بروتوكول وزارة الصحة لاضطراب فرط الحركة وتشتت الانتباه (ADHD) عبر مختلف مراحل الحياة

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اطماره الجر
Ministry of Health
MOH Protocols for the Management of Attention Deficit Hyperactive Disorder (ADHD)
Across the Life Span
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اطرف الجزء
Ministry of Health
Table of Contents
• Introduction....3
A. Purpose....3
B. Aim & Scope ....3
C. Targeted Population....4
D. Setting 4
E. Methodology 4
F. Updating 5
G. Conflict of Interest....5
H. Funding 5
I. DISCLAIMER....5
• Managing ADHD (Algorithm)....6
• Management of Attention Deficit Hyperactivity Disorder (ADHD)....7
A. Non-Pharmacological Management....7
B. Pharmacological Management:....7
- Appendix 1 (Vanderbilt Rating Scale – Parents version)....16
- Appendix 2 (Vanderbilt Rating Scale – Teachers version)....19
- Appendix 3 – Risperidone Monitoring Requirements....22
• References....26
Methodology references....27
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اداريلج
Ministry of Health
- Introduction
A. Purpose
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic, usually persistent, neurodevelopmental condition with genetic and neurobiological roots, associated with a high rate of comorbid neuropsychiatric disorders, the most common of which are anxiety and mood disorders, personality disorders, and substance-related disorders \( [1,2] \) . ADHD is among the most common and heritable neurodevelopmental disorders, with a global prevalence of 5.29 % and an 8 % local prevalence in Saudi Arabia, in both children and adults, with a modest increase in male prevalence \( [3-5] \) .
ADHD is defined as a constant lack of attention, impulsivity, and hyperactivity before age 12 that are developmentally inappropriate and evident in more than one sitting, producing academic, occupational, and social problems [7]. As a result, it affects a person's day-to-day activities, producing disruption in academic, occupational, and social aspects, which impacts their family and community [6]. An ADHD diagnosis can be performed through the clinical examination and rating scales more commonly used in children and youth to help measure the severity of the symptoms and track the response to therapy [8,9].
The biopsychosocial model of managing ADHD can be classified into two types of interventions; the pharmacological type, which includes stimulant and non-stimulant medications, and the non-pharmacological type, which includes psychoeducation, social interventions, behavioral interventions, psychotherapy, and educational/vocational accommodations.
The early diagnosis and appropriate management of ADHD guarantee the best result and reduce the risk of developing other comorbid psychiatric disorders \( [12] \) . The diverse clinical presentation, high comorbidities rate, and various elements of ADHD management create a challenge for health care practitioners. It is necessary to have a simplified, user-friendly, and up-to-date protocol to improve the quality of care and health care results for the ADHD population.
B. Aim & Scope
These protocols aim to deliver evidence-based recommendations on assessment and the non-pharmacological and pharmacological management of Attention Deficit Hyperactive Disorder (ADHD). This protocol also aims to reduce the unnecessary use of psychotropics in children under the age of six and to ensure that, when unavoidable, they are prescribed according to best practice. It provides an overview of fundamental principles and practical resources for less experienced employees, which they may implement and discuss with their superiors. Multidisciplinary teams can utilize it as a shared reference point to aid in coordinated treatment, and more experienced professionals can use it as a refresher or training resource. The protocol should be applied within a framework of local policies and procedures
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தேவி அருகு
Ministry of Health
C. Targeted Population
The protocol is intended to be a practical and ready reference for health professionals who work in settings where they will care for patients with ADHD. Given the extensive range of expertise, disciplines, and positions of employees at the MOH, it is impossible to capture the whole scope of specialist practice that can be used by experienced professionals across different disciplines and settings. As a result, this protocol can be applied in several cases.
D. Setting
- Iradah Complex / Hospital and Mental Health.
– Psychiatric clinics in MOH General Hospitals.
E. Methodology
Phase 1: In the literature, a group of mental health professionals looked for clinical practice protocols for assessing and managing ADHD across the lifespan. Furthermore, another member looked through the MOH's directory for registered drugs listed in international protocols. Several clinical practice protocols emerged from the search, with seven being the most recent and commonly used. Six CPGs for ADHD were chosen for further examination; the American Academy of Pediatrics (AAP) in 2012 [2], the University of Michigan Health System (UMHS) in 2012 [3], and the National Institute of Health and Care Excellence (NICE) in 2016 (updated in 2018) [4], the National Health Medical Research Center (NHMRC) in 2013 [5], the Canadian ADHD Resource Alliance (CADDRA) updated in 2018 [6], the Singapore Ministry of Health (SMOH) in 2014 [7] and finally, the Adapted Saudi Arabian ADHD guidelines (Saudi Arabia 2021) [8]. According to our literature review, a summary evaluation of six of the seven most relevant CPGs was undertaken in 2019 using the AGREE-II tool [9]. The Saudi CPG was created using NICE guidelines and tweaked to fit the Saudi Health System. Since it was tweaked to fit the local system and was based on accessible international guidelines, it was chosen for further assessment. The Saudi CPG paper, as well as the supplementary handbook, were reviewed by four assessors. For each item with a score of less than 6, assessors expressed their explanation in the comment section of the AGREE-II score sheet. Differences of opinion among assessors were handled by requesting individuals who had provided outlying scores to re-assess after a group discussion.
Phase 2: The protocol was sent to a group of experts in the field of Child and Adolescent Psychiatry and Behavioral Pediatrics to provide their input and review. Their input was collected over three weeks, followed by further meetings and assessment for the feedback by the committee.
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اذالجر
Ministry of Health
F. Updating
The first version of this protocol was created in 2022. The protocol will be updated every five years or if any changes or updates are released by international/national protocols, pharmacotherapy references, or MOH formulary.
