The American Academy of Pediatrics has released new recommendations for assessment of school-age children with attention deficit/hyperactivity disorder (ADHD).  ADHD is the most common neurobehavioral disorder of childhood.  Multiple studies in various practice settings have shown the incidence of ADHD to be between 4 and 12% of all school-age children.  Children with ADHD may experience significant problems in school with academic underachievement and behavior problems, and have troublesome relationships with family members and peers.

There has been a growing interest and concern that ADHD is being over diagnosed, and no doubt there are wide variations in the criteria used across the country to make this diagnosis.  But there is also concern that this condition is being under diagnosed in some situations because of parental reluctance to label their child or to use medication.  The need for an accurate well established diagnosis is the reason the American Academy of Pediatrics has released these new standardized guidelines.  They are designed for children between the ages of 6 and 12, and were developed by a panel of medical, mental health, and educational experts.

 The new guidelines recommend the following:

1.  ADHD evaluations should be initiated by the primary care provider for children who show signs of school difficulties, academic underachievement, troublesome relationships with teachers, the family or peers, and other behavioral problems.  Questions to the parents either directly or through symptom questionnaires, regarding school and behavioral issues may help alert the physician to the possibility of ADHD.

2.  In diagnosing ADHD, physicians should use the DSM-IV criteria developed by the American Psychiatric Association.  These criteria require that the symptoms be present in at least two setting, e.g.. school and home, and that the symptoms affect the child’s academic or social functioning for at least 6 months.

3.  The assessment of ADHD should include information obtained directly from the parents or caregivers, as well as the classroom teacher or other school professional regarding the core symptoms of ADHD.  These include difficulties with concentration and completing tasks, impulsive behavior, and may include hyperactivity and difficulty staying in their place.  The age of onset, duration of symptoms, and the degree of impairment should be assessed.

4.  Evaluation of the child with ADHD should also include assessment for co-existing conditions such as language and learning problems, aggression, disruptive behavior, depression, and anxiety.  Most studies have shown that as many as 30% of children with ADHD have a co-existing condition.

Treatment guidelines were not included in this recent statement by the American Academy of Pediatrics, but will be presented at a later date.  Treatment has been equally controversial, but it is clear that a single approach to treatment is not appropriate for any child.  Many children will benefit from behavioral treatment to improve their school, family and peer relationships.  Educational strategies are needed for all these children whether medicine is used or not.  A significant number of children with ADHD respond dramatically to mediation, with improvement in their concentration, school work and relationships.  Prior to using medication, a thorough discussion of side effects should be done by the physician and the parents should understand the expected action and possible side effects of the medicine their child will be taking