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Conventional ADHD Update

Includes new age ranges.

2000 first clinical guidelines published by the American Academy of Pediatrics
2001 first AAP guidelines for treatment
now there's new info allowing recommendations for kids young as 4 and old as 18 (old range 6-12)
American Academy of Pediatrics National Conference & Exhibition 2011. Presented October 16, 2011.
more meds approved by FDA for ADHD
new emphasis on chronic nature of ADHD

Incid
mc ped neurobehavioral disorder = attention-deficit/hyperactivity disorder (ADHD)

DX criteria
eval for ADHD if: academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity
impairment in more than 1 major setting
info from adults who know the child: parents/guardians, teachers, other school/mental health clinicians
clinical judgment insufficient alone
must assess for coexisting conditions ie ODD, GAD, Dep
confirm that DSM criteria are met (4th ed)

TX:
meds dose titrated for max benefit and minimum SEs, adults must consent to meds
weigh risk of starting meds (without evidence) vs risk of delayed dx/tx

first line tx for preschool kids is behavior therapy
imp to tx young-->incr school success
2nd line: Methylphenidate if behavioral interventions unsuccessful

elementary age (6-11yrs) "should" get both behavioral and med tx
stimulants best supported by evidence
less evidence but also useful: atomoxetine, ER guanfacine, and ER clonidine, in that order

adolescents (age, 12 - 18 years)
"should" consent to and receive FDA-approved meds and/or behav therapy (pref both)
difficult to dx dt less adults involved

SOURCE
http://www.medscape.org/viewarticle/751972?src=cmemp

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