ADHD dossier — AAP 2019 (Wolraich PMID 31570648) + APA 2024 (verify) + NICE NG87 (2018 last updated 2024) + MTA 16-yr (Hechtman 2018 PMID 30019501) Covers F90.0 predominantly inattentive, F90.1 predominantly hyperactive-impulsive, F90.2 combined, F90.8 other, F90.9 unspecified; pediatric ~5-7% prevalence (M:F ~2:1); adult ~2.5-4% prevalence (less gender-skewed); ~60% have ≥ 1 comorbidity (ODD/CD 30-50%, anxiety ~25%, depression 15-20%, LD 20-30%, sleep, tics, SUD) Step 1 stimulant first-line for ≥ 6 yr: methylphenidate-class (Concerta 18-72 mg, Focalin XR, Ritalin LA, Daytrana patch, IR 5 mg BID-TID) OR amphetamine-class (Adderall XR 5-30 mg, Vyvanse 30-70 mg, Mydayis); baseline HR + BP + weight + height + cardiac history + FH SCD < 35; no routine EKG in healthy children; growth velocity + appetite + sleep monitoring Q3-6 mo Preschool 4-5 yr: behavioral parent training (Triple P / Incredible Years) FIRST-LINE per AAP 2019; methylphenidate IR 2.5-5 mg BID-TID only if behavioral inadequate (only stimulant with FDA evidence at this age) Step 2 within-class switch (Concerta → Focalin XR; Adderall XR → Vyvanse); Step 3 cross-class switch (methylphenidate ↔ amphetamine); Step 4 non-stimulant (atomoxetine 0.5 → 1.2-1.4 mg/kg/day pediatric max 100 mg; viloxazine 100-400 mg pediatric / 200-600 mg adult); Step 5 alpha-2 agonist augmentation (guanfacine ER 1-4 mg/day pediatric / 1-7 mg adult HS; clonidine ER 0.1-0.4 mg/day pediatric HS) Atomoxetine FDA black-box for SI in pediatric — C-SSRS first 4 wk; CYP2D6 substrate; LFT monitoring if symptomatic; 4-wk onset (counsel on delayed effect); FDA-approved pediatric ADHD Alpha-2 agonist rebound HTN on abrupt discontinuation — taper; bedtime sedation common; HR + BP monitoring; FDA-approved pediatric ADHD Behavioral therapy: parent training (Triple P / Incredible Years / PCIT) for pediatric; CBT for adult ADHD per Safren manual (2005 + 2017); 12-15 sessions focusing on organization + planning + time management + emotion regulation School accommodations: 504 plan (Section 504 of Rehabilitation Act 1973) OR IEP (under IDEA) — pediatric academic decline; workplace accommodations under ADA for adults Driving safety counseling for adolescent + adult ADHD — increased MVA risk especially untreated or undertreated CRITICAL anti-patterns: NEVER initiate stimulant without baseline HR + BP + weight + height + cardiac history + FH SCD < 35 screen; NEVER prescribe stimulant in structural heart disease / serious arrhythmia / recent MI (FDA black-box); NEVER prescribe stimulant in active SUD without addiction-medicine + non-stimulant or restricted-monitoring strategy; NEVER co-prescribe stimulant with MAOI within 14 d (hypertensive crisis); NEVER ignore tic emergence on stimulant; NEVER ignore acute chest pain / palpitations / syncope on stimulant; NEVER omit growth velocity + appetite + sleep monitoring in pediatric stimulant patients; NEVER omit screening for comorbidities (MDD / anxiety / SUD / sleep / eating disorders); NEVER skip transition planning at age 17-18; NEVER initiate stimulant in pregnancy without reproductive-psychiatry risk-benefit consult; NEVER skip multi-informant report for pediatric diagnosis; NEVER skip school accommodations evaluation for pediatric with academic decline; NEVER omit MDQ before stimulant initiation in suggestive bipolar features; NEVER continue stimulant in persistent severe HTN; NEVER omit driving safety counseling for adolescent / adult