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Key Points for Practice
• Most children diagnosed with ADHD also meet criteria for another behavioral health disorder.
• Parent training in behavior management is strongly recommended for children up to middle school age with ADHD or behavior concerning for ADHD.
• School evaluation of children with ADHD can lead to accommodations and additional learning services to optimize academic performance.
From the AFP Editors
Attention-deficit/hyperactivity disorder (ADHD) is diagnosed in 7% to 8% of children. It affects academic achievement and socioemotional well-being. The American Academy of Pediatrics (AAP) updated guidelines to emphasize evaluation for comorbid conditions and overcoming systemic barriers to increase treatment equity.
Diagnosis
The average age at ADHD diagnosis is seven years. ADHD is twice as common in boys than it is in girls, which is partially explained by increased hyperactivity and impulsiveness in boys. Children who are at the younger end of their academic grade are more likely to be diagnosed with ADHD.
ADHD should be considered in children four years or older with academic or behavioral concerns and symptoms of inattentiveness, hyperactivity, or impulsivity. The AAP supports the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria requiring six or more symptoms (Table 11) for at least six months. Symptoms must occur in more than one social setting, including home, school, or day care, and be unexplained by age or another condition. For adolescents, symptoms must have been present before 12 years of age. Neuropsychological testing does not increase diagnostic accuracy.
TABLE 1.Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder
| Inattention* |
| Appearing not to listen |
| Avoiding tasks requiring sustained attention |
| Careless mistakes |
| Difficulty organizing |
| Difficulty sustaining attention |
| Easily distracted |
| Failing to finish tasks |
| Forgetfulness |
| Losing things |
| Hyperactivity and impulsivity* |
| Always “on the go” |
| Blurting out answers before questions are completed |
| Difficulty waiting for turn |
| Excessively talkative |
| Fidgeting |
| Inability to play quietly |
| Inability to stay seated |
| Interrupting or intruding on others |
| Restlessness |