The American Academy of Pediatrics expanded its guidelines for diagnosing and treating kids with attention-deficit hyperactivity disorder, recommending that doctors evaluate all patients aged four to 18 who show signs of the condition.

The new guidelines update decade-old recommendations that focused on diagnosing and managing ADHD in kids aged six to 12. But behavior problems, over-activity and trouble paying attention can show up earlier, researchers said, and ADHD often persists into adolescence or even adulthood.

Pediatricians should also look out for learning disabilities, anxiety and other issues that can go hand-in-hand with ADHD. And, they should tailor treatment with behavior therapy and medication based on kids' age and severity of symptoms, says a statement published in Pediatrics

 

Drafted by a 14-member committee, the new recommendations say pediatricians should consult with parents, teachers and other adults in the community about kids' behavior or school-related problems to help them make an accurate diagnosis -- because affected children may not always show symptoms in the doctor's office.

If kids are diagnosed with ADHD, those adults will also play an important role in treatment strategies, especially in young kids.

 

MANAGE BEHAVIOR

To treat four- and five-year olds, the authors recommend that parents are trained in techniques to help manage behavior, including positive reinforcement and ignoring or punishing certain behaviors when necessary.

Only when that doesn't work, and moderate or severe ADHD persists, should young kids be put on medication.

J. Russell Ramsay, who studies ADHD at the University of Pennsylvania's Perelman School of Medicine, said that many young children are overactive or have trouble focusing at times, but that for ADHD to be diagnosed, that behavior must "cause life impairments" in multiple environments -- at home, at school and in relationships with peers.

 

School-aged kids, teachers or parents can give behavior therapy using similar strategies as in preschoolers. Some may need special education plans, including less homework if it takes them a long time to complete, Ramsay said.

Stimulant medications such as Vyvanse, Ritalin and Concerta have also been shown to be effective alone or alongside therapy in this age group.

Those drugs may have side effects, the report notes, including appetite loss, sleep problems and stomach pain. Youngsters with some signs of ADHD, but not a full diagnosis, shouldn't be medicated, the report says.

 

Medication certainly has a stronger effect on the core behavior symptoms of ADHD, but it's a matter of what the family's preference is (and) what services are available for them," said Dr. Mark Wolraich of the University of Oklahoma Health Sciences Center, the guidelines' lead author.

"Where at all possible for school-aged kids and adolescents, trying to implement both (medication and therapy) is probably going to be most effective."

Medication and individual behavior therapy are recommended for teens with ADHD. The authors emphasize that doctors need to keep their eyes open for any signs of drug or alcohol abuse in this group -- and if those problems exist, they should be a treatment priority

excerpt from article By Genevra Pittman

NEW YORK | Sun Oct 16, 2011

Reuters Health