G. Conflict of Interest
This protocol was developed based on valid scientific evidence. No financial relationships with pharmaceutical, medical device, and biotechnology companies.
H. Funding
No fund was provided.
I. DISCLAIMER
This Clinical protocol is an evidence-based decision-making tool for managing health conditions. It is based on the best information available when writing and is to be updated regularly. This protocol is not intended to be followed as a rigid treatment protocol. It is also not meant to replace the clinical judgment of practicing physicians but is the only tool to help manage patients with ADHD. Treatment decisions must always be made individually, and prescribing physicians must customize care and tailor treatment regimens to patients' unique situations and health histories. Physicians should check the approved product monographs within their institution's formulary for dosage, special warnings, precautions for usage, contraindications, and monitoring of side effects and potential risks. When choosing treatment options, consider any constraints imposed by the institution's formulary. During the decision-making process for picking specific drugs within a recommended specialized class, prescribing physicians should consult their institution's formularies.
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اشراح الجيد
Ministry of Health
• Managing ADHD (Algorithm)
ADHD MANEGEMENT ALGOTITHM

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السلام عليكم
السلام عليكم
Ministry of Health
• Management of Attention Deficit Hyperactivity Disorder (ADHD)
A. Non-Pharmacological Management
Children under the age of 5:
ADHD-focused group parent-training programs are the first-line treatment for children under 5[10,11].
Children aged five and over and youth up to 18 years old
ADHD-focused group parent-training programs are the first-line treatment for children aged five and youth [10,11].
Parents and carers of children and youth with mild ADHD, comorbid oppositional defiant disorder, or conduct disorder might consider individual/group training programs.
Consider Cognitive Behavioural Therapy (CBT) for youth with ADHD who have responded well to pharmacological management; however, symptoms are still causing considerable impairment in at least one of the following domains:
• Social skills with peers
• Problem-solving difficulties
- Self-control skills
• Active listening skills
Adults:
Adults with ADHD who have made an informed decision not to take medication or who have difficulty adhering to medication due to tolerability or other factors should consider non-pharmacological treatment.
Provide a structured Cognitive Behavioral Therapy CBT, or supportive psychological intervention focused on ADHD and associate impairments with regular follow-up to determine whether medication is needed.
B. Pharmacological Management:
Baseline assessment
ADHD Patients should have a full assessment prior to starting their medication for ADHD [11], which should include:
1) A review to confirm they continue to meet the criteria for ADHD and need treatment.
2) A review of mental health and social circumstances, including but not limited to the presence of coexisting mental health and neurodevelopmental condition, and risk assessment for substance misuse and drug diversion.
3) A detailed review of physical health, including but not limited to height and weight, baseline pulse and blood pressure, a cardiovascular assessment if there is a family history
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السلام علي
السلام علي
السلام علي
السلام علي
السلام علي
or other risk factors, and an electrocardiogram (ECG) if the treatment may affect the QT interval.
Consult for a pediatric cardiology specialist's approval before starting medication for ADHD if there is a history of congenital heart disease or previous cardiac surgery, history of sudden death in a first-degree relative under 40 suggesting a cardiac disease, other cardiogenic symptoms like; shortness of breath on exertion compared with peers, fainting on exertion or in response to fright or noise, palpitations that are rapid, regular, and start and stop suddenly... etc.
Consult for a pediatric hypertension specialist approval before starting medication for ADHD if blood pressure is consistently above the 95th centile for age and height.
Approved Pharmacological Agents in ADHD
Children under the age of 5:
Children under the age of five should receive ADHD-focused caregiver/parents training and environmental modification.
Pharmacological agents are not suggested or approved, although off-label use of immediate-release methylphenidate (Ritalin) can be considered in certain circumstances where non-pharmacological cases are unavailable or do not provide optimal symptom control. For dosing information, refer to table 2.
Children aged five and over and youth up to 18 years old.
The first-line agents are methylphenidates, both immediate and sustained release formulations. A 6-week trial at an adequate dose with limited response warrants a switch to another agent. If stimulants are not tolerated, contraindicated, or show slight improvement, third-line agents such as Atomoxetine and Clonidine can be considered. For dosing information, refer to table 2.
Adults:
Long-acting methylphenidates is the first-line treatment option [10,11]. If stimulants are not tolerated, contraindicated, or show slight improvement, Atomoxetine can be considered a second-line treatment option. For dosing information, refer to table 2.
Monitoring of Pharmacological Interventions
Comorbidity with ADHD is common; stimulants have shown overall efficacy in managing ADHD and associated impairments; however, they are inappropriate for children and adolescents with psychotic illnesses and substance use disorders.
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اصيل الجيزه
Ministry of Health
Monitoring requirements (Table 1)
<table><tr><td>Medication</td><td>Monitoring</td></tr><tr><td>MethylphenidatesA) Immediate-release preparations (e.g. Ritalin)B) Sustained-release preparations (e.g., Concerta)</td><td>1- Height should be measured every 3-6 months.2- Weight should be measured every 3-6 months.3- Height and weight should be plotted on a growth chart.4- Monitor vitals, including heart rate and blood pressure, every 3-6 months.5- Changes in the potential for drug misuse and diversion may come with changes in circumstances and age. In these situations, sustained-release methylphenidate or Atomoxetine may be preferred.</td></tr><tr><td>Atomoxetine</td><td>While on Atomoxetine, you should observe for:Agitation and irritabilitySuicidal thinking and self-harming behavior, or any unusual changes in behavior, especially during the initial months of treatment/ change in dose.Switch to mania.</td></tr><tr><td>Clonidine Bupropion</td><td>Monitor heart rate and blood pressure at baseline, with every dose increase and every 3-6 months due to the risk of bradycardia.</td></tr></table>
Unadvisable use of antipsychotics in ADHD
Second-generation antipsychotics, such as Risperidone and Aripiprazole, have been widely used off-label for managing ADHD symptoms, especially in children younger than six years old. However, unfortunately, there is no data available from Saudi Arabia to quantify this use and address the related concerns. This increase in use could be hypothesized to be due to issues with the availability of approved pharmacological options or the lack of Saudi FDA approval of a wide range of stimulant and non-stimulant options that are otherwise evidence-based and supported for ADHD management.
