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AAP updates guidelines on ADHD, emphasizes proper diagnosis


The American Academy of Pediatrics (AAP) has updated its guidelines for treating children with Attention Deficit /Hyperactivity Disorder for the first time since 2011, changing some criteria for diagnosis, updating current medications and emphasizing the need to rule out other causes of symptoms.

The “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents,” is based on the most recent research on ADHD, a common disorder that can profoundly affect a child’s academic achievement, well-being and social interactions.

The guidelines, released online today, will be published in the October 2019 Pediatrics along with a care algorithm for medical providers that addresses practical issues related to procedures for the evaluation, treatment and monitoring of children and teens for ADHD. The guidelines address children from age 4 to 18, with special attention provided for care of preschool-aged children (ages 4-6) and teens.

“ADHD is a chronic illness that can have a devastating impact if left untreated,” Mark L. Wolraich, MD, FAAP, lead author of the report and prominent clinician and researcher in ADHD, said in a prepared statement. “A pediatrician can help families figure out what is going on and work with families to help children succeed in managing their symptoms and behavior.”

According to national data, about 9.4 percent of U.S. children ages 2-17 have been diagnosed at one time with ADHD, with hyperactive and impulsive symptoms that tend to decline during adolescence and lead to inattentiveness. Boys are more than twice as likely as girls to be diagnosed with ADHD. Both boys and girls with the disorder typically show symptoms of an additional mental disorder and may also have learning and language problems.

The updated guidelines are based on the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” published by the American Psychiatric Association. Recommendations include:

  • In diagnosis, fewer problem behaviors are required as criteria for ADHD in patients age 17 and older.
  • Guidance is provided to rule out other causes of ADHD-like symptoms and identify co-occurring conditions, such as depression, anxiety, substance use, autism and trauma.
  • Treatments for ADHD have remained essentially the same, but AAP emphasizes the need for ongoing medical care and coordination with others from the school and community.
  • Parent training in behavior management is recommended as the first-line treatment for preschoolers.
  • The guidelines describe parent training in behavior management.
  • Studies describe some value in similar parent and teacher training in behavior management for high school students with ADHD.

The AAP also identifies system-level challenges that clinicians face in seeking to implement the guidelines and provides suggested strategies to overcome barriers to care. These challenges include limited access to mental health specialists; the lack of adequate pediatric training in mental health; limited consultative services; barriers to communication with schools and consultative services; health insurance restrictions on certain medications; and appropriate payment for services.

“While we know ADHD can be challenging and frustrating for families, children who are identified early and receive proper treatment can learn to manage their symptoms and be successful,” Dr. Wolraich said. “With the help of supportive and caring adults, this is a team effort that pays off over the long term.”

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