Patient Education

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Treatment Plan Record for a Child With ADHD

Overview

Use this form to record information about your child's treatment plan for attention deficit hyperactivity disorder (ADHD). Review the plan with your doctor often. Together you can keep the plan up to date.

My child's main symptom of ADHD is (inattention, impulsiveness, or hyperactivity) ______________________.

An example of this symptom is:

My child expresses the other symptoms of ADHD in the following ways.

My child takes the following medicine for ADHD at the listed times.

My child has the following learning disabilities or other medical conditions often associated with ADHD. (If not applicable, cross out this statement.)

We are helping my child control the following behavior.

We are using the following consequences or methods to help my child control behavior.

My child is participating in a social skills training program to learn:

Other things about my child's health:

Credits

Current as of: July 31, 2024

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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Credits

Current as of: July 31, 2024

Author: Ignite Healthwise, LLC Staff

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Patient Education

Topic Contents

Treatment Plan Record for a Child With ADHD

Overview

Credits

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