There is no evidence to support the use of antipsychotics, especially in children with no underlying comorbidities such as ASD and severe behavioral challenges (NICE, 2020). Hence, the use of antipsychotics for managing ADHD should only be resorted to when the first- and second-line options of nonpharmacological and pharmacological management have been utilized. If antipsychotics are to be utilized, it is essential to discuss with the family the lack of evidence to support it, the possible side effects, and the importance of metabolic monitoring of the child on it. (Appendix CAMESA guideline).
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اطرف الجزء
Ministry of Health
Management of Children older than five years, youth up to 18 years old, and adults with ADHD (Table 2)
<table><tr><td colspan="2">Medication</td><td>Indication &amp; Authorization</td><td>Dosage</td><td>Special Precautions</td></tr><tr><td rowspan="3">Stimulants</td><td>Methylphenidates</td><td>AuthorizedFirst-line for all age groups</td><td>Low doses of immediate-release or sustained-release preparations should be used at first, per starting doses in the Saudi National Formulary (SNF)</td><td>1- In a child or youth whose blood pressure is consistently above the 95th centile for age and height, refer to a pediatric specialist before starting medication for ADHD.2- consider the following strategies if weight loss is a clinical concern:Taking medicine either with or after food, instead of before mealsHaving additional meals or snacks early in the morning or late at night when the stimulant effects have worn off and consuming high-calorie foods of good nutritional valueObtaining dietary adviceTaking a planned break from treatment</td></tr><tr><td>B) Sustained-release preparations (e.g., Concerta)</td><td>Sustained-release preparations should be given as a single dose in the morning. Concerta&#x27;s average duration of action is 12 hours.Immediate-release preparations should be given in two or three doses (if needed).Dose titration:1- Immediate release (Ritalin):2- Starting dose is 5 mg PO BID and can be increased by 5-10 mg increments weekly, not to exceed 60 mg PO daily divided dose (BID or TID).3- Sustained-release</td><td>Taking medicine either with or after food, instead of before mealsHaving additional meals or snacks early in the morning or late at night when the stimulant effects have worn off and consuming high-calorie foods of good nutritional valueObtaining dietary adviceTaking a planned break from treatment3- If a child or youth&#x27;s height over time is adversely influenced by medication (that is, they have not reached the height expected for their age), consider a planned break in treatment over school holidays to allow &#x27;catch-up&#x27; growth.4- If psychotic symptoms emerge</td></tr></table>
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اطمار
Ministry of Health
<table><tr><td></td><td></td><td></td><td>(Concerta):4- The starting dose is 18 mg PO daily and can be increased by 18 mg increments weekly, not to exceed 54 mg daily for children and 72 mg daily for youth (13-18 years) and adults.When shifting from Immediate to sustained release:1- Ritalin 5 mg PO q8h is equivalent to Concerta 18 mg.2- Ritalin 10 mg PO q8h is equivalent to Concerta 36 mg.3- Ritalin 15 mg PO q8h is equivalent to Concerta 54 mg.4- Ritalin 20 mg PO q8h is equivalent to Concerta 72 mg.</td><td>while on stimulants, the medication should be withdrawn, and a full psychiatric assessment should be conducted. Atomoxetine could be considered as an alternative in such circumstances.5- Although there is no evidence that methylphenidate raises the incidence of seizures, a neurological consultation is essential if there is a history of seizures, neurological conditions, or seizures that emerged after starting the medication. Dexamfetamine or Atomoxetine may be considered an alternative when a neurological specialist approves.6- If tics emerged while on methylphenidate, the following distinctions should be made:·Whether the tics are stimulant-related.·Whether the tic-related impairment surpasses the benefits of the current treatment.In case of stimulant-related tics, options include:·Reduction of the dose of methylphenidate.·Changing to Atomoxetine or stop drug treatment.7- Stimulants may worsen</td></tr></table>
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اطماره الجلد
Ministry of Health
<table><tr><td></td><td></td><td></td><td></td><td>anxiety symptoms in individuals with a history of coexisting anxiety. This issue can be approached by either lowering the dose of the stimulant or adding an SSRI to manage anxiety. In addition, a switch to Atomoxetine may be effective.8- Symptoms of aggression and suicidality but not completed suicide were reported with stimulants.</td></tr></table>
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اطمار الجيز
Ministry of Health
<table><tr><td colspan="2">Medication</td><td>Indication &amp; Authorization</td><td>Dosage</td><td>Special Precautions</td></tr><tr><td rowspan="4">Non-Stimulants</td><td rowspan="4">Atomoxetine</td><td>AuthorizedThird-line for children over five and youth.Second-line in adultsIndicated when:1- There is a contraindication to the use of stimulants.2- There is a high risk of developing side effects.3- With comorbid Tic disorder, Tourette&#x27;s syndrome, anxiety disorders, Neurological contra-indications, and risk of Stimulant misuse.4- If stimulants have been tried and showed no desirable effect at the maximum tolerated dose.</td><td>In Children &gt; 6 years of age and weighing up to 7okg:Start with 0.5 mg/kg/day. Increase after 3-7 days to a target dose of 1.2 mg/kg/day.The dose can be given once daily or in 2 divided doses; it should not exceed 1.4 mg/kg/day or 100 mg/day, whatever is less.In children and youth where weight is over 7okg and in adults:Start with 40mg once daily and increase after 3-7 days to 80mg once daily or in divided doses.Maximum recommended dose is 100mg/day.A trial of 6 weeks on a maintenance dosage should be allowed to determine the medication&#x27;s effectiveness.</td></tr><tr><td>Non-Stimulants</td></tr></table>
Special Precautions
1- In the presence of arrhythmia, sustained resting tachycardia, or systolic blood pressure > 95th percentile (or a clinically significant increase) measured on two occasions, a referral to a pediatric specialist is needed.
