Attention deficit hyperactivity disorder (ADHD) is a disorder that manifests in childhood with symptoms of hyperactivity, impulsivity, and/or inattention. The symptoms affect cognitive, academic, behavioral, emotional, and social functioning.
DIAGNOSTIC CRITERIA — Diagnostic criteria for ADHD include symptoms of hyperactivity, impulsivity, and/or inattention that occur in more than one setting and affect function (eg, academic, social, emotional, etc).
Attention deficit hyperactivity disorder (ADHD) is a chronic condition; education of patients, families, and teachers regarding the diagnosis is an integral part of treatment. Management centers on the achievement of target outcomes, which are chosen in collaboration with the child, parents, and school personnel. Coexisting conditions must be treated concurrently with ADHD.
Treatment of ADHD may involve behavioral/psychologic interventions, medication, and/or educational interventions, alone or in combination. Decisions regarding the choice of therapy should involve the patient and his or her parents.
ADHD in children 4 to 18 years of age without comorbid conditions can usually be managed by the primary care provider. Indications for referral to or consultation with a specialist (eg, developmental behavioral pediatrician, child neurologist, psychopharmacologist, child psychiatrist, clinical child psychologist) may include :
•Coexisting psychiatric conditions (eg, oppositional defiant disorder, conduct disorder, substance abuse, emotional problems)
•Coexisting neurologic, or medical conditions (eg, seizures, tics, autism spectrum disorder, sleep disorder)
For preschool children (age 4 through 5 years) who meet the diagnostic criteria for ADHD, we recommend behavior therapy rather than medication as the initial therapy (Grade 1A). The addition of medication to behavior therapy may be indicated if target behaviors do not improve with behavioral therapy and the child’s function continues to be impaired.
For school-aged children (≥6 years) and adolescents with ADHD, we suggest that behavioral interventions be added to medication therapy (Grade 2C). Adding behavioral/psychologic therapy to stimulant therapy in school-aged children and adolescents does not provide additional benefit for core symptoms of ADHD, but may affect symptoms of coexisting conditions (eg, oppositional/aggressive behavior) and lower the dose of stimulant therapy necessary to achieve the desired effects.
Children and adolescents with ADHD have an increased risk of substance use, particularly those with comorbid oppositional defiant disorder, or conduct disorder; and intentional and unintentional injuries; those who drive have an increased risk of motor vehicle accidents.