WHAT TO TRY FIRST
After the diagnosis of ADHD is made according to professional criteria (DSM-IV), the American Academy of Pediatrics suggests:
Children age 6-11 years and adolescents age 12-18: Any FDA-approved medication for ADHD with or without evidence based parent- and/or teacher-administered behavior/psychological therapy. Among medications, they feel that the evidence is stronger for stimulants (such as methylphenidate). Stimulant medications are started at a low dose which is gradually increased over 1 to 3 months with close monitoring by the physician.
Adults: According to the National Institute for Health and Care Excellence - the organization that provides the British government with independent evidence-based advice on drugs and treatments:
"Drug treatment is the first-line treatment for adults with ADHD with either moderate or severe levels of impairment. Methylphenidate is the first-line drug. Psychological interventions without medication may be effective for some adults with moderate impairment, but there are insufficient data to support this recommendation."
WHAT ELSE TO TRY
Children age 6-11 years: If the initial stimulant medication is ineffective at the maximum dose or has intolerable side effects, the Kaiser Permanente Care Management Institute recommends switching to a different stimulant, possibly adding a second stimulant or a different class of medication (such as guanfacine), or switching to atomoxetine. Consultation with a specialist is recommended.
Adults: According to the National Institute for Health and Care Excellence:
"If methylphenidate is ineffective or unacceptable, atomoxetine can be tried. If there is residual impairment despite some benefit from drug treatment, or there is no response to drug treatment, cognitive-behavioral therapy may be considered."
American Academy of Pediatrics. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011 Nov;128(5):1007-22
Kaiser Permanente Care Management Institute. Diagnosis and treatment of attention deficit hyperactivity disorder in school-age children and adolescents 2012 clinical practice guideline. Oakland (CA): Kaiser Permanente Care Management Institute; 2012 Mar.
National institute for Health and Care Excellence. Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults. 2008 Sep (reaffirmed 2013 Jul). NGC:007193