2- In the presence of seizure exacerbation or the emergence of seizure activities secondary to the introduction of Atomoxetine, the medicine must be discontinued, and a referral to a pediatric neurology specialist is required.
3- Sexual dysfunction and dysmenorrhoea should be monitored as potential side effects of Atomoxetine.
4- A black box warning is associated with the use of Atomoxetine. There is a small risk of new-onset or increased suicidal thinking, especially during the initial phase of treatment.
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اطمار
Ministry of Health
<table><tr><td colspan="2">Medication</td><td>Indication &amp; Authorization</td><td>Dosage</td><td>Special Precautions</td></tr><tr><td rowspan="2">Other (OFF-label Drugs)</td><td>Clonidine</td><td>When there is no sufficient response to stimulants, Atomoxetine.</td><td>Start with 0.1 mg daily. Then, increase by 0.1 mg weekly increments to reach a maximum dose of 0.4 mg PO daily in divided doses with the bigger dose at bedtime.</td><td>Informed consent should be obtained and documented.Practice caution when prescribing the medication to an individual with cardiovascular diseases such as heart block and bradyarrhythmia.Common adverse effects include constipation, dry mouth, headache, nausea, and postural hypotension.Discontinuation should be gradual in 0.1 mg increments to avoid rebound hypertension.</td></tr><tr><td>Bupropion</td><td>It can be used in adults as an off-label medication for ADHD if the approved medications were not tolerated or showed poor response.</td><td>Extended-release Formulation 150 mg PO daily. Then, increase by 150 mg weekly with a target dose of 300-450 mg PO daily.</td><td>Avoid use in individuals with bulimia nervosa for the risk of bupropion lowering the seizure threshold.Consult neurology in individuals with a seizure disorder for the risk of lowering the seizure threshold.</td></tr></table>
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الطرفيه
مستجمه
مستجمه
Review of medication and discontinuation
ADHD medication should be reviewed at least yearly, and a discussion with the person with ADHD (and their families and carers as appropriate) should be made to decide whether the medication should still be used [11].
The review should include a comprehensive assessment of the following:
- Preference of the patient and their family or carers as appropriate.
- Benefits, including how well the current treatment is working throughout the day.
- Adverse effects.
- Clinical need and whether medication has the optimized impact on education and/or employment.
• Effects of missed doses.
- Planned dose reductions, and periods of no treatment.
- Effect of medication on existing or new mental health, physical health, or neurodevelopmental conditions.
- Need for support and type of support if medication has been optimized, ADHD symptoms continue to cause significant impairment.
If an overall balanced assessment of benefits and harms indicates that this is appropriate, a trial period with drug discontinuation or dose reduction is considered. The reason should be recorded if a decision is made to continue taking the medication [11].
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اطرفه الصحه
Ministry of Health
- Appendix 1 (Vanderbilt Rating Scale – Parents version)
<table><tr><td colspan="6">مقياس ف抬ريت للتعليم، مطلوبات ولي اخري</td><td>D3</td></tr><tr><td colspan="6"></td><td>تاريخ البيم :</td></tr><tr><td colspan="6"></td><td>اسح الطفل :</td></tr><tr><td colspan="6"></td><td>تاريخ الميكت :</td></tr><tr><td colspan="6"></td><td>اسح ولي الامر :</td></tr><tr><td colspan="6"></td><td>مفت، ولي الامر :</td></tr><tr><td colspan="6">تعليمات : يجب مراعاه ما يناسب عمر طلاق عند الاجابه علي كل عباره قمها يي ، واثاء تعينه الاستمراه يرجي مراعاه سلوكيات الطلقه في اثناء الوقت</td><td></td></tr><tr><td colspan="6">الاحياء علي كل العبارات يختارين رغم واحد ققط من الارقام الموجوده بجانب كل عباره . والذي يتري منه يناسب طلاق . يمو ملاقطه انه يجب</td><td></td></tr><tr><td colspan="6">الاحياء علي كل العبارات يختارين رغم واحد ققط .</td><td></td></tr><tr><td colspan="6">هل اخري هذا التقييم في وقت كان فيه الطلاق :</td><td></td></tr><tr><td colspan="6">يتباول جرعات دوايه □ يتناول جرعات دوايه</td><td></td></tr><tr><td>طوال الوقت</td><td>مسقط الاحيان</td><td>احيانا</td><td>ايها</td><td>الاغراض</td><td></td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>لا ينته للقاصيل الادموي. يتركت اخطاع منج الاجراءات</td><td>١.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>المربيه وحسوبه في الفrikز المستمر علي ما يجبح عليه انجازه (خاصه الاجراءات المربيه في الحصف والمزلز).</td><td>٢.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتبو و عاته لا يستمع حين يوجد له الكتم مباشره.</td><td>٣.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>لا يتخي التعليمات يقتل في اتمام الاثмطه (ليس بسبب الرفض او عدم الغي)</td><td>٤.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يسبب عليهم المهام والانشطه مثل ترتيب غرفه وجدوله اوقات الالوالعب والثم.</td><td>٤.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتجيب ويكرو او لا يرغب في بيع الاشطه التي تطلاب مهجودا تدهها مستمرا مثل حل واجبات المدرسه الميويه.</td><td>٥.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يفقد الاثوات و الاشياء الضروريه لانجاز المهام او التشطه (مثل الاعتن) (الواييات) او الابعت.</td><td>٦.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتشت انتهايه بسهوله للشجيج او اي مشرات اخري.</td><td>٨.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>بتنمي تنطلاته اليوويه ، مثل تبديل ملاتيبه قبل الفروو وتتطيف استلام</td><td>٩.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>وتربب حفيفه.</td><td>١٠.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يعير عن ملكه ببياء او قدميه او يتحرك كثيرا علي الكربي.</td><td>١١.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يترك مكابه، جنما يوتقي منه البقاء فيه (كما يحصل اثناء الطعام او الجمع الاعراء علي برامج التلفاز).</td><td>١١.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يرحفي او يتصل كثيرا في اوقات غير مناسبه نجما يجب ان يقي.</td><td>١٢.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>بواجه صعوبه عندما يحلب منه اللعب بهده او المشاركه في الاعلاب بهذه.</td><td>١٣.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>دايم الحرك كه ونكه يعمل بمحرك.</td><td>١٤.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتكتم بكتره.</td><td>١٥.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتسع بالجابه قبل اتمام السؤال المطروح عليه.</td><td>١٥.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يوصب عليه التطال دوره قبل الصبر.</td><td>١٧.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يقاطع حديديه الاخرين او يقتم انشتهتم.</td><td>١٨.</td><td></td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يجادل الكبار.</td><td>١٩.</td><td></td></tr></table>
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
Copyright © 2005 American Academy of Pediatrics, University of North Carolina at Chapel Hill for its North Carolina Center for Children's Healthcare Improvement, and National Initiative for Children's Healthcare Quality
Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolanich, MD.
