New Guidelines for Pediatric ADHD

Contributing author: Mark L. Wolraich, MD. In 2000, the American Academy of Pediatrics (AAP) released its first clinical recommendations for the diagnosis and evaluation of ADHD in children and followed that a year later with treatment recommendations. In 2011, the AAP updated these guidelines due to new evidence that has emerged in the management of children with ADHD. Important Changes to the Guidelines The AAP’s 2011 guideline update recommends that primary care physicians (PCPs) evaluate children for ADHD from age 4 through 18. The earlier version of the guidelines covered children ages 6 to 12. This change was made because of an accumulation of evidence in recent years in a broader pediatric population. Enough evidence has emerged that we now feel comfortable about the criteria being appropriate for preschoolers and adolescents. Previously, the AAP had one guideline for diagnosis and evaluation and another for treatment. Now, the academy has included diagnosis, evaluation, and treatment in a single document. The revised guideline also includes recommendations for managing pediatric patients who exhibit some signs and symptoms of ADHD but don’t meet current diagnostic criteria for the condition. This information is particularly applicable to PCPs. Furthermore, a new process-of-care algorithm has been developed to provide physicians with step-by-step guidance on implementing the recommendations, and the AAP’s ADHD toolkit has been revised based on this algorithm. Key Action Statements for Pediatric ADHD The 2011 AAP guideline includes a summary of several key action statements: PCPs should initiate an ADHD evaluation for any child aged 4 to 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. Symptoms and behavior must...