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AAP: New Guidelines Issued for ADHD Diagnosis, Treatment

Age for ADHD diagnosis, treatment expanded to 4 to 18 years; age-based interventions suggested

MONDAY, Oct. 17 (HealthDay News) -- The American Academy of Pediatrics (AAP) has expanded the age for attention-deficit hyperactivity disorder (ADHD) diagnosis and treatment by primary care physicians (PCPs) to 4 to 18 years, and recommends age-based interventions, according to a report published online Oct. 16 in Pediatrics to coincide with presentation at the annual conference of the AAP, held from Oct. 15 to 18 in Boston.

To provide new evidence-based guidelines for PCPs, Mark Wolraich, M.D., from the AAP's Subcommittee on ADHD, and colleagues updated the 2000 clinical recommendations for evaluation and diagnosis of ADHD, and the 2001 recommendations for treatment.

The authors report that the AAP has expanded the age for diagnosis and treatment of ADHD by PCPs from 6 to 12 years to 4 through 18 years. Any child presenting with academic or behavioral problems, and inattention, hyperactivity, or impulsivity symptoms should be evaluated for ADHD (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and other co-existing conditions by PCPs. The PCPs should follow the principles of the chronic care model and the medical home while managing these children and youth with special health care needs. PCPs should first prescribe parent and teacher-administered behavior therapy to preschoolers (4 to 5 years old), and methylphenidate if this fails. PCPs should prescribe U.S. Food and Drug Administration-approved medications, preferably in addition to behavior therapy, for school-age children (6 to 11 years) and for adolescents (12 to 18 years old). PCPs should adjust the dose of ADHD medication for maximum benefit with minimum adverse effects.

"Because ADHD is a chronic condition, it requires a team approach, including the patients, their parents, the pediatrician, therapists, and teachers," Wolraich said in a statement.

Two of the members of the writing committee disclosed financial relationships with pharmaceutical companies, including Shire, Eli Lilly, Shionogi, and Next Wave Pharmaceutical, all of which manufacture ADHD therapies.

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