Revised - 1102
American Academy of Pediatrics
DEPOSITED TO THE HEALTH OF ALL CHILDREN

NICHO
National Institute for Children's Healthcare Quality

MCNEIL PEDIATRICS
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اداره الصحه
Ministry of Health
<table><tr><td colspan="5">مقياس فظربت للتقريب عروت الي اشر تي</td><td>D3</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يقق اعصابه (يصبح عصبا لاعور لا تقرجبدق)</td><td>20</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يرغم الاستعمال (اطعه) لطابك اكفري ار قاتيم)</td><td>21</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يعصد از تاج الاربين)</td><td>22</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>بلوم الاخرين علي اخله او صرفكە/ابيه</td><td>23</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>حسان ويسيل محزيه من قبل الاخرين)</td><td>24</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>عصبي و مسعا</td><td>25</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>حفور والديه رغبه بالانم</td><td>26</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>مستد في تحامله ويهد او يخيف الاخرين)</td><td>27</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>بيذا بالمشاجرات البنيه</td><td>28</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يكتب البنوم المشكل في ليتجب اي ادلات (مثل) يحتل علي</td><td>29</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>الاخرين) (مشكل)</td><td>30</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتبيب عن المربيه بدون اتن الاغل والالمربيه</td><td>31</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>عتب جمديا مع الاخرين</td><td>32</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>سبق له وارس ايياء قيطه (غاليه الثمن)</td><td>33</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتمح تحرير بمسكات الخير</td><td>34</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>سبق ان استخدم سحها من الممكن ان يسب اذي بالغا (عصا، سن) حلويه، ملسن</td><td>35</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>قابي مع الحيوانات</td><td>36</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>سبق له ان تعمد اشعال حريق بغرض الايتي</td><td>37</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>سبق لهzwقف متزل شخص اخري او سيارته</td><td>38</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>سبق لهzwقف بقي خارج المزل ليله بون ان</td><td>39</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>سبق لهzwقف احب ما علي مساريه نشاط جنسي معه</td><td>40</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يتتاهه الخوف والهم واتفق.</td><td>41</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يخلف من تجربه اثياء جيده خشيه ارتكاب الاختطاع</td><td>42</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يشعر بحكم (و نون) قيمته وي انه قال من الاخرين.</td><td>43</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يلوم قصه علي المشارك و يشعر بالذيب.</td><td>44</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يشعر بالوحده و بلكه غير مغروب و غير محبوب و يكتي بان “ي</td><td>45</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>يشعر بالحرزن والثماعه و الاحياط.</td><td>46</td></tr><tr><td>3</td><td>2</td><td>1</td><td>0</td><td>خجل وسهل احجه.</td><td>47</td></tr></table>
American Academy of Pediatrics
DEPARTMENT OF THE HEALTHCIT OF ALL CHILDREN

NICHQ
National Institute for Childbirth Health Care Quality

McNeil Pediatrics
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الطبيه
Ministry of Health
<table><tr><td colspan="6">مقياس تغريه للتطوير، مطريات الي اخري، تبع</td><td>D3</td></tr><tr><td>يعاني من</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>يعاني الصيريه صعوبه تحياده</td><td>توسط</td><td>جيد جنا</td><td>مستار</td><td></td><td></td><td>الاداء</td></tr><tr><td>5</td><td>4</td><td>3</td><td>2</td><td>1</td><td></td><td>الاداء العمري العام</td></tr><tr><td>5</td><td>4</td><td>3</td><td>2</td><td>1</td><td></td><td>الافراء</td></tr><tr><td>5</td><td>4</td><td>3</td><td>2</td><td>1</td><td></td><td>الارابعيه</td></tr><tr><td>5</td><td>4</td><td>3</td><td>2</td><td>1</td><td></td><td>علاقه مع والله</td></tr><tr><td>5</td><td>4</td><td>3</td><td>2</td><td>1</td><td></td><td>علاقه مع لغه</td></tr><tr><td>5</td><td>4</td><td>3</td><td>2</td><td>1</td><td></td><td>علاقه مع افراء</td></tr><tr><td>5</td><td>4</td><td>3</td><td>2</td><td>1</td><td></td><td>شركه المتعلقه بالعمله المثلا: الفرق</td></tr></table>
: علاقه
