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PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1158-1170
AMERICAN ACADEMY OF PEDIATRICS:
Clinical Practice Guideline: Diagnosis and Evaluation of the
Child With Attention-Deficit/Hyperactivity Disorder
This clinical practice guideline provides recommendations for the assessment and diagnosis of school-aged children with attention-deficit/hyperactivity disorder (ADHD). This guideline, the first of 2 sets of guidelines to provide recommendations on this condition, is intended for use by primary care clinicians working in primary care settings. The second set of guidelines will address the issue of treatment of children with ADHD.
The Committee on Quality Improvement of the American Academy of Pediatrics selected a committee composed of pediatricians and other experts in the fields of neurology, psychology, child psychiatry, development, and education, as well as experts from epidemiology and pediatric practice. In addition, this panel consists of experts in education and family practice. The panel worked with Technical Resources International, Washington, DC, under the auspices of the Agency for Healthcare Research and Quality, to develop the evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for evaluation of the child with ADHD. Major issues contained within the guideline address child and family assessment; school assessment, including the use of various rating scales; and conditions seen frequently among children with ADHD. Information is also included on the use of current diagnostic coding strategies. The deliberations of the committee were informed by a systematic review of evidence about prevalence, coexisting conditions, and diagnostic tests. Committee decisions were made by consensus where definitive evidence was not available. The committee report underwent review by sections of the American Academy of Pediatrics and external organizations before approval by the Board of Directors.
The guideline contains the following recommendations for diagnosis of ADHD: 1) in a child 6 to 12 years old who presents with inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems, primary care clinicians should initiate an evaluation for ADHD; 2) the diagnosis of ADHD requires that a child meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria; 3) the assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms, and degree of functional impairment; 4) the assessment of ADHD requires evidence directly obtained from the classroom teacher (or other school professional) regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment, and associated conditions; 5) evaluation of the child with ADHD should include assessment for associated (coexisting) conditions; and 6) other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD but may be used for the assessment of other coexisting conditions (eg, learning disabilities and mental retardation).
This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with ADHD. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decisionmaking. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.
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Related Article
- Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder
- Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement
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T. Zink, N. Elder, and J. Jacobson How Children Affect the Mother/Victim's Process in Intimate Partner Violence Arch Pediatr Adolesc Med, June 1, 2003; 157(6): 587 - 592. [Abstract] [Full Text] [PDF]
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 K Shaw, I Wagner, H Eastwood, and G Mitchell A qualitative study of Australian GPs' attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) Fam. Pract., April 1, 2003; 20(2): 129 - 134. [Abstract] [Full Text] [PDF]
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 J. A. Naglieri, S. Goldstein, J. S. Iseman, and A. Schwebach Performance of Children with Attention Deficit Hyperactivity Disorder and Anxiety/Depression on the WISC-III and Cognitive Assessment System (CAS) Journal of Psychoeducational Assessment, March 1, 2003; 21(1): 32 - 42. [Abstract] [PDF]
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R. T. Brown Introduction to the Special Issue: Training in Pediatric Psychology J. Pediatr. Psychol., March 1, 2003; 28(2): 81 - 83. [Full Text] [PDF]
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L. M. O'Brien, C. R. Holbrook, C. B. Mervis, C. J. Klaus, J. L. Bruner, T. J. Raffield, J. Rutherford, R. C. Mehl, M. Wang, A. Tuell, et al. Sleep and Neurobehavioral Characteristics of 5- to 7-Year-Old Children With Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder Pediatrics, March 1, 2003; 111(3): 554 - 563. [Abstract] [Full Text] [PDF]
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M. T. Stein and J. M. Perrin Diagnosis and Treatment of ADHD in School-age Children in Primary Care Settings: A Synopsis of the AAP Practice Guidelines Pediatr. Rev., March 1, 2003; 24(3): 92 - 98. [Full Text] [PDF]
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 J. D. Unnever and D. G. Cornell Bullying, Self-Control, and Adhd J Interpers Violence, February 1, 2003; 18(2): 129 - 147. [Abstract] [PDF]
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J. M. Zito, D. J. Safer, S. dosReis, J. F. Gardner, L. Magder, K. Soeken, M. Boles, F. Lynch, and M. A. Riddle Psychotropic Practice Patterns for Youth: A 10-Year Perspective Arch Pediatr Adolesc Med, January 1, 2003; 157(1): 17 - 25. [Abstract] [Full Text] [PDF]
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F. P. Glascoe Safety Words Inventory and Literacy Screener: Standardization and Validation Clinical Pediatrics, November 1, 2002; 41(9): 697 - 704. [Abstract] [PDF]
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 R. Bussing, B. T. Zima, F. A. Gary, and C. W. Garvan Use of Complementary and Alternative Medicine for Symptoms of Attention-Deficit Hyperactivity Disorder Psychiatr Serv, September 1, 2002; 53(9): 1096 - 1102. [Abstract] [Full Text] [PDF]
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D. A. Kube, M. C. Petersen, and F. B. Palmer Attention Deficit Hyperactivity Disorder: Comorbidity and Medication Use Clinical Pediatrics, September 1, 2002; 41(7): 461 - 469. [Abstract] [PDF]
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D. Johnson Getting your arms around ADHD: New tools help pediatricians implement Academy's recent diagnostic guidelines AAP News, August 1, 2002; 21(2): 64 - 64. [Full Text] [PDF]
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J. Biederman, F. A. Lopez, S. W. Boellner, and M. C. Chandler A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study of SLI381 (Adderall XR) in Children With Attention-Deficit/Hyperactivity Disorder Pediatrics, August 1, 2002; 110(2): 258 - 266. [Abstract] [Full Text] [PDF]
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J. T. Combs Lack of Right Ear Advantage in Patients with Attention-Deficit/Hyperactivity Disorder Clinical Pediatrics, May 1, 2002; 41(4): 231 - 234. [PDF]
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