Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children.
The primary care clinician should initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.
To make a diagnosis of ADHD, the primary care clinician should determine that Diagnostic and Statistical Manual of Mental Disorders have been met. Information should be obtained primarily from reports from parents or guardians, teachers, and other school and mental health clinicians involved in the child’s care. The primary care clinician should also rule out any alternative cause.
In the evaluation of a child for ADHD, the primary care clinician should include assessment for other conditions that might coexist with ADHD, including emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neurodevelopmental disorders), and physical (eg, tics, sleep apnea) conditions.
ADHD symptoms may include:
- Impulsiveness
- Disorganization and problems prioritizing
- Poor time management skills
- Problems focusing on a task
- Trouble multitasking
- Excessive activity or restlessness
- Poor planning
- Low frustration tolerance
- Frequent mood swings
- Problems following through and completing tasks
- Hot temper
- Trouble coping with stress
What's typical behavior and what's ADHD? Almost everyone has some symptoms similar to ADHD at some point in their lives. If your difficulties are recent or occurred only occasionally in the past, you probably don't have ADHD. ADHD is diagnosed only when symptoms are present in more than one environment (i.e. school, home, community) and cause ongoing problems.
The gold standard for ADHD treatment includes stimulant medication but there are other options to help manage ADHD symptoms and executive functioning.
Clinical Guidelines
- Clinical Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder (AAP):
Includes table of medications used in the treatment of ADHD and table of effective behavioral techniques for children with ADHD (Clinical Practice Guidelines)
- AAP ADHD Toolkit:
The American Academy of Pediatrics (AAP) ADHD toolkit contains useful information for the diagnosis and treatment of children with attention-deficit/hyperactivity disorder. This resource toolkit contains a wide array of screening, diagnosis, treatment, and support materials for clinicians and other health care professionals, is available for purchase.
- Florida Best Practice Medication Guidelines - Treatment flowchart
Treatment Flowchart
Screening for ADHD
Any of the specific ADHD rating scales can be used for screening/early detection. However, it is more practical to use general mental health and developmental screening instruments for routine surveillance in the primary care setting.
Examples of general screening instruments that include ADHD symptoms along with other mental health symptoms: (These instruments are approved for compliance and reimbursement within the MassHealth screening initiative.)
- Pediatric Symptom Checklist
35 item questionnaire, public domain, parent report and youth self-report versions, available in multiple languages.
- Achenbach System of Empirically Based Assessment (ASEBA)
Formerly known as CBCL, 113-item questionnaire, parent report, youth self-report, and teacher report versions generate comprehensive profiles with normed subscales when the instrument is scored; requires data entry for computer scoring or fairly complex hand-scoring.
Rating Scales
Vanderbilt ADHD Diagnostic Parent/Teacher Rating Scale-Instructions and Scale
- For children 6-12 years old
- Parent form: 55 items; Teacher form: 43 items
- 10 minutes to complete
- Parent and teacher complete questionnaire
- Free
- Used for information about symptoms and performance in different settings; not intended for diagnosis.
ADHD Rating Scale IV
- For children 6-12 years old
- 18 items, takes minutes to complete
- Parent, child, and clinician complete questionnaire
- $46 for unlimited copies, manual, parent questionnaires in English and in Spanish; includes both school and home versions
- For diagnosis and monitoring improvement
Swanson, Nolan, and Pelham (SNAP-