<table><tr><td></td><td>لاستخدام المعتي فقط :</td></tr><tr><td></td><td>عدد الاسيله من 1-9 الي 3 نقط</td></tr><tr><td></td><td>عدد الاسيله من 10-18 الي 3 نقط</td></tr><tr><td></td><td>اجمالي القاط الي اجرزت في اسيله الاعراض من 1-18</td></tr><tr><td></td><td>عدد الاسيله من 19-26 الي 3 نقط</td></tr><tr><td></td><td>عدد الاسيله من 27-40 الي 3 نقط</td></tr><tr><td></td><td>عدد الاسيله من 41-47 الي 3 نقط</td></tr><tr><td></td><td>عدد الاسيله من 48-55 الي اجرزت 4-5 نقط</td></tr><tr><td></td><td>متوسط نتيجه:</td></tr></table>
American Academy of Pediatrics
BIDIGATIO TO THE HEALTH OF ALL CHILDREN
NICHQ
International Institute for Children's Health Care Quality
McNeil Pediatrics
(1) 2017年1月1日，公司召开2017年第一次临时股东大会，并通知全体董事。
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الطبيه
Ministry of Health
• Appendix 2 (Vanderbilt Rating Scale – Teachers version)
<table><tr><td colspan="4">مقصي خاضربت التنيب، مطلقات المطعين</td><td>D4</td></tr><tr><td colspan="4"></td><td>اسم المعل:</td></tr><tr><td colspan="4"></td><td>وقت الحصه:</td></tr><tr><td colspan="4"></td><td>اسم الفصل الدراسي / متقي.</td></tr><tr><td colspan="4"></td><td>تاريخ اليوم:</td></tr><tr><td colspan="4"></td><td>اسم المعل:</td></tr><tr><td colspan="4"></td><td>الصف:</td></tr><tr><td colspan="4"></td><td>العلب:</td></tr><tr><td colspan="4"></td><td>تعلبات: عند التقييم، يجب مراعاه ما يناسب عمر المظل الذي سيشخص عن قيل عيره من الحيات التاليه. و تثلك يجب ان يخفي سلوك المظل من اخري</td></tr><tr><td colspan="4"></td><td>استماره تثميم تم تثميمها. يجب ان تثميمها. يجب ان تثميم السلوبات.</td></tr><tr><td colspan="4"></td><td>فقط من الارقم الموجوده يجب علي عربيه. و الذي تراه ينسب التميم. مع ملاحظه انه يجب الاجابه علي كل العبارات باغتر. يثميم واحد فقط</td></tr><tr><td colspan="4"></td><td>هل اجري هذا التقيم في وقت كان فيه الطل</td></tr><tr><td colspan="4"></td><td>يتناول جرعات موانيه</td></tr><tr><td></td><td>لا تيقل جرعات موانيه</td><td>لا تيقل جرعات موانيه</td><td>طالب الوقت</td><td>الاعراض</td></tr><tr><td></td><td>لا يتبه للتحصيل الامرير ويرتكب لخطات نعمه من الاجمالات. مثل الاجراءات.</td><td>لا يتبه للتحصيل الامرير ويرتك لخطات موانيه. مثل الاجمالات.</td><td>لا</td><td>المسريه.</td></tr><tr><td></td><td>يجد صوره في التريز المستمر علي العوام والاتشطه.</td><td>2</td><td>2</td><td>2</td></tr><tr><td></td><td>يبدو يكنه لا يصفي حن يرجله له الكات مباشره.</td><td>3</td><td>3</td><td>3</td></tr><tr><td></td><td>لا يتبو التعليمات و يظل في اتمام الاعمال الم турيه (ليس بسبب) الرفق في التعليمات.</td><td>4</td><td>4</td><td>4</td></tr><tr><td></td><td>يسمح عليه قريت العيام والاتشطه مثل قريت يرجله و طلاقه في العمال.</td><td>5</td><td>5</td><td>5</td></tr><tr><td></td><td>يتجب، يكره او لا يرجب الي تويج الاشتقد التي تطلب منه الترخز الذي استثمر مثل ممل مساله حمايه في الفصل.</td><td>6</td><td>6</td><td>6</td></tr><tr><td></td><td>يفقد الاثوات في التجاب الترمه الجاز العيام او الاتشطه مثل الواجبات المكسيه، الالقاب، او الكف).</td><td>7</td><td>7</td><td>7</td></tr><tr><td></td><td>يتشتت انتباه سبهوله مع المثرات الحارجيه.</td><td>8</td><td>8</td><td>8</td></tr><tr><td></td><td>بسي نشاط الله وسبحا الوجود معه الي المرسيه.</td><td>9</td><td>9</td><td>9</td></tr><tr><td></td><td>يحر عن ملكه ييده او قضيه او يتحرك كتيرا علي الكرسي.</td><td>10</td><td>10</td><td>10</td></tr><tr><td></td><td>يخار مقدمدها في الصفه او في ان مكان يستقي مع المقاق فيه.</td><td>11</td><td>11</td><td>11</td></tr><tr><td></td><td>يركض او يستق اختما عبدا لححليم سمه الجوس في مقتد.</td><td>12</td><td>12</td><td>12</td></tr><tr><td></td><td>لديه صوره في المشايه كفي الالغاب، اتجليم يكتب.</td><td>13</td><td>13</td><td>13</td></tr><tr><td></td><td>دايم الحره كفو عه، متق عه بمحرك.</td><td>14</td><td>14</td><td>14</td></tr><tr><td></td><td>يكتم بكف.</td><td>15</td><td>15</td><td>15</td></tr><tr><td></td><td>يكتم بكف.</td><td>16</td><td>16</td><td>16</td></tr><tr><td></td><td>يكتم بكف.</td><td>17</td><td>17</td><td>17</td></tr><tr><td></td><td>يكتم بكف.</td><td>18</td><td>18</td><td>18</td></tr><tr><td></td><td>يكتم بكف.</td><td>19</td><td>19</td><td>19</td></tr><tr><td></td><td>يكتم بكف.</td><td>20</td><td>20</td><td>20</td></tr></table>
The information maintained in this publication do not indicate or convey commercial information or services as standard or modified content. Variations, taking time agreement and individual circumstances, may be appropriate.
