Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks difficulty keeping materials and belongings in order messy, disorganized work has poor time management fails to meet deadlines). Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities (e.g., overlooks or misses details, work is inaccurate). For older adolescents and adults (age 17 and older), at least five symptoms are required. Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. Inattention: Six (or more) of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: A persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development, as characterized by 1 and/or 2:ġ. 2, 27, 45Ĭonsensus guidelines, large retrospective cohort showing no significant increased incidence of serious cardiovascular eventsĪ. 43, 51 – 53, 55Ĭonsistent results from small double-blind randomized controlled trials comparing stimulants to placebo or nonstimulant medicationsĮlectrocardiography is not recommended before starting stimulants or second-line medications if the cardiovascular examination is normal and there is no increased cardiovascular risk based on other medical conditions or family history. Stimulant medications are recommended as the most effective therapy for reducing ADHD symptoms. 2, 26, 27, 29, 30, 32Ĭonsensus guidelines, systematic review of small or medium-sized clinical trials with mixed results or methodologic limitations Psychosocial interventions should be first-line treatment for ADHD in preschool children (four to five years) and should be offered as an adjunct to medications in children six years and older. 2, 27, 43, 44, 51 – 55Ĭonsensus guidelines, systematic reviews of small and large randomized controlled trials showing improved ADHD symptom scores single retrospective cohort study showing long-term improvement Medications should be offered as first-line treatment for ADHD in children six years and older. The evaluation for ADHD should include a comprehensive history, physical examination, use of a validated ADHD assessment tool with input from multiple raters and consideration of coexisting or alternative diagnoses. 2, 27Įxpert opinion, consensus guideline in the absence of clinical trials Regular follow-up is key in the management of ADHD and should assess symptoms, overall function, presence of comorbidities, adverse effects of treatment, and medication use.Ĭhildren four years and older and adolescents with poor attention, distractibility, hyperactivity, impulsiveness, poor academic performance, or behavior problems at home or at school should be evaluated for ADHD. Nonstimulant medications are less effective but reasonable as adjunct or alternative therapy when stimulants are ineffective or not tolerated. Stimulant medications are well-established as an effective treatment for reducing symptoms of ADHD in elementary school children and adolescents. Psychosocial interventions are the recommended first-line treatment for preschool children (four to five years) and can improve overall function when used as an adjunct therapy in elementary school children (six to 11 years of age) and adolescents (12 to 17 years of age). The goals of treatment include symptom reduction and improved social and cognitive function. The combination of Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria and validated screening tools completed by parents, teachers, or other adults can aid in establishing the diagnosis. A comprehensive history and physical examination should assess for comorbid or other conditions that can mimic ADHD. The evaluation for ADHD begins when parents or caregivers present to primary care physicians with concerns about behavior problems or poor school or social function. children between two and 17 years of age and may pose long-term morbidity if untreated. Attention-deficit/hyperactivity disorder (ADHD) is a multidimensional chronic neurodevelopmental condition that affects 8.4% of U.S.
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