Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder

This clinical practice guideline provides evidence-based recommendations fo r the treatment of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). This guideline, the second in a set of policies on this co ndition, is intended for use by clinicians working in primary care settings . The initiation of treatment requires the accurate establishment of a diag nosis of ADHD; the American Academy of Pediatrics (AAP) clinical practice g uideline on diagnosis of children with ADHD(1) provides direction in approp riately diagnosing this disorder. The AAP Committee on Quality Improvement selected a subcommittee composed o f primary care and developmental-behavioral pediatricians and other experts in the fields of neurology, psychology, child psychiatry, education, famil y practice, and epidemiology. The subcommittee partnered with the Agency fo r Healthcare Research and Quality and the Evidence-based Practice Center at McMaster University, Ontario, Canada, to develop the evidence base of lite rature on this topic.(2) The resulting systematic review, along with other major studies in this area, was used to formulate recommendations for treat ment of children with ADHD. The subcommittee also reviewed the multimodal t reatment study of children with ADHD(3) and the Canadian Coordinating Offic e for Health Technology Assessment report (CCOHTA).(4) Subcommittee decisio ns were made by consensus where definitive evidence was not available. The subcommittee report underwent extensive review by sections and committees o f the AAP as well as by numerous external organizations before approval fro m the AAP Board of Directors. The guideline contains the following recommendations for the treatment of a child diagnosed with ADHD: Primary care clinicians should establish a treatment program that recognize s ADHD as a chronic condition. The treating clinician, parents, and child, in collaboration with school pe rsonnel, should specify appropriate target outcomes to guide management. The clinician should recommend stimulant medication and/or behavior therapy as appropriate to improve target outcomes in children with ADHD. When the selected management for a child with ADHD has not met target outco mes, clinicians should evaluate the original diagnosis, use of all appropri ate treatments, adherence to the treatment plan, and presence of coexisting conditions. The clinician should periodically provide a systematic follow-up for the ch ild with ADHD. Monitoring should be directed to target outcomes and adverse effects, with information gathered from parents, teachers, and the child. This guideline is intended for use by primary care clinicians for the manag ement of children between 6 and 12 years of age with ADHD. In light of the high prevalence of ADHD in pediatric practice, the guideline should assist primary care clinicians in treatment. Although many of the recommendations here also may apply to children with coexisting conditions, this guideline primarily addresses children with ADHD but without major coexisting conditi ons. The guideline is not intended for use in the treatment of children wit h mental retardation, pervasive developmental disorder, moderate to severe sensory deficits such as visual and hearing impairment, chronic disorders a ssociated with medications that may affect behavior, and those who have exp erienced child abuse and sexual abuse. This guideline is not intended as a sole source of guidance for the treatment of children with ADHD. Rather, it is designed to assist the primary care clinician by providing a framework for decision-making. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition, and may not prov ide the only appropriate approach to this problem.