American Academy of Pediatrics
DEPARTMENT FOR THE HEALTH OF ALL CHILDREN

Copyright © 2005 American Academy of Pediatrics, University of New Orleans
Copyright (New Orleans) © 2005 American Academy of Pediatrics
© Applied Biology, Inc. © 2005 American College of Pediatrics® Healthcare Programs
Adapted from the Vanskeroff Rating Scale developed by Mark L. Welsch, MD.

The following table is provided in the image:

McNEIL PEDIATRICS
(1) 2017年1月1日，公司召开2017年第一次临时股东大会，并通知全体董事。
www.moh.gov.sa
SaudiMOH
MOHPortal
SaudiMOH
Saudi_Moh

الطبيه
Ministry of Health
مشري قطريت للتعجب مطریت المعلين، تبع
D4
: است العمل
: وقت الصقه
: است المصل الزامي / متع
: است المطل
: است
:

الطبيه
Ministry of Health
بتري فدريت للتنيع. ملومات المعلمين، تبع
D4
الرجاء تسليم الاستمراه ل:
العوان البريدي : ٤
____
____
رقم الفاكس : ٤
لاستخدام المكيف فقط :
: 3-1 18-10 1-1 18-10 1-1 18-10 1-1 18-10 1-1 18-10 1-1
: 3-1 28-19 1-1 28-19 1-1 28-19 1-1 28-19 1-1 28-19 1-1
: 3-1 35-29 1-1 35-29 1-1 35-29 1-1 35-29 1-1 35-29 1-1
: 4-1 43-36 1-1 43-36 1-1 43-36 1-1 43-36 1-1 43-36 1-1
: 1-1
American Academy of Pediatrics
BIOGATI BED 101 HABITAN OF ALL CHILDREN
NICHO
McNEIL PEDIATRICS
CHINADOR QINTO-HOM & JAMIE PRANCICHE DE
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السلام علي
Ministry of Health
- Appendix 3 – Risperidone Monitoring Requirements
Monitoring Safety of Second-Generation Antipsychotics (SGA) in Children Based on the CAMESA Guidelines
Patient
Name: ____
Gender: ____
DOB
(YYYY/MM/
DD):
SGA Risperidone
Medication (Risperdal)
:
Target
Symptoms (e.g.
tics, rage,
psychosis):
<table><tr><td>Parameter</td><td></td><td>Pre-Treatment Base line</td><td>1 Mo nth</td><td>2 Mo nth</td><td>3 Month</td><td>6 Month</td><td>9 Mo nth</td><td>12 Mo nth</td></tr><tr><td>General Information:</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Assessment Date (YYYY/MM/DD):</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Patient Age at Assessment:</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Daily Dose of risperidone:</td><td></td><td>mg</td><td>mg</td><td>mg</td><td>mg</td><td>mg</td><td>mg</td><td>mg</td></tr><tr><td>Physical Examination Maneuvers:</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Height (cm)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Height percentile 1</td><td>Round to nearest 5, 10, 25, 50, 75, 90, or 95 %ile</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Weight (kg)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>
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<table><tr><td>Weight percentile1</td><td>Round to nearest5, 10, 25,50, 75,90, or 95%ile</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2">BMI (kg/m2)1</td><td>#DI V/o!</td><td>#DI V/o!</td><td>#DI V/o!</td><td>#DIV/o!</td><td>#DIV/o!</td><td>#DI V/o!</td><td>#DI V/o!</td></tr><tr><td>BMI percentile1</td><td>Use CDC calculator to calculate value1</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2">Waist Circumference (at level of umbilicus) (cm)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Waist Circumference percentie 2</td><td>&gt;90, or round to nearest 10, 25, 50, 75, or 90 %ile</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2">Systolic Blood Pressure (mm Hg)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Systolic Blood Pressure percentile 3</td><td>Provide range (&lt;50, 50-90, 90-95, 95-99, or ≥99)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2">Diastolic Blood Pressure (mm Hg)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Diastolic Blood Pressure percentile 3</td><td>Provide range (&lt;50, 50-90, 90-95, 95-99, or ≥99)</td><td colspan="2"></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2">Neurological Examination:</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>
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<table><tr><td>Neurological Exam completed?4</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Neurological Exam Normal or Abnormal?</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>
<table><tr><td colspan="8">Laboratory Evaluations:</td></tr><tr><td>Test</td><td>Normal Values</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Fasting Plasma Glucose5</td><td>≤6.1 mmol/L</td><td>5</td><td></td><td></td><td>5</td><td>5,8</td><td>5,7</td></tr><tr><td>Fasting Insulin6,7</td><td>≤100 pmol/L</td><td>6</td><td></td><td></td><td>6</td><td>6,8</td><td>6,7</td></tr><tr><td>Fasting Total Cholesterol7,8</td><td>&lt;5.2 mmol/L</td><td></td><td></td><td></td><td></td><td>8</td><td>7</td></tr><tr><td>Fasting LDL-C7,8</td><td>&lt;3.35 mmol/L</td><td></td><td></td><td></td><td></td><td>8</td><td>7</td></tr><tr><td>Fasting HDL-C7,8</td><td>≥1.05 mmol/L</td><td></td><td></td><td></td><td></td><td>8</td><td>7</td></tr><tr><td>Fasting Triglycerides 7,8</td><td>&lt;1.5 mmol/L</td><td></td><td></td><td></td><td></td><td>8</td><td>7</td></tr><tr><td>AST7</td><td></td><td></td><td></td><td></td><td></td><td>7</td><td>7</td></tr><tr><td>ALT7</td><td></td><td></td><td></td><td></td><td></td><td>7</td><td>7</td></tr><tr><td>Prolactin9,10</td><td></td><td></td><td></td><td></td><td></td><td>10</td><td>10</td></tr><tr><td>Amylase11</td><td>1,1</td><td>1,1</td><td>1,1</td><td></td><td>11</td><td>11</td><td>1,1</td></tr><tr><td>Other (e.g. A1C, OGTT, etc.); Please List</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Physician Initials:</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>
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Notes:
1. Use CDC age and gender-specific growth charts at http://www.cdc.gov/growthcharts/to determine percentiles for height, weight & BMI.
