New ADHD Guidelines Include Preschoolers, Older Teens

But behavioral therapy should be first treatment in youngest children

By Serena Gordon
HealthDay Reporter

SUNDAY, Oct. 16 (HealthDay News) -- In new guidelines released Sunday, the American Academy of Pediatrics has expanded the age range for the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) to children as young as 4 and as old as 18.

For the youngest children, the academy is emphasizing the use of behavior treatments over medication in most cases.

"I think the most significant changes are expanding the ages from preschool through adolescence. The original guidelines were from 6 to 12, because that's where the evidence was. We've been able to broaden the scope of the guidelines because there was more evidence available for preschoolers and adolescents," said the lead author of the new recommendations, Dr. Mark Wolraich, CMRI Shaun Walters Professor of Pediatrics and the Edith Kinney Gaylord Presidential Professor at the University of Oklahoma Health Sciences Center in Oklahoma City.

Wolraich added that the new guidelines also give pediatricians advice on managing inattention or hyperactivity problems that don't quite meet the definition of ADHD.

The new guidelines will be presented at the academy's annual meeting in Boston and will be published in the November issue of Pediatrics.

More than 5 million children in the United States have been diagnosed with ADHD, according to the U.S. Centers for Disease Control and Prevention. Children with the disorder show signs of inattentiveness, impulsivity and hyperactivity. They may be unable to pay attention in class, or may spend a lot of time fidgeting in their seats or talking nonstop. Although most kids may display this type of behavior at one time or another, it becomes a problem when it occurs most of the time, according to the U.S. National Institute of Mental Health.

Treatment for ADHD may include medications or behavior therapy, or both. In fact, Wolraich said that "the combination of both medication and behavioral therapy is probably the best choice when possible."

A recent study, published online on Sept. 28 in the American Journal of Psychiatry, found that the use of ADHD medication is on the rise, with 5 percent of American children now taking stimulant medications such as Ritalin or Adderall to treat the disorder. Those researchers suggested that the increase might be due to a greater recognition of ADHD as a chronic condition, leading to children staying on medications for longer periods.

The new guidelines recommend that unless a child in the 4- to 6-year-old age group has a serious problem, that behavior therapy should be the first treatment tried. If necessary, medications can be added later.

"Although there is less evidence [on outcomes for this age group], the hope is that starting treatment in preschool if a child has serious problems will lead to better outcomes," said Wolraich.

Dr. Richard Gallagher, director of special projects at the Institute for Attention-Deficit Hyperactivity and Behavior Disorders at the NYU Child Study Center in New York City, said, "Medications should be used very carefully. I'm admittedly biased since I primarily do behavioral work, but behavioral work does have its limits. If a child is getting into dangerous situations or presenting with problems interacting appropriately with peers and adults, medications can be very useful. When monitored carefully, medications are safe for the vast majority of kids."

The guidelines also emphasize the need for pediatricians to recognize that ADHD is a chronic condition, and while treatments are available to control symptoms, there is no cure for the disorder.

Wolraich said that one of the reasons the AAP expanded the age up to 18 is because there have been more studies showing that ADHD continues into late adolescence, and even into adulthood.

"ADHD is a chronic condition. We can provide symptomatic treatment, but it doesn't cure the condition. Treatment has to be an ongoing process. Symptoms may change over time, and there needs to be consideration for change in treatment as a child develops," said Wolraich.

"Kids usually stay on medications for about three years. For some, that's enough. It gives them time to become better at compensating for their deficits. But, for many kids, the need for treatment is ongoing," he added.

Gallagher recommended that parents bring up any concerns they have about their child with their pediatrician. "This is a condition that can be recognized early," he said.

More information

To learn more about attention-deficit hyperactivity disorder, visit the U.S. National Institute of Mental Health.

SOURCES: Mark L. Wolraich, M.D., CMRI Shaun Walters Professor of Pediatrics and the Edith Kinney Gaylord Presidential Professor, University of Oklahoma Health Sciences Center, Oklahoma City; Richard Gallagher, M.D., director, special projects, Institute for Attention-Deficit Hyperactivity and Behavior Disorders, NYU Child Study Center, and associate professor, child and adolescent psychiatry, NYU School of Medicine, New York City; November 2011 Pediatrics; Oct. 16, 2011, presentation, American Academy of Pediatrics National Conference and Exhibition, Boston

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