Game Changers in Pediatrics 2011

Laurie Scudder, DNP, PNP


November 23, 2011

In This Article

New ADHD Guidelines

The American Academy of Pediatrics (AAP) issued the first update to guidelines for management of attention deficit/hyperactivity disorder (ADHD) in 10 years.[2] Previous guidelines addressed issues in children from 6-12 years of age; these new guidelines provide guidance for a much broader range of kids from 4 to 18 years. The new guidelines clearly outline the role of the primary care clinician in both diagnosis and management. The biggest change -- consider therapy with methylphenidate in preschoolers if parent or teacher administered behavior therapy does not provide significant improvement.

For teens, clinicians need to try to obtain information from at least 2 teachers as well as from other adults including coaches, guidance counselors, or leaders of community activities in which the adolescent participates. US Food and Drug Administration (FDA)-approved agents are first line, with the teen's consent, though ideally this should be combined with age appropriate behavioral therapy. A process-of-care supplement provides detailed information to assist clinicians in implementing the guideline by taking them through each aspect of the process.

Other key findings:

  • ADHD should be recognized as a chronic condition and the care for these children should follow the principles of the chronic care model and the medical home.

  • Elementary aged children should ideally be offered both FDA-approved pharmacotherapy and parent or teacher administered behavioral therapy.

  • Behavior therapy should be considered for children with hyperactive or impulsive behaviors that don't meet full diagnostic criteria for ADHD.

Why Is This a Game Changer?

Preschoolers are now covered by the guidelines and so pediatric providers can feel confident in offering therapy to these younger kids. The process-of-care algorithmic portion of the guideline was developed and will be included in the revised AAP ADHD toolkit scheduled for release in November 2011. Joseph Girone, MD, a developmental pediatrician and clinical Professor of Pediatrics at Jefferson Medical College in Philadelphia cautions clinicians to remember that the first line of treatment for preschoolers is parent and teacher administered behavior therapy. Only when behavioral therapy does not provide significant improvement, should the child be considered for therapy with methylphenidate.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.