Recommendation 1:In a child six to 12 years of age who presents with inattention, hyperactivity, impulsivity, academic underachievement or behavior problems, the primary care physician should initiate an evaluation for ADHD. The initial assessment should include the following:

  1. Standard history and physical examination, with the AACAP recommending a review of the child's developmental history, confirmation of normal hearing and vision, and a review of the family history for ADHD, learning difficulties or psychiatric illness

  2. Neurologic examination

  3. Family assessment, with the AACAP recommending assessment of family stressors and family coping style

  4. School assessment (see recommendation 4)

Recommendation 2:The diagnosis of ADHD requires that a child meet diagnostic criteria for the disorder (see Table 3).
Recommendation 3:The assessment of ADHD requires evidence directly obtained from parents or care-givers regarding the core symptoms of ADHD in various settings, child's age at onset of the symptoms, duration of symptoms and degree of functional impairment.

  1. Use of (ADHD-specific) scales is a clinical option when evaluating a child for ADHD.

  2. Use of broad-band scales is not recommended in the diagnosis of ADHD.

Recommendation 4:The assessment of ADHD requires evidence obtained directly from the classroom teacher (or other school professional) regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment and coexisting conditions in the child. A physician should review any reports from a school-based multidisciplinary evaluation, including assessments from the child's teacher or other school-based professional.

  1. Use of (ADHD-specific) scales is a clinical option when evaluating a child for ADHD.

  2. Use of broad-band scales is not recommended in the diagnosis of ADHD.

Recommendation 5:The evaluation of a child with ADHD should include an assessment for coexisting conditions (i.e., learning and language disabilities, oppositional defiant disorder, conduct disorder, anxiety and depression).
Recommendation 6:Other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD.