ADHD across the lifespan — structured clinical viva

This is persistent adolescent ADHD with incomplete adherence, emerging SUD risk, driving risk, and functional academic threat — not a simple "increase the dose" request. Re-confirm diagnosis and comorbidity (mood, anxiety, learning, sleep), quantify cannabis use, and assess diversion/sharing. Review prior stimulant dose, formulation, side-effects and true adherence before escalating potency.[3][6]

Pharmacological options. Optimise long-acting stimulant coverage if adherence and diversion risk allow; avoid unsupervised bulk short-acting IR. If diversion/SUD risk is high or stimulants poorly tolerated, switch or trial atomoxetine (delayed onset, non-controlled) with weight-based titration framework, or consider guanfacine XR with BP/HR/sedation monitoring. Shared decision with the young person is essential for adherence.[1][2]

SUD. Treat cannabis use with motivational interviewing and integrated care; untreated ADHD and SUD feed each other. Do not abandon ADHD treatment solely because of cannabis, but do not ignore it.[3]

Driving. Elevated relative accident risk literature supports concrete counselling: distraction, impulsivity, sleep, substances, medication timing; document advice; reporting is jurisdiction-specific.[4]

Psychosocial. School accommodations, organisational coaching/CBT skills (adult residual CBT evidence generalises the value of structured skills work), and planned transition to adult ADHD/shared-care services with a written care plan.[5][6]