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
