New ADHD Guidelines Released
The Society for Developmental and Behavioral Pediatrics has released a new guideline for the assessment and treatment of children and adolescents with complex attention-deficit/hyperactivity disorder (ADHD).
They defined complex ADHD “based on age (<4 years or presentation at age >12 years), presence of coexisting conditions (neurodevelopmental, mental health, medical, or psychosocial factors adversely affecting health and development), moderate to severe functional impairment, diagnostic uncertainty, or inadequate response to treatment.”
The guidelines include 5 key action statements:
- Upon referral from a primary care physician, specialists should initiate a comprehensive assessment and treatment plan for any child through age 18 years with suspected or diagnosed complex ADHD (grade B, strong recommendation).
- When evaluating a patient with complex ADHD, clinicians should conduct an evaluation including medical history; physical examination; and psychological assessment based on the patient’s symptom severity, functional impairments, cognitive/developmental level, and the judgement of the clinician (grade B, strong recommendation).
- Psychoeducation about ADHD and coexisting conditions should be implemented at the outset of treatment, and evidence-based behavioral and educational interventions should be provided to all patients.
- Treatment should include approaches that address ADHD and account for coexisting conditions, with treatment focusing on areas of functional impairment and not just on symptom reduction (grade C to B, recommendation).
- Treatment should include ongoing monitoring of patients throughout life, with a focus on preparing for key developmental transitions (grade B, strong recommendation).
“ADHD is often associated with coexisting conditions and other factors that complicate the diagnostic and treatment process, placing affected children and adolescents at increased risk for serious adverse outcomes in adulthood. This guideline provides recommendations for key aspects of the assessment and treatment of children and adolescents with complex ADHD and highlights areas for advocacy and research to address problems with access to recommended services and gaps in the evidence base,” they concluded.
—Michael Potts
Reference:
Barbaresi WJ, Campbell L, Diekroger EA, et al. Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the assessment and treatment of children and adolescents with complex attention- deficit/hyperactivity disorder [published online January 30, 2020]. J Dev Behav Pediatr. 41:S1–S23,2020. doi: 10.1097/DBP.0000000000000770