ADHD Psychopharmacology Treatment Algorithm Presented at APSARD Annual Conference

To shed light on evidence-based treatment decisions, Kevin P. Muthu, MD, and David N. Osser, MD, developed a psychopharmacology treatment algorithm for adult patients with ADHD. The algorithm aims to clarify treatment decisions in the context of common and often challenging comorbidities. The poster detailing their work was presented at American Professional Society of ADHD and Related Disorders (APSARD) 2026 Annual Conference in San Diego, California.¹

Muthu and Osser, leveraged recent study data to devise the treatment algorithm. Based on their research, they found several key themes: the importance of proper medical screening before initiating treatment; the value of weight-based dosing to achieve optimal outcomes with methylphenidate; and the evolving evidence supporting ADHD treatment in carefully selected patients with bipolar disorder or substance use disorders.

The algorithm itself details important issues such formulation selection and dosing strategies, substance use disorders, psychosis considerations, comorbid bipolar disorder, and medical clearance and cardiovascular considerations. Muthu and Osser also discussed the role nonstimulant options should play in treatment considerations.

In reviewing the literature and making recommendations, they highlighted the rational decision-making given the bigger picture. For instance, stimulant use should not be contraindicated in patients with substance use disorder who are in remission, Muthu explained, but clinicians should consider guardrails. “For these patients, we strongly recommend extended-release formulations over immediate-release to reduce the risk of misuse and diversion. We also recommend close monitoring, including random pill counts and functional assessment measures,” he said.

“While no algorithm can substitute for clinical judgment, and every patient requires individualized assessment, this framework can help guide evidence-informed decision-making in this complex population,” Osser told Psychiatric Times.

Lack of treatment remains one of the biggest burdens for patients with ADHD. Increased mortality, unemployment, incarceration, and psychiatric comorbidity are all sequelae of untreated ADHD, said Osser. “Appropriate treatment can meaningfully improve outcomes across all major life domains. As clinicians, we have both the opportunity and the responsibility to recognize and treat this condition effectively.

Osser is an associate professor of psychiatry at Harvard Medical School; a psychiatrist at the Veterans Affairs (VA) Boston Healthcare System, Brockton Division; and codirector of the VA National Bipolar Disorders TeleHealth Program. He is also a member of Psychiatric Times editorial board and conceived the Psychopharmacology Algorithm Project at the Harvard South Shore Psychiatry Residency Program. Muthu is clinical fellow in psychiatry at Veterans Affairs Boston Healthcare System.

Reference

1. Muthu KP, Osser DN. A Pragmatic, evidence-derived psychopharmacology algorithm for adult ADHD. Poster presented at the APSARD 2026 Annual Conference; January 15-18, 2026; San Diego, CA.