The American Academy of Pediatrics (AAP) released new recommendations on 01-May-2000 for the assessment of school-age children with attention-deficit/hyperactivity disorder (ADHD).
Research in various community and practice settings shows that between 4 and 12 percent of all school-age children may have ADHD, making it the most common childhood neurobehavioral disorder. Children with ADHD may experience significant functional problems such as school difficulties, academic underachievement, troublesome relationships with family members and peers, and behavioral problems.
In recent years, there has been growing interest in ADHD as well as concerns about possible over diagnosis. In surveys among pediatricians and family physicians across the country, wide variations were found in diagnostic criteria and treatment methods for ADHD.
The new standardized AAP guidelines were developed by a panel of medical, mental health and
educational experts. The Agency for Healthcare Research and Quality provided significant research and background information for the new policy.
The new guidelines, designed for primary care physicians diagnosing ADHD in children age 6 to 12, include the following recommendations:
- ADHD evaluations should be initiated by the primary care clinician for children who show signs of school difficulties, academic underachievement, troublesome relationships with teachers, family members and peers, and other behavioral problems. Questions to parents, either directly or through a pre-visit questionnaire, regarding school and behavioral issues may help alert physicians to possible ADHD.
- In diagnosing ADHD, physicians should use DSM-IV criteria developed by the American Psychiatric Association. These guidelines require that ADHD symptoms be present in two or more of a child's settings, and that the symptoms adversely affect the child's academic or social functioning for at least six months.
- The assessment of ADHD should include information obtained directly from parents or caregivers, as well as a classroom teacher or other school professional, regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms and degree of functional impairment.
- Evaluation of a child with ADHD should also include assessment for co-existing conditions: learning and language problems, aggression, disruptive behavior, depression or anxiety. As many as one-third of children diagnosed with ADHD also have a co-existing condition.
Other diagnostic tests, sometimes considered positive indicators for ADHD, have been reviewed and considered not effective. These tests include lead screening, tests for generalized resistance to thyroid hormone, and brain image studies.
Comprehensive ADHD treatment guidelines are also in development.
The American Academy of Pediatrics is an organization of 55,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.
Visit the AAP's Web site at www.aap.org or visit the new diagnosis guidelines directly at www.aap.org/policy/ac0002.html