Treatments that include medication and behavioral therapies are described, but most updates concern diagnosis and the need for continuous monitoring and care.
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 will be published in the October 2019 issue of Pediatrics, along with a care algorithm for medical providers that address 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 the care of preschool-aged children (ages 4-6) and teens.
"ADHD is a chronic illness that can have a devastating impact if left untreated," said Mark L. Wolraich, MD, FAAP, lead author of the report and prominent clinician and researcher in ADHD. "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% 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.
"We know that a child diagnosed with ADHD will benefit most when there is a partnership between families, their doctors, and their teachers, who may need to create special instructional plans and support," said Joseph F. Hagan, Jr., MD, FAAP, co-author of the guidelines and vice chairperson for the AAP Subcommittee on Children and Adolescents with Attention Deficit/Hyperactivity Disorder.
"Coaches, school guidance counselors and other people who play a significant role in a child's life often have a lot they can contribute in providing information and working on solutions."
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.
The AAP outlines areas where further research is needed, such as studies of medications and therapies that are used clinically but not approved by the U.S. Food and Drug Administration for ADHD.
"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."
Additional Information from HealthyChildren.org: