From the Guidelines
The American Academy of Pediatrics (AAP) guidelines for managing ADHD in children recommend a comprehensive approach that includes behavior therapy and FDA-approved medications, with the specific treatment varying by age. For preschool-aged children (4-5 years), behavior therapy is the first-line treatment, with methylphenidate considered if behavior therapy is insufficient 1. For elementary and middle school-aged children (6-12 years), the AAP recommends a combination of FDA-approved medications and behavior therapy, with stimulants as first-line medications 1. Some key points to consider when managing ADHD in children include:
- Initiating an evaluation for ADHD for any child who presents with DSM-5 criteria, including documentation of symptoms and impairment 1
- Screening for comorbid conditions, including emotional or behavioral conditions, developmental conditions, and physical conditions 1
- Managing children and adolescents with ADHD in the same manner as those with special health care needs, following the principles of the chronic care model and the medical home 1
- Titrating doses of medication to achieve maximum benefit with tolerable side effects 1
- Considering educational interventions and individualized instructional supports as a necessary part of any treatment plan 1 The AAP guidelines emphasize a team approach involving parents, teachers, and healthcare providers, with regular follow-ups to assess symptoms, growth, blood pressure, and potential side effects 1.
From the Research
Diagnosis and Assessment of ADHD
- The American Academy of Pediatrics (AAP) developed an evidence-based clinical practice guideline for the assessment and diagnosis of school-aged children with attention-deficit/hyperactivity disorder (ADHD) 2.
- The guideline contains six recommendations for the diagnosis of ADHD, including:
- Initiating an evaluation for ADHD in children six to 12 years of age who present with inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems.
- Requiring a child to meet the criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders.
- Assessing ADHD symptoms in various settings, including evidence from parents or caregivers and teachers.
- Evaluating for coexisting conditions.
- The assessment of ADHD should include evidence directly obtained from parents or caregivers and teachers regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment, and associated conditions 2.
Treatment of ADHD
- The AAP guidelines for managing ADHD in children recommend a comprehensive treatment plan that includes medication, behavioral therapy, and lifestyle changes 2, 3.
- Methylphenidate is a commonly prescribed medication for ADHD, and studies have shown that it can improve ADHD symptoms, general behavior, and quality of life in children and adolescents with ADHD 4, 5.
- However, the evidence for the effectiveness of methylphenidate is of very low quality, and the magnitude of the associated improvement is uncertain 4, 5.
- Non-stimulant medications, such as atomoxetine, are also approved for the treatment of ADHD in adolescence 6.
- Behavioral therapy (BT) has also been shown to be effective in reducing ADHD symptoms and improving functioning in adolescents with ADHD, and may produce greater overall benefits on measures of impairment than medication alone 6.
Recommendations for Treatment Selection
- The decision to use medication, behavioral therapy, or a combination of both to treat a child with ADHD should be based on individual circumstances and needs 6.
- The AAP recommends that primary care clinicians use a patient-centered approach to develop a comprehensive treatment plan that includes medication, behavioral therapy, and lifestyle changes 2, 3.
- Further research is needed to determine the most effective treatment strategies for different subgroups of children with ADHD, including those with coexisting conditions or varying levels of severity 4, 6.