Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Abstract

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Dr Holbrook was not an author of the accompanying supplemental section on barriers to care. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Antioxidants as a Potential Target against Inflammation and Oxidative Stress in Attention-Deficit/Hyperactivity Disorder

“…The pooled worldwide prevalence of ADHD is 7.2% for children and adolescents and 3-5% for adults [3][4][5]. Boys are more than twice as likely as girls to receive a diagnosis of ADHD [6]. Approximately 50% of individuals diagnosed in childhood and adolescence persist with symptoms into adult life [1,7].…”

“…Comorbidity in ADHD is very common at roughly 70%, the main disorders being emotional or behavioural conditions, such as anxiety, oppositional defiant, depression and substance use disorders, and developmental conditions, such as learning and language disorders, autism spectrum disorders (ASD), and physical conditions (tics and sleep apnoea) [8][9][10]. The diagnosis of ADHD is based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the criteria include: inattention and/or hyperactive and impulsive symptoms for the last six months or more, onset before the age of 12 years old, and symptoms causing at least moderate psychological, social, and/or educational or occupational impairments based on interview and/or direct observation in multiple settings [6].…”

“…The management of ADHD comprises multimodal treatments that include psychosocial and educational interventions [6]. Nevertheless, pharmacological treatment is the first choice of therapy to improve symptoms, using psychostimulants such as methylphenidate (MPH) and amphetamines, which inhibit the reuptake of dopamine and norepinephrine, thus increasing catecholaminergic activity in the prefrontal cortex, striatum, and hippocampus, improving symptoms [6,17].…”

“…The management of ADHD comprises multimodal treatments that include psychosocial and educational interventions [6]. Nevertheless, pharmacological treatment is the first choice of therapy to improve symptoms, using psychostimulants such as methylphenidate (MPH) and amphetamines, which inhibit the reuptake of dopamine and norepinephrine, thus increasing catecholaminergic activity in the prefrontal cortex, striatum, and hippocampus, improving symptoms [6,17]. The second choice of therapy is with non-psychostimulants such as atomoxetine (ATX), which is a selective norepinephrine reuptake inhibitor, guanfacine, and clonidine, which are selective α-2 adrenergic receptor agonists [18,19].…”

Parent–Child Interaction Therapy (PCIT) for young children with Attention-Deficit Hyperactivity Disorder (ADHD) in Japan

“…Early interventions for these preschoolers are important taking into account of their prognosis that may lead to impairments in academic, interpersonal, and occupational domains. Treatment guidelines for children with ADHD recommend environmental adjustments, psychosocial treatment, and psychopharmacotherapy according to the severity of impairment [1]. Psychostimulant medications which are regarded as first-line treatment in psychopharmacotherapy are not recommended for children under age of 6 because of the paucity of investigation of the efficacy and safety in this age group [2].…”