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Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental condition in U.S. children, and it affects 8.4% of children between two and 17 years of age (greater than 5 million).1 Of the children who are affected, 62% are treated with medication, less than one-half have received behavioral treatment, and nearly one-fourth have not received treatment.1 Children with ADHD are at risk of long-term morbidities, including poor academic performance, low self-esteem, difficult relationships, substance use, injury, and other maladaptive behaviors.2 This article presents evidence-based answers to common questions about the evaluation and management of childhood ADHD.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Children 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.2,27 | C | Expert opinion, consensus guideline in the absence of clinical trials |
| 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.2,15,17–19,27 | C | Expert opinion, consensus guideline in the absence of clinical trials |
| Medications should be offered as first-line treatment for ADHD in children six years and older.2,27,43,44,51–55 | B | Consensus guidelines, systematic reviews of small and large randomized controlled trials showing improved ADHD symptom scores; single retrospective cohort study showing long-term improvement |
| 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.2,26,27,29,30,32 | B | Consensus guidelines, systematic review of small or medium-sized clinical trials with mixed results or methodologic limitations |
| Stimulant medications are recommended as the most effective therapy for reducing ADHD symptoms.43,51–53,55 | B | Consistent results from small double-blind randomized controlled trials comparing stimulants to placebo or nonstimulant medications |
| Electrocardiography 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.2,27,45 | C | Consensus guidelines, large retrospective cohort showing no significant increased incidence of serious cardiovascular events |
ADHD = attention-deficit/hyperactivity disorder.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence,...