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New ADHD guidelines lower age of diagnosis

New guidance from the American Academy of Pediatrics expands the age at which children can be diagnosed with attention-deficit/hyperactivity disorder. The recommendations also encourage physicians to partner with parents, teachers and mental health specialists when creating a treatment plan for these patients. The guidelines, published online Oct. 16 in Pediatrics, recommend that physicians evaluate children age 4 to 18 for ADHD if they have academic or behavioral problems and symptoms of inattention, hyperactivity or impulsivity. That marks a shift from AAP guidance issued in 2000 and 2001, which called for assessments for the neurobehavioral disorder in children age 6 to 12. "Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school," said Mark Wolraich, MD, chair of the subcommittee that wrote the guidelines and professor of pediatrics at the University of Oklahoma Health Sciences Center. In 2007, more than 5 million U.S. children 4 to 17 (9.5%) had been diagnosed with ADHD, according to the most recent data from the Centers for Disease Control and Prevention. Boys were more likely than girls to have the condition, the CDC said. An AAP subcommittee, which included developmental-behavioral pediatricians, examined English language peer-reviewed articles on ADHD published between 1998 and 2009. The AAP recommends that physicians gather information about patients' behavior from parents, teachers and mental health specialists. When making a diagnosis, physicians should follow the criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, the AAP said. The academy also encourages physicians to assess patients who have ADHD for other health issues, such as anxiety, depression, language disorders and sleep apnea. Physicians who have trouble determining whether a patient has the neurobehavioral disorder, or those who feel unable to treat it, should refer the child to a mental health specialist, the AAP said. For preschool children age 4 and 5 with ADHD, doctors are encouraged to first try behavioral interventions, such as training parents about behavior management techniques. When elementary school-age youths and adolescents are diagnosed, they should be treated with medication approved by the Food and Drug Administration and behavior therapy, the AAP said. Patients who have problems with attention and hyperactivity but do not meet all the diagnostic criteria of ADHD should be treated with behavioral intervention rather than medication, according to the new guidelines. The AAP also issued updated tools to help physicians diagnose and manage patients with the condition. The full and original article can be found at: http://www.ama-assn.org/amednews/2011/10/31/hlsb1101.htm
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