New guidelines from the American Academy of Pediatrics expand the age range over which doctors can diagnose and manage ADHD in children.

According to the nation’s largest organization of pediatricians, attention-deficit hyperactivity disorder (ADHD) can now be diagnosed in children as young as 4 and as old as 18.


The new guidelines from the American Academy of Pediatrics (AAP) expand the age range over which doctors can diagnose and manage ADHD in children, and are based on recent research; previous guidelines released in 2000 and 2001 covered children ages 6 to 12.

“Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school,” said Dr. Mark Wolraich, a pediatrician at the University of Oklahoma Health Sciences Center and lead author of the report.

The guidelines were released today in Boston at the pediatricians’ annual conference.

But with ADHD now the most common neurobehavioral disorder in children, some experts worry about changes that could lead to even more kids being diagnosed — and medicated.

A text-message survey of 100 U.S. pediatricians conducted by Truth On Call for found that 60 of them think ADHD is overdiagnosed in kids, 35 feel it’s diagnosed appropriately and 5 think it might be underdiagnosed.

As of 2007, 9.5 percent of U.S. children had been diagnosed with ADHD, according to the Center for Disease Control and Prevention. And cases of ADHD are already on the rise; between 2003 and 2007, rates of ADHD diagnoses increased 5.5 percent per year, the CDC says.

Any child ages 4 to 18 who has behavioral problems or problems in school and has symptoms of inattention, hyperactivity and impulsivity should be evaluated for ADHD, Wolraich said. To be diagnosed as having the condition, the child must display these problems in more than one setting (for instance, both at home and at school).

Although the new guidelines allow for children as young as 4 can be diagnosed with ADHD, there are challenges in diagnosing these kids, Wolraich said. For instance, children too young to have started school may be under the supervision of only their parents, in which case, there are no teachers or daycare providers to confirm behaviors.

In making diagnoses in these young kids, doctors should look for symptoms to last at least 9 months, instead of the 6 months required for older children, Wolraich said.

“These are the kids who are really getting into trouble,” and may have been kicked out of two or three preschool programs, Wolraich said.

In some cases, parents could undergo training to help manage behavior problems in their kids before a diagnosis is made, he said.

Diagnosing teens, on the other hand, likely requires talking to adults other than their parents, who may have little contact with them, Wolraich said. Doctors should try to obtain information from teachers, couches, counselors and other community leaders who may interact with the teen.

In children ages 4 and 5, doctors should first try to treat ADHD with behavioral therapies. Only if such therapies fail, and a child has problems functioning in everyday life because of ADHD, should doctors prescribe the ADHD drug methylphenidate (known by its brand names Ritalin, Concerta and others) to kids in this age group, according to the new guidelines.

For elementary school children and adolescents, both behavioral therapy and FDA-approved ADHD medications are recommended.

The guidelines emphasize that ADHD is a long-term condition that may last into adulthood.

“As a chronic illness, you have to do all the things that are important to managing a chronic condition,” including educating the family and following the children closely as they grow up, Wolraich said.

The new guidelines will be published in the November issue of the journal Pediatrics.

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