What changed recently

The 2025 APA guideline replaces the 2017 edition, which rested on a single systematic review, and instead draws on 15 systematic reviews while weighing outcomes beyond PTSD symptom scores. It gives strong recommendations to cognitive processing therapy, prolonged exposure and trauma-focused CBT as first-line treatment for adults, with EMDR carried as a conditional recommendation.

The fourth edition is the first revision since 2006 and condenses guidance into 16 graded recommendations covering anorexia nervosa, bulimia nervosa and binge-eating disorder. New elements include routine screening for eating disorders during initial psychiatric evaluation, individualised weight goals in anorexia, eating-disorder-focused psychotherapy as the core treatment, and family-based therapy for adolescents; avoidant/restrictive food intake disorder is discussed but left without recommendations for lack of trial data.

NG222 updates and replaces CG90, abandoning the 2009 stepped-care model in favour of a two-category split into less severe and more severe depression, with a menu of treatment options that patients choose from through shared decision-making rather than a fixed intensity ladder. It also newly covers further-line treatment, chronic depression, depression with coexisting personality disorder and psychotic depression, and adds guidance on reviewing and stopping antidepressants.

The third edition replaces the 2004 guideline and reframes it around graded evidence-based statements, recommending clozapine for treatment-resistant schizophrenia and where suicide risk persists despite other treatment, and suggesting it where aggression persists. It also gives long-acting injectable antipsychotics a defined role for patients who prefer them or have poor or uncertain adherence, reflecting second-generation LAI formulations unavailable in 2004.

The 2020 clinical report consolidates the two separate 2007 AAP reports on evaluation and on management into a single document and reframes practice around acting before a formal diagnosis, urging developmental surveillance at every well-child visit and autism-specific screening at 18 and 24 months with intervention started for identified delays without waiting for diagnostic confirmation. It also updates prevalence, genetic contributions, co-occurring medical and behavioural conditions, and the evidence base for interventions accumulated since 2007.

The 2020 focused update substantially revises 35 recommendations from the 2015 guideline and adds 13 new ones, reflecting newly approved buprenorphine formulations and a targeted evidence review. Among the additions is explicit guidance that all FDA-approved medications for opioid use disorder be available to people in criminal justice settings, with medication choice driven by the individual treatment plan.

The 2019 AAP guideline updates the 2011 version for DSM-5 and adds a new key action statement requiring clinicians to screen for and address coexisting conditions, since most children with ADHD have at least one comorbidity and around 18 percent have three or more. Other recommendations were adjusted only incrementally, with specific guidance retained for preschool-aged children and adolescents across ages 4 to 18.

NG116 updates and replaces the 2005 CG26 guideline, adding new recommendations on access to care, transitions between services, care principles and information-giving, and support for people with complex needs such as coexisting conditions. It also sets age-specific rules absent from the earlier version, restricting EMDR in 7- to 17-year-olds to those who do not respond to or engage with trauma-focused CBT, and ruling out drug treatment for PTSD in under-18s.

NG87 replaces CG72 and technology appraisal TA98, and changes adult pharmacotherapy by making lisdexamfetamine or methylphenidate the first-line choice and moving atomoxetine out of the second-line position it held in 2008. For children aged 5 and over methylphenidate remains first-line, with lisdexamfetamine, dexamfetamine and then atomoxetine as sequential alternatives after inadequate six-week trials, and new sections cover recognition, information and support, adherence, and medication review and discontinuation.

NG69 updates and replaces the 2004 CG9 guideline on the back of a much larger evidence base, naming specific psychological therapies rather than the largely non-specific advice of 2004. For adults with anorexia nervosa it offers a choice of eating-disorder-focused CBT, MANTRA or specialist supportive clinical management, and CBT-ED becomes the recommended treatment for bulimia nervosa, binge-eating disorder and OSFED.

CG185 updates every section of the 2006 CG38 guideline, and following a 2011 network meta-analysis narrows first-line treatment of acute mania to antipsychotics such as haloperidol, olanzapine, quetiapine or risperidone, demoting the wider range of options including valproate that CG38 had listed alongside them. It also bars valproate in girls and women of childbearing potential and keeps the prohibition on antidepressant monotherapy, requiring an antipsychotic if mania or hypomania emerges on an antidepressant.

CG178 updates and replaces CG82, broadening the scope from schizophrenia alone to psychosis generally, so that schizoaffective, schizophreniform and delusional disorder are covered. It restructures the recommendations so psychological intervention and antipsychotic medication are presented in parallel rather than sequentially, with CBT and family intervention offered to all patients alongside any drug treatment.

CG113 updates and replaces the 2004 CG22 anxiety guideline and tightens the position on benzodiazepines, which are no longer acceptable as an adjunct to antidepressant treatment for generalised anxiety disorder and are restricted to short-term use during a crisis. It sets out a stepped-care structure running from education and active monitoring through low-intensity self-help to high-intensity CBT or applied relaxation, with SSRIs as the first-choice drug treatment.