Clinical Practice Guideline

ADHD in Children and Adolescents

ADHD: Clinical Practice Guidelines for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

(Endorsed, May 2012)

The guideline on ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents was developed by the American Academy of Pediatrics (AAP) and endorsed by the American Academy of Family Physicians (AAFP).

Key Recommendations

  • Any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity should be evaluated for ADHD.
  • The diagnosis of ADHD should be based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, with information obtained from parents/guardians, teachers, and other school and mental health clinicians involved in the child’s care.
  • Alternative causes of the behavior should be ruled out.
  • A child being evaluated for ADHD should also be assessed for other conditions that might coexist with ADHD, including emotional, behavioral, developmental, and physical conditions.
  • Children with ADHD should be managed following the principles of the chronic care model and the Medical Home.
  • Preschool-aged children (4-5 years of age) should be treated with behavior therapy as the first line of treatment. Methylphenidate may be prescribed if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child’s function.
  • Elementary school-aged children (6-11 years of age) should be treated with FDA-approved medications for ADHD and /or behavioral therapy.
  • Adolescents (12-18 years of age) should be treated with FDA-approved medications for ADHD and may be treated with behavioral therapy.
  • Medication doses should be titrated to achieve maximum benefit with minimum adverse effects.

Access the article with full recommendation for more information on ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.

* Please note that the AAP has also developed a Process of Care Supplemental Appendix document, available on the AAP website, which may be of value but has not been reviewed by the AAFP.


These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.