Treatment Plan Record for a Child With ADHD

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…

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Medical review

Adam Husney MDKathleen Romito MDLouis Pellegrino MD

Last Updated

05/28/2019

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This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.

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Treatment Plan Record for a Child With ADHD

Topic 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 ofMay 28, 2019

Author: Healthwise Staff
Medical Review: Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Louis Pellegrino, MD – Developmental Pediatrics

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.

Share this article

Article Info

Author

Medical review

Adam Husney MDKathleen Romito MDLouis Pellegrino MD

Last Updated

05/28/2019

Legal

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.