There’s no question Attention Deficit/Hyperactivity Disorder (ADHD) is common in kids — about 9.4% of children ages 2 to 17 have been diagnosed with the disorder. And as a parent, it’s normal to want clear answers about whether or not your child could be affected and/or how to best treat your child if they’ve been diagnosed.
That clarity starts with thorough medical guidelines, which is why the American Academy of Pediatrics (AAP) has updated its own ADHD protocol for the first time since 2011. The AAP published the updated ADHD guidelines today in the AAP journal Pediatrics.
So what’s changed? These are the most notable tweaks to the ADHD guidelines:
Doctors Need to Rule Out Other Conditions
ADHD symptoms can be easily confused with symptoms of other conditions such as depression, anxiety, substance use, autism and trauma. So the AAP is stressing that doctors look for other causes of kids’ ADHD-like behaviors — to rule out a misdiagnosis and/or to see if there’s another disorder in addition to the ADHD (a.k.a. a co-occurring condition) that should also be treated.
“The majority of children with ADHD have at least one co-occurring condition — the most common in primary care are learning and language disorders,” Mark L. Wolraich, MD, FAAP, lead author of the report and prominent clinician and researcher in ADHD, tells SheKnows. “We really wanted to make sure the primary care clinicians are thinking about those conditions either as alternatives to ADHD or as causes of the symptoms. Some conditions, like anxiety and depression can cause some similar behaviors and may need to be addressed first.”
People Age 17+ Need to Meet Fewer Criteria to Be Diagnosed
Hyperactivity tends to decrease as kids grow up but inattentive symptoms tend to remain after age 17, so older teens and adults with ADHD may not have as many symptoms as kids and younger teens do. This new guideline could help prevent ADHD from going undiagnosed in affected older teens and young adults.
Emphasis on Ongoing Care and Getting the Village Involved
Wolraich says medicines and behavioral interventions help a child cope with the symptoms of ADHD, but to maintain the benefits kids need ongoing medical, educational and behavioral care. To provide that care, there needs to be coordination with their schools and communities. Schools should play a role, making sure a child with ADHD is receiving the educational services they need. Plus, kids should be getting necessary psychiatric or psychological interventions.
“It’s important to have that looked at by a child’s primary care clinician, and parents play a very important role in managing their child’s care,” says Dr. Wolraich.
Parents Are Key in Helping Kids Learn Positive Behaviors
For kids who are diagnosed with ADHD at a young age — ages 4 to 6 specifically — the first line of treatment should be parent training in behavioral therapy. This isn’t a new concept, but the AAP now describes it more clearly in the guidelines. “There was some confusion because the most common behavioral therapy for that age group is play therapy which has not been found effective for ADHD,” says Dr. Wolraich. “Instead, research has found programs that help parents manage the child’s behavior has been most effective.”
High school students also benefit when their parents and teachers are trained in behavioral management.
If you have a child with ADHD, talk to their doctor about how behavioral management strategies might help your child and how you can learn them.
Approved Medication + Behavioral Therapy = The Best Combo
The new guidelines also go into detail about medications. In the past, some medications not typically meant to treat ADHD — off-label meds — have been prescribed for patients with it. However, AAP doctors are discouraging that practice, since today there’s wide variety of medications available that are FDA-approved to treat ADHD.
“We encourage clinicians to treat ADHD with both medication and behavioral interventions,” says Dr. Wolraich. “That’s really optimal.”
Often, parents feel confused about ADHD or overwhelmed by the possibility of a diagnosis, but the first step is talking to your child’s pediatrician about any concerns you may have.
“ADHD is a real a problem that can have a significant impact on kids’ performance in school and in other settings but there are treatments that really do work,” says Dr. Wolraich. “They require a lot of effort and coordination both from parents and clinicians.”
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