CDC BMI Calculator is found at:
http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx?CalculatorType=Metric
2. Use http://www.idf.org/webdata/docs/Mets_definition_children.pdf (Tables 4 to 6 on pgs. 18-19) to determine age, gender, & ethnicity-specific percentiles for waist circumference.
3. Use http://pediatrics.aappublications.org/content/114/Supplement_2/555.full.pdf+html (Tables 3 to 4 on pgs. 558-9) to determine age, gender, & height specific percentiles for blood pressure.
4. Tools available for monitoring extrapyramidal symptoms include Abnormal Involuntary Movement Scale (AIMS), Simpson Angus Scale, Extrapyramidal Symptom Rating Scale, & Barnes Akathisia Rating Scale.
5. When fasting plasma glucose values are between 5.6 and 6.0 mmol/L, an oral glucose tolerance test (OGTT) should be performed.
6. When fasting insulin levels > 100 pmol/L, an OGTT should be performed. The normal reference range may vary between centers.
7. Testing is recommended in overweight or obese children.
8. If three-month screening laboratory tests are normal, the BMI has remained under the 85th percentile, & the waist circumference has remained under the goth percentile, repetition of lab work for cholesterol, LDL-C, HDL-C, & triglycerides can be made on a yearly basis.
9. Assessment of prolactin levels should be completed according to protocol except when the patient is displaying clinical symptoms of hyperprolactinemia (i.e., menstrual irregularity, gynecomastia, or galactorrhea), in which case more frequent monitoring may be warranted. Risperidone has the greatest effect on prolactin.
10. The decision to measure prolactin at these time points may be based on the presence of clinical symptoms of hyperprolactinemia, such as menstrual irregularity, gynecomastia, or galactorrhea. If no symptoms of hyperprolactinemia are present, recommend monitoring of prolactin on a yearly basis.
11. It is recommended that amylase levels be checked when the patient presents with clinical symptoms of pancreatitis (i.e., abdominal pain, nausea, vomiting).
Dark Gray Shading = not recommended
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References
1. Thapar A, Cooper M, Eyre O, Langley K. What have we learnt about the causes of ADHD? J Child Psychol Psychiatry. 2013 Jan;54(1):3-16. doi: 10.1111/j.1469-7610.2012.02611.x. Epub 2012 Sep 11. PMID: 22963644; PMCID: PMC3572580.
2. Katzman, M.A., Bilkey, T.S., Chokka, P.R. et al. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry 17, 302 (2017).
4. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007 Jun;164(6):942-8. doi: 10.1176/ajp.2007.164.6.942. PMID: 17541055.
5. Altwaijri YA, Al-Subaie AS, Al-Habeeb A, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the Saudi National Mental Health Survey. Int J Methods Psychiatr Res. 2020;29:e1836.
6. Harpin VA. The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child. 2005 Feb;90 Suppl 1(Suppl 1):i2-7. doi:10.1136/adc.2004.059006. PMID: 15665153; PMCID: PMC1765272.
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5R). Philadelphia: American Psychiatric Pub; 2013.
8. Chang LY, Wang MY, Tsai PS. Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis. Pediatrics. 2016 Mar;137(3):e20152749. doi: 10.1542/peds.2015-2749. PMID: 26928969.
9. Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol. 2003 Dec;28(8):559-67. doi: 10.1093/jpepsy/jsg046. PMID: 14602846.
10. Canadian ADHD Practice Guidelines | Canadian ADHD Resource Alliance (CADDRA) [Internet]. Caddra.ca. 2018 [cited 15 June 2019].
11. 11. Evidence Based Clinical Practice Guideline for Management of Attention Deficit Hyperactivity Disorder ADHD in Saudi Arabia.
12. Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV. Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics. 2009 Jul;124(1):71-8. doi: 10.1542/peds.2008-3347. PMID: 19564285; PMCID: PMC2954591.
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اصدار الجلد
Ministry of Health
Methodology references
1. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. PEDIATRICS. 2011; 128(5):1007–1022.
2. For Health Professionals: Clinical Practice Guidelines: ADHD, University of Michigan Health System [Internet]. Med.umich.edu. 2018 [cited 15 June 2019].
3. Clinical Practice Points on the Diagnosis, Assessment and Management of ADHD in Children and Adolescents| National Health and Medical Research Council (NHMRC) [Internet]. Nhmrc.gov.au. 2018[cited 15 June 2019].
4. Canadian ADHD Practice Guidelines | Canadian ADHD Resource Alliance (CADDRA) [Internet]. Caddra.ca. 2018 [cited 15 June 2019].
5. ADHD | Ministry of Health [Internet]. Moh.gov.sg. 2014 [cited 15 June 2019].
6. Bashiri, F.A., et al. Adapting evidence-based clinical practice guidelines for people with attention deficit hyperactivity disorder in Saudi Arabia: process and outputs of a national initiative. Child Adolescent Psychiatry Mental Health 15, 6 (2021).
7. Amer, Y. S., et al. (2019). Appraisal of clinical practice guidelines for managing attention deficit hyperactivity disorder (ADHD) using the AGREE II Instrument: A systematic review. PloS one, 14(7), e0219239. https://doi.org/10.1371/journal.pone.0219239
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