The AAFP has endorsed the American Academy of Pediatrics (AAP) guidelines(pediatrics.aappublications.org) concerning the diagnosis, evaluation and treatment of attention deficit hyperactivity disorder (ADHD) in both children and adolescents.
Family physician Theodore Ganiats, M.D., the AAFP's representative on the AAP committee that recommended the changes, told AAFP News Now that the update is important for FPs because ADHD is such a common and often misdiagnosed disease.
"There are many management options (for ADHD), and several proposed treatments aren't effective," he said. "This guideline helps the busy FP quickly understand the issues and improve practice. It provides simple guidelines for diagnosing and managing the disease."
Ganiats, the executive director of the University of California San Diego (UCSD) Health Services Research Center and a professor of family and preventive medicine at the UCSD School of Medicine in La Jolla, Calif., said the accompanying toolkit(www2.aap.org) also provides useful devices that help diagnose and manage the condition.
The new guidelines expand the age range from ages 6-12 years to 4-18 years and expand scope to include consideration of behavioral interventions "to directly address problem-level concerns in children based on the Diagnostic and Statistical Manual for Primary Care (DSM-PC), Child and Adolescent Version IV."
The guidelines also offer a checklist concerning diagnosis, evaluation and treatment of ADHD in children and adolescents, suggesting that physicians
- include an assessment for other conditions that might coexist with ADHD;
- recognize ADHD as a chronic condition and, therefore, consider children and adolescents with ADHD as children and youth with special health care needs;
- prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first-line treatment for preschool-aged children and methylphenidate if the behavior interventions do not provide significant improvement and there is moderate-to severe continuing disturbance in the child’s function;
- prescribe FDA-approved medications for elementary school-aged children and evidence-based parent- and/or teacher-administered behavior therapy if possible;
- treat adolescents with both FDA-approved medications and behavior therapy with the assent of the patient; and
- titrate doses of the medication for all age groups to achieve maximum benefit with a minimum of adverse effects.
The AAP also has developed a supplemental implementation document that has not yet been reviewed by the AAFP.