ADHD; NEVER omit informed consent on Schedule II abuse / dependence / diversion risks; NEVER omit re-evaluation when academic / occupational function declines despite "adequate" treatment Severity triggers (10): acute_stimulant_cardiovascular_event (life-threatening — discontinue + cardiology + alternative non-stimulant), stimulant_diversion_or_misuse (severe — addiction-medicine + switch to non-stimulant or restricted-monitoring), adhd_with_concurrent_substance_use (severe — non-stimulant first; routes to opioid / alcohol dossiers), adhd_with_acute_suicidal_ideation (life-threatening — routes to psych.suicidality.ed.core.v1), pediatric_growth_velocity_concern_on_stimulant (moderate — growth + appetite monitoring + drug holidays), pregnancy_adhd_medication_decision (moderate — behavioral first; immediate-release preferred if continued), tic_emergence_on_stimulant (moderate — switch to atomoxetine or alpha-2 agonist; not absolute contraindication), transition_to_adult_care_at_18 (mild — bridge to adult psychiatry + medication continuity), rebound_irritability_or_appetite_loss_severe (moderate — adjust dose / formulation / class + alpha-2 agonist for rebound), academic_or_occupational_decline_despite_treatment (moderate — re-evaluate diagnosis + comorbidities + adherence + dose + class) Two setting playbooks: outpatient (psychiatry + pediatrics; stimulant titration + behavioral therapy + school/workplace accommodations + weekly-monthly visits during titration → Q3-6 mo maintenance + growth velocity + cardiovascular + comorbidity surveillance) + ED (acute stimulant CV event + acute SI + severe agitation + manic switch); transition setting encoded indirectly via severity_trigger Action plan green/yellow/red includes stimulant CV warning (chest pain / palpitations / syncope) + appetite / sleep / mood / tic monitoring + Stanley-Brown safety plan if SI + driving safety + workplace/school accommodations Sibling differentiation: psych.depression.core.v1 (~15-20% comorbid MDD; treat ADHD first if mild MDD), psych.anxiety-disorders.core.v1 (~25% comorbid anxiety; treat both if moderate-severe), psych.opioid_use_disorder.core.v1 (non-stimulant first; AVOID benzo + opioid), psych.alcohol_withdrawal.core.v1 (~15-20% AUD; non-stimulant preferred), psych.eating-disorders.core.v1 (BED ~20-30% overlap; lisdexamfetamine dual-indication; NEVER stimulant in active AN-R), psych.bipolar-disorder.core.v1 (MDQ before stimulant; stimulant-induced manic switch risk), psych.suicidality.ed.core.v1 (active SI cross-route; compose not replace; atomoxetine FDA black-box pediatric) Front-end note: no existing ADHD-specific panel surface in src/components/panels/ob-peds-psych/ today; this dossier is the back-end pathway pack. Vanderbilt / SNAP-IV / ASRS / Conners panel surfaces flagged for future wire-up batch Workup IDs all resolve to registered umbrellas in clinical-tools-registry — workup.suicide_risk + workup.chest_pain + workup.severe_agitation + workup.insomnia Calculator IDs all resolve to registered tools — calc.phq9 + calc.gad7 + calc.audit_c + calc.ckd_epi_2021. calc.vanderbilt + calc.snap_iv + calc.asrs + calc.conners + calc.adhd_rs + calc.cssrs + calc.mdq + calc.diva flagged for future clinical-tools-registry batch — referenced via narrative + workup.suicide_risk for now Phenotype matrix (subtype × severity × age × treatment_status × comorbidity × medication_response × substance_use × pregnancy × functional_impact × cardiovascular_history) is encoded indirectly via severity_triggers + setting_playbooks + sibling_differentiation. First-class TS field for phenotype matrix is schema-blocked — see docs/framework-audit/shard-5-obped-id-state.md Schema-blocked queue Bayesian linkage (Vanderbilt parent + teacher both ≥ 6/9 + functional impairment ≥ 2 settings LR+ ~5-10 per AAP 2019 PMID 31570648; ASRS v1.1 part-A ≥ 4/6 LR+ ~4-6 per Kessler 2005 PMID 15841682 NEEDS_SOURCE_REVIEW; SNAP-IV ≥ 90th percentile LR+ ~5; Conners ≥ 65 T-score LR+ ~5-8; ADHD-RS ≥ 90th percentile LR+ ~5-8; DIVA-5 positive LR+ ~8-10; PHQ-9 ≥ 10 LR+ ~4-7 comorbid MDD; GAD-7 ≥ 10 LR+ ~4-7 comorbid anxiety; AUDIT-C positive LR+ ~3-5 AUD; MDQ positive LR+ ~7 bipolar; FH SCD < 35 OR cardiac history LR+ ~5 for cardiac risk on stimulant; T_treat = DSM-5-TR ADHD criteria + multi-informant + functional impairment ≥ 2 settings; T_test = sub-threshold + mild impairment → watchful waiting; T_switch within-class = inadequate at 4-6 wk; T_switch cross-class = both classes failed; T_augment = partial response → alpha-2 agonist; T_maintenance_discontinuation = sustained remission ≥ 12 mo + agreement; cross-dossier routing to psych.depression + psych.anxiety-disorders + psych.opioid_use_disorder + psych.alcohol_withdrawal + psych.eating-disorders + psych.bipolar-disorder + psych.suicidality.ed documented in co-located research bundle). ROS/DDx LR seed data audited by npm run audit:ros-ddx-coverage (cross-cutting; not touched by this shard) PRODUCTION blockers / open gaps: (1) RxCUIs not yet validated via scripts/research/rxnav-validate.ts; lisdexamfetamine RxCUI 1148486 + viloxazine RxCUI 2519996 + Concerta-specific RxCUI (vs methylphenidate base 1819) NEEDS_RXNAV_VALIDATION; atomoxetine 38415 PARTIAL; guanfacine 5487 PARTIAL; clonidine 2599 PARTIAL; (2) manifest reuses psych.depression.core.v1.ts pointer per peds.febrile-infant / psych.bipolar / psych.alcohol_withdrawal / psych.suicidality / psych.anxiety-disorders / psych.ptsd / psych.eating-disorders precedent — dedicated manifest out-of-shard-scope; (3) calc.vanderbilt + calc.snap_iv + calc.asrs + calc.conners + calc.adhd_rs + calc.cssrs + calc.mdq + calc.diva not in clinical-tools-registry — referenced via workup.suicide_risk + narrative; (4) APA Practice Guideline for Adult ADHD 2024 publication status PMID NEEDS_SOURCE_REVIEW + AAP CPG 2019 (Wolraich 31570648) confirmed + MTA 16-yr (Hechtman 30019501) confirmed + Kessler ASRS 2005 PMID 15841682 NEEDS_SOURCE_REVIEW + Safren CBT-adult-ADHD manual (book) + AAP/AHA 2008 cardiac screening PMID NEEDS_SOURCE_REVIEW + Tourette Syndrome Study Group 2002 methylphenidate + tics PMID NEEDS_SOURCE_REVIEW + Triple P + Incredible Years parent training manuals (programs) + Faraone 2005 heritability PMID NEEDS_SOURCE_REVIEW + Horowitz Lancet Psych 2019 hyperbolic taper PMID NEEDS_SOURCE_REVIEW + Hirschfeld MDQ 2000 PMID NEEDS_SOURCE_REVIEW + Stanley-Brown 2012 SPI PMID NEEDS_SOURCE_REVIEW + Mann JAMA 2005 lethal-means PMID NEEDS_SOURCE_REVIEW — referenced by label only; not added to evidence.pmids per verification rule; (5) targeted test file pending (relies on dossier-contract.test.ts); (6) panel→dossier wire (Vanderbilt / SNAP-IV / ASRS / Conners panel) not authored — flagged for future wire-up batch; (7) pediatric < 6 yr standalone deferred to future peds dossier; (8) ADHD in autism spectrum / intellectual disability / complex neurodevelopmental phenotypes deferred to future dossiers