Ambulatory Guideline: Attention-Deficit Hyperactivity Disorder
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New information in this update includes:
- Ages for diagnosis expanded
- Children: The ages for evaluating children for ADHD now includes ages 4-18.
- Adults: ADHD extends into adulthood. The diagnosis and treatment of adults is now addressed.
- Algorithm for diagnosis and treatment has been expanded to include more detail
- Drug treatment tables have been revised
- Monitoring for drug (stimulant) seeking behavior is addressed.
Key aspects of care include:
- ADHD is a chronic condition that can persist into adulthood
- Many other conditions co-exist with ADHD and should be assessed (e.g. depression, anxiety, learning disabilities etc.)
- No specific test can make the diagnosis of ADHD. The DSM-IV-TR criteria should be met to make the diagnosis, which includes obtaining information from multiple sources when possible
- Combine pharmacologic and behavioral treatment to enhance longer term success.
- Stimulants (generally methylphenidate) remain the first line (best researched, safest, and most effective) for pharmacologic treatment.
- Behavioral treatment for children includes interventions with parents, with child, and with school.
- Special considerations apply to 3 to 5 year olds, mentally retarded, and other groups.
- Several untrue common beliefs about ADHD are noted. Evidence is summarized regarding the (often lack of) effectiveness of special diets and complementary therapy commonly used by parents and patients.
- Appendix A has management tools and Appendix B has differential diagnosis and treatment resources
The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Release Date: April 2013
Termination Date: March 2023
Continued availability of CME credit for this activity depends on a thorough review of its content every three years. This activity was last reviewed for currency and accuracy in February 2020, and availability of CME credit continued.
John M. O'Brien, MD; Family Medicine
Jennifer G. Christner, MD; Child Behavioral Health
Bernard Biermann, MD, PhD; Child/Adolescent Psychiatry
Barbara T. Felt, MD; Behavioral Pediatrics
R. Van Harrison, PhD; Medical Education
Paramjeet K. Kochhar, MD; Pediatrics
Stephanie A. Riolo, MD; Child Psychiatry
Darcie-Ann Streetman, Pharm D; College of Pharmacy
Financial Disclosure Information:
There are no financial relationships to disclose for this CME activity.
UMHS Guidelines Oversight Team:
Grant Greenberg, MD, MA, MHSA
R. Van Harrison, PhD
Literature Search Services:
Taubman Medical Library