Guidelines for Treatment of ADD/ADHD

The American Academy of Pediatrics (AAP) released new recommendations for treating school-age children with attention deficit/hyperactivity disorder (ADHD). This guideline is intended for primary care physicians who have already accurately established an ADHD diagnosis. Last year the AAP released guidelines for diagnosing ADHD.

ADHD is a condition of the brain that makes it difficult for children to control their behavior in school and social settings. It is one of the most common chronic conditions of childhood and affects between 4 and 12 percent of all school-age children. About three times more boys than girls are diagnosed with ADHD.

Children with ADHD may experience significant functional problems such as school difficulties, academic underachievement, troublesome relationships with family members and peers, and behavioral problems. Different children have different symptoms or problems with ADHD.

The new standardized AAP guidelines were developed by a panel of medical, mental health and educational experts. The AAP partnered with the Agency for Healthcare Research and Quality, and the Evidence-based Practice Center at McMaster University in Canada to develop the evidence base of literature on the topic. The recommendations were based on scientific studies that carefully evaluated treatments of school-age children with ADHD.

The new guidelines include the following recommendations:

• Primary care clinicians should establish a treatment program that recognizes ADHD as a chronic condition. This implies the need for education about the condition, and a sustained monitoring system to track the effects of treatment and developmental changes in behavior.
• The treating clinician, parents, and child, in collaboration with school personnel, should specify appropriate goals to guide management. Goals should relate to the specific problems of the individual child, e.g., school performance, difficulty finishing tasks, problems with interactions with schoolmates.
• If appropriate, the clinician should recommend behavior therapy and/or stimulant medication to improve specific symptoms in children with ADHD. The guideline provides a review of the scientific evidence for recommending medication and behavior therapy.
• When the treatment for a child with ADHD has not met its goals, clinicians should re-evaluate the original diagnosis, all appropriate treatments, adherence to the treatment plan, and coexisting conditions, including learning disabilities and mental health conditions.
• The clinician should provide a periodic and systematic follow-up for the child with ADHD. Monitoring should be directed to the child's individual goals, and any adverse effects of treatment, with information gathered from parents, teachers and the child. The guidelines recommend areas for future research in treatment options, long-term outcomes and other areas in the management of children with ADHD.

Already one of the most common and most studied conditions of childhood, ADHD treatment has increased in recent years. Treatments, both medications and behavior therapy, improve the functioning of most children with ADHD. Long-term management of ADHD requires active teamwork among clinicians, parents and teachers to help assure the best outcomes. While there is no proven cure for ADHD at this time, and the cause is unclear, research is ongoing to learn more about the role of the brain in ADHD and the best ways to treat the disorder.

Source: American Academy of Pediatrics

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