KAS 1: The pediatrician or other PCC should initiate an evaluation for ADHD for any child or adolescent age 4 years to the 18th birthday who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. 5, 6Įvidence Quality, Strength of Recommendation Unfortunately, third-party payers seldom pay appropriately for these time-consuming services. In addition, the AAP holds that primary care pediatricians should be prepared to diagnose and manage mild-to-moderate ADHD, anxiety, depression, and problematic substance use, as well as co-manage patients who have more severe conditions with mental health professionals. 3 Given the nationwide problem of limited access to mental health clinicians, 4 pediatricians and other PCCs are increasingly called on to provide services to patients with ADHD and to their families. Special attention should be given to these populations when assessing comorbidities as they relate to ADHD and when treating for ADHD symptoms. There is some evidence that African American and Latino children are less likely to have ADHD diagnosed and are less likely to be treated for ADHD. The procedures recommended in this guideline necessitate spending more time with patients and their families, developing a care management system of contacts with school and other community stakeholders, and providing continuous, coordinated care to the patient and his or her family. There are many system-level barriers that hamper the adoption of the best-practice recommendations contained in the clinical practice guideline and the PoCA. 2) PoCA for the Diagnosis and Treatment of Children and Adolescents With ADHD (Prevention is addressed in the Mental Health Task Force recommendations. Although this document is specific to children and adolescents in the United States in some of its recommendations, international stakeholders can modify specific content (ie, educational laws about accommodations, etc) as needed. These supplemental documents are designed to aid PCCs in implementing the formal recommendations for the evaluation, diagnosis, and treatment of children and adolescents with ADHD. In response, this guideline is supported by 2 accompanying documents, available in the Supplemental Information: (1) a process of care algorithm (PoCA) for the diagnosis and treatment of children and adolescents with ADHD and (2) an article on systemic barriers to the care of children and adolescents with ADHD. Since 2011, the release of new research reflects an increased understanding and recognition of ADHD’s prevalence and epidemiology the challenges it raises for children and families the need for a comprehensive clinical resource for the evaluation, diagnosis, and treatment of pediatric ADHD and the barriers that impede the implementation of such a resource. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians’ ability to adopt their recommendations. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. These publications do not support dramatic changes to the previous recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline’s recommendations. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000 recommendations for treatment followed in 2001. Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders of childhood and can profoundly affect children’s academic achievement, well-being, and social interactions.
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