ABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral condition and the second most common chronic illness in children. The observance of specific behaviors in multiple settings have remained the most successful method for diagnosing the condition, and although there are differences in specific areas of the brain, and a high heritability estimate (â¼76%), they are not diagnostically specific. Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy dating back to the 1970s. Likewise, behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy during the same time period. Both medication and behavioral interventions are symptomatic treatments. The availability of only symptomatic treatments places ADHD in the same category as other chronic conditions such as diabetes and asthma. Successful treatment of most individuals requires ongoing adherence to the therapy. Improved communication between patients and their families, primary and mental health providers, and school personnel is necessary for effective ADHD treatment. Further enhancement of electronic systems to facilitate family, school, and provider communication can improve monitoring of ADHD symptoms and functional performance. The American Academy of Pediatrics ADHD guidelines were initially developed to help primary care clinicians address the needs of their patients with ADHD and were further refined with the second revision in 2019.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Central Nervous System Stimulants/therapeutic use , Child , Child Behavior , Decision Support Systems, Clinical , Diagnostic and Statistical Manual of Mental Disorders , History, 20th Century , History, 21st Century , Humans , Parenting , Practice Guidelines as Topic , Quality Improvement , Quality of Health Care , Software , Transition to Adult CareABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Adolescent , Age Factors , Algorithms , Attention Deficit Disorder with Hyperactivity/epidemiology , Central Nervous System Stimulants/adverse effects , Central Nervous System Stimulants/therapeutic use , Child , Child, Preschool , Combined Modality Therapy/methods , Health Services Accessibility , Humans , Pediatrics , Psychotherapy/methods , Societies, Medical , United StatesABSTRACT
Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient.
Subject(s)
Fetal Alcohol Spectrum Disorders/diagnosis , Nervous System Diseases/etiology , Prenatal Exposure Delayed Effects/diagnosis , Adolescent , Child , Diagnosis, Differential , Female , Humans , Nervous System Diseases/diagnosis , PregnancySubject(s)
Attitude of Health Personnel , Physician's Role , Physicians, Primary Care/economics , Vaccines/economics , Female , Humans , MaleSubject(s)
Homosexuality, Female/psychology , Marriage , Parent-Child Relations , Adaptation, Psychological , Adolescent , Cross-Sectional Studies , Family Relations , Fathers , Female , Homosexuality, Female/statistics & numerical data , Humans , Longitudinal Studies , Male , Mother-Child Relations , Mothers , Parenting/psychology , Parenting/trends , United StatesSubject(s)
Child Welfare , Health Policy , Health Promotion/organization & administration , Leadership , Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Social Marketing , Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Time Factors , United StatesABSTRACT
During and after disasters, pediatricians can assist parents and community leaders not only by accommodating the unique needs of children but also by being cognizant of the psychological responses of children to reduce the possibility of long-term psychological morbidity. The effects of disaster on children are mediated by many factors including personal experience, parental reaction, developmental competency, gender, and the stage of disaster response. Pediatricians can be effective advocates for the child and family and at the community level and can affect national policy in support of families. In this report, specific children's responses are delineated, risk factors for adverse reactions are discussed, and advice is given for pediatricians to ameliorate the effects of disaster on children.
