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Clinical Practice Guidelines

The American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics have developed practice parameters describing the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) based on the current scientific evidence and the clinical consensus of ADHD experts in the field.

 

American Academy of Child and Adolescent Psychiatry (AACAP) Practice Parameters

Practice Parameters for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder
Journal of the American Academy of Child and Adolescent Psychiatry, 46:7, 894-921, 2007

These practice parameters focus on the assessment, diagnostic, and treatment planning process, emphasizing a developmental perspective. Recommendations are based on extensive review of the scientific literature and clinical consensus among experts in the subject. Assessment includes clinical interviews with the child and parents and standardized rating scales from parent and teachers. Testing of intelligence and academic achievement is usually required. Comorbidity is common.

The cornerstones of treatment are support and education of parents, appropriate school placement, and psychopharmacology. The primary medications are psychostimulants, but antidepressants and alpha-adrenergic agonists are used in special circumstances. Other treatments such as behavior modification, school consultation, family therapy, and group therapy address remaining symptoms.

Practice parameter on the use of psychotropic medication in children and adolescents
American Academy of Child & Adolescent Psychiatry
September 2009

This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, and mixed salts amphetamine.

 

AAP Clinical Practice Guidelines

Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
American Academy of Pediatrics
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management
Pediatrics, October 16, 2011

This clinical practice guideline updates and brings together into one document two separate guidelines issued in 2000 (for evaluation and diagnosis) and in 2001 (for treatment).

The Guideline's six key action statements are summarized as follows:

  1. Pediatricians and primary care physicians should initiate evaluation for ADHD for children age 4-18. This expanded age range (previously guidelines focused on ages 6-11) is based on emerging evidence form the past decade indicating existing diagnostic criteria are effective in accurately diagnosing children in this expanded age range.
  1. A diagnosis of ADHD should follow established guidelines in DSM-IV (and DSM-5 when updated), including the requirements for symptom documentation over time and in more than 1 major setting (e.g. home and school/preschool).
  1. The evaluation should include assessment of other conditions which commonly co-occur with ADHD, including emotional and behavioral conditions, developmental disorders, and physical conditions.
  1. Pediatricians and primary care provides should see ADHD as a condition requiring chronic care and should use a chronic care and medical home model in the coordination of care from all involved.
  1. Recommendations for treatment vary, depending on the child's age.
    1. Preschool aged children (4-5 yrs.): parent or teacher administered behavioral intervention should be the first line of treatment; and medication (methylphenidate) may be considered if first line treatments are not available or insufficient.
    2. Elementary school-aged children (6-11 yrs.): the combination of medication and behavioral interventions has the best outcome.
    3. Adolescents (12-18 yrs.): FDA-approved medications for this age group should be prescribed, preferably along with behavior therapy.
  1. If medication is prescribed, it should be titrated to ensure the child receives the maximum benefit with the least degree of adverse side effects.

AAP developed these guidelines in collaboration with several professional organizations, including the American Academy of Child and Adolescent Psychiatry, the Child Neurology Society, the Society for Pediatric Psychology, the National Association of School Psychologists, the Society for Developmental and Behavioral Pediatrics, and the American Academy of Family Physicians. CHADD was the only family-based organization also to participate in the development of these guidelines, represented on the team by former CHADD President Beth Kaplanek.

     


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