Pediatric ADHD
Also known as: childhood ADHD
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Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
American Academy of Pediatrics (AAP) · 2019 · 2019 guideline (Pediatrics 144(4):e20192528)
The AAP's current guideline on recognising, assessing and treating ADHD in children and adolescents, produced by its ADHD subcommittee. It updates the 2011 version to align with DSM-5 and newer evidence, which the authors describe as producing incremental rather than sweeping changes.
Attention deficit hyperactivity disorder: diagnosis and management
National Institute for Health and Care Excellence (NICE), UK · 2018 · NG87, last updated 13 September 2019
NICE guideline NG87 covers recognition, referral, diagnosis and management of ADHD across children, young people and adults, including medication choice and monitoring, dietary advice, and service organisation and training.
US vs EU key differences
- Who diagnoses differs: the AAP directs primary care clinicians to initiate evaluation for ADHD in any child aged 4 to 18 presenting with academic or behavioural problems, whereas NICE requires diagnosis by a specialist psychiatrist, paediatrician or other appropriately qualified professional with ADHD expertise. source
- Sequencing of medication differs: NICE requires environmental modifications to be put in place and reviewed first, offering medication only if impairing symptoms persist, while the AAP recommends FDA-approved medication together with behavioural training for elementary-age children. source
- Both converge on first-line drug choice in children: NICE names methylphenidate (short- or long-acting) as first-line from age 5, and the AAP names methylphenidate as the agent to consider in 4- and 5-year-olds when behavioural treatment fails. source
- For preschoolers the AAP makes evidence-based parent training in behaviour management and/or behavioural classroom intervention the first-line treatment for children aged 4 to 5, reserving medication for continued moderate-to-severe impairment. source
What changed recently
- US2011 guideline → 2019 guideline (Pediatrics 144(4):e20192528)2019-09-30
The 2019 AAP guideline replaced the 2011 version with mostly incremental changes, the main substantive addition being a new key action statement requiring clinicians to screen for and manage coexisting emotional, behavioural, developmental and physical conditions in children evaluated for ADHD. Parent training in behaviour management remains first-line for preschoolers aged 4 to 6.
source ↗curation confidence 90% - EUCG72 (2008) → NG872019-09-13
NG87 replaced CG72 with new recommendations spanning recognition, information and support, non-pharmacological management, medication choice, adherence, follow-up and planned discontinuation, and aligned diagnosis with the current DSM criteria. The September 2019 amendment clarified that a pre-treatment ECG is unnecessary before stimulants, atomoxetine or guanfacine when cardiovascular history and examination are normal.
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