Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder

This clinical practice guideline provides recommendations for the assessmen t and diagnosis of school-aged children with attention-deficit/hyperactivit y disorder (ADHD). This guideline, the first of 2 sets of guidelines to pro vide recommendations on this condition, is intended for use by primary care clinicians working in primary care settings. The second set of guidelines will address the issue of treatment of children with ADHD. The Committee on Quality Improvement of the American Academy of Pediatrics selected a committee composed of pediatricians and other experts in the fie lds of neurology, psychology, child psychiatry, development, and education, as well as experts from epidemiology and pediatric practice. In addition, this panel consists of experts in education and family practice. The panel worked with Technical Resources International, Washington, DC, under the au spices of the Agency for Healthcare Research and Quality, to develop the ev idence base of literature on this topic. The resulting evidence report was used to formulate recommendations for evaluation of the child with ADHD. Ma jor issues contained within the guideline address child and family assessme nt; school assessment, including the use of various rating scales; and cond itions seen frequently among children with ADHD. Information is also includ ed on the use of current diagnostic coding strategies. The deliberations of the committee were informed by a systematic review of evidence about preva lence, coexisting conditions, and diagnostic tests. Committee decisions wer e made by consensus where definitive evidence was not available. The commit tee report underwent review by sections of the American Academy of Pediatri cs and external organizations before approval by the Board of Directors. The guideline contains the following recommendations for diagnosis of ADHD: 1) in a child 6 to 12 years old who presents with inattention, hyperactivi ty, impulsivity, academic underachievement, or behavior problems, primary c are clinicians should initiate an evaluation for ADHD; 2) the diagnosis of ADHD requires that a child meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria; 3) the assessment of ADHD requires evi dence directly obtained from parents or caregivers regarding the core sympt oms of ADHD in various settings, the age of onset, duration of symptoms, an d degree of functional impairment; 4) the assessment of ADHD requires evide nce directly obtained from the classroom teacher (or other school professio nal) regarding the core symptoms of ADHD, duration of symptoms, degree of f unctional impairment, and associated conditions; 5) evaluation of the child with ADHD should include assessment for associated (coexisting) conditions ; and 6) other diagnostic tests are not routinely indicated to establish th e diagnosis of ADHD but may be used for the assessment of other coexisting conditions (eg, learning disabilities and mental retardation). This clinical practice guideline is not intended as a sole source of guidan ce in the evaluation of children with ADHD. Rather, it is designed to assis t primary care clinicians by providing a framework for diagnostic decisionm aking. It is not intended to replace clinical judgment or to establish a pr otocol for all children with this condition and may not provide the only ap propriate approach to this problem.