567-012-0121-z.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
4. American Academy of Pediatrics. ADHD: clinical practice guidelines for the
diagnosis, evaluation and treatment of attention deficit hyperactivity disorder
in children and adolescents. Pediatrics. 2011;128(5):1-16. https://doi.org/
10.1542/peds.2011-2654.
5. Verkujil N, Perkins M, Fazel M. Childhood attention-deficit/hyperactivity dis-
order. BMJ. 2015;350(8009):h2168. https://doi.org/10.1136/bmj.h2168.
6. Fuermaier ABM, Tucha L, Koerts J, et al. Cognitive impairment in adult
ADHDdPerspective matters! Neuropsychology. 2015;29(1):45-58. https://
doi.org/10.1037/neu0000108.
7. Chan E, Fogler JM, Hammerness PG. Treatment of attention deficit/hyperac-
tivity disorder in adolescents: a systematic review. JAMA. 2016;315(18):
1997-2008. https://doi.org/10.1031/jama.2016.5453.
8. McClain EM, Burks EJ. Managing attention deficit/hyperactivity disorder in
children and adolescents. Prim Care. 2015;42(1):99-112.
9. Nugent K, Smart W. Attention-deficit/hyperactivity disorder in postsecondary
students. Neuropsychiatr Dis Treat. 2014;10:1781-1791. https://doi.org/
10.2147/NDT.S64136.
10. Weyandt LL, Oster DR, Gudmondsdottir BG, DuPaul G, Anastopuolos A. Neu-
ropsychological functioning in college students with or without ADHD.
Neuropsychology. 2017;31(2):160-172. https://doi.org/10.1037/neu0000326.
6 C. Parsons / The Journal for Nurse Practitioners xxx (xxxx) xxx
11. American College Health Association. American college health assessment II:
reference group executive summary, Spring 2018. https://www.acha.org/
documents/ncha/NCHAII_Spring_2018_Reference_Group_Executive_Summary.
pdf. Published 2018. Accessed February 20, 2020.
12. Brandy J, Penckofer S, Solari-Twadell P, Velsor-Friedrich B. Factors predictive
of depression in first-year college students. J Psychosoc Nurs Ment Health Serv.
2015;53(2):38-44. https://doi.org/10.3928/02793695-20150126-03.
13. Furczyk K, Thome J. Adult ADHD and suicide. Atten Defic Hyperact Disord.
2014;6:153-158. https://doi.org/10.1007/s12402-014-0150-1.
14. Humphreys KL, Eng T, Lee SS. Stimulant medication and substance use out-
comes: a meta-analysis. JAMA Psychiatry. 2013;70:740-749. https://doi.org/
10.1001/jamapsychiatry.2013.1273.
15. Wagner EH, Austin BT. Improving chronic illness care: translating evidence
into action. Health Aff (Millwood). 2001;20(6):64-78. https://doi.org/10.1377/
hlthaff.20.6.64.
16. Additudemag. www.additudemag.com. Accessed April 3, 2020.
17. Ramsey JR. Assessment and monitoring of treatment response in adult ADHD
patients: current perspectives. Neuropsychiatr Dis Treat. 2017;13:221-232.
https://doi.org/10.2147/NDT.S104706.
18. Wolraich ML, Hagan JF, Allan C, et al. Subcommittee on children and adoles-
cents with attention-deficit/hyperactive disorder. Clinical practice guideline
for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity
disorder in children and adolescents. Pediatrics. 2019;144(4), E20192528.
19. Amyx ML, Hastings KB, Reynolds EJ, Weakley JA, Dinkel S, Patzel B. Manage-
ment and treatment of attention-deficit/hyperactivity disorder on college
campuses. J Psychosoc Nurs Ment Health Serv. 2015;53(11):46-51. https://
doi.org/10.3928/02793695-20151021-03.
20. American Academy of Family Physicians. Adult ADHD Toolkit. https://
www.aafp.org/family-physician/patient-care/prevention-wellness/emotional-
wellbeing/adhd-toolkit.html. Accessed April 6, 2020.
Cindy Parsons, DNP, PMHNP-BC, is an associate professor of nursing at the University of
Tampa in Tampa, FL, and can be contacted at cindy.parsons@ut.edu.
In compliance with standard ethical guidelines, the author reports no relationships
with business or industry that would pose a conflict of interest.