Brain health: Clinical guidance and practice resources
Cognitive health plays a critical role in patients’ functioning and quality of life across the lifespan, from early neurologic injury to age-related cognitive decline.
Advances in brain health research and evolving diagnostic and management approaches make it essential for family physicians to stay current in caring for patients with cognitive and neurologic concerns.
This page brings together evidence-based clinical guidance and practice resources to support family physicians in the identification, evaluation, and longitudinal management of conditions affecting cognitive health, including dementia, stroke, and traumatic brain injury.
Clinical guidelines and recommendations
Clinical practice guidelines
Attention-Deficit/Hyperactivity Disorder
(Endorsed, 2020)
The American Academy of Pediatrics developed the updated guideline, ADHD: Clinical practice guideline for the diagnosis, evaluation and treatment of ADHD in children and adolescents, which the American Academy of Family Physicians (AAFP) endorsed.
Key recommendations
Any child aged 4–18 years 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, 5th 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 under evaluation for ADHD should also be assessed for other conditions that might coexist, 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 (aged 4–5 years) should be treated with behavioral therapy as the first line of treatment.
Methylphenidate may be prescribed if the behavioral interventions do not provide significant improvement and if the disturbance in the child’s function continues and is moderate to severe.
Elementary school-aged children (aged 6–11 years) should be treated with FDA-approved medications for ADHD and/or behavioral therapy.
Adolescents (aged 12–18 years) should be treated with FDA-approved medications, with assent, for ADHD and may be treated with behavioral therapy.
Medication doses should be titrated to achieve maximum benefit with minimum adverse effects.
Comorbid conditions should be diagnosed and managed appropriately.
Clinical preventive service recommendations
USPSTF found insufficient evidence to determine whether screening for autism spectrum disorder in children aged 18–30 months results in more benefit than harm when no concerns have been raised. This recommendation applies to children without a known diagnosis or developmental delay and no reported concerns from parents or clinicians.
USPSTF concludes there is insufficient evidence to assess whether screening for cognitive impairment in adults aged 65 and older without symptoms results in more benefit than harm. This recommendation applies to community-dwelling older adults who do not exhibit recognized signs of cognitive decline.
USPSTF found insufficient evidence to determine whether screening asymptomatic children aged 5 years or younger for speech and language delays leads to more benefit than harm. This recommendation applies to children without signs, symptoms or parental or clinician concerns about speech, language, hearing or development.