In Brief: Updated guidelines issued for attention deficit hyperactivity disorder (ADHD)

In Brief

The American Academy of Pediatrics (AAP) has updated its guidelines for the diagnosis and management of attention deficit hyperactivity disorder (ADHD). Although much of the advice remains the same, the guidelines offer several significant changes worth noting:

Screening. The AAP now recommends that any child or teenager, ages 4 to 18, be screened for ADHD if he or she develops academic or behavior problems in addition to symptoms suggesting ADHD, such as inattention, hyperactivity, or impulsive behavior. This represents an expansion of the previous recommendations, which were restricted to children ages 6 to 12.

Diagnostic criteria. The AAP recommends that diagnosis of ADHD be made on the basis of criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A key element of this recommendation is the reminder that symptoms such as inattention and hyperactive behavior should be observed in more than one setting. This means that a clinician should obtain information from parents, teachers, and other caregivers before making a diagnosis.

Treatment. For preschool children (ages 4 or 5), the AAP recommends that the first-line treatment offered for ADHD be in the form of behavioral therapy, with medication held in reserve for use only when behavior modification does not produce significant improvement. For older children and teenagers, the AAP recommends either medication or behavioral therapy for ADHD — but concludes that the combination of both is probably best.

American Academy of Pediatrics. “ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents,” Pediatrics (Nov. 2011): Vol. 128, No. 5, electronic publication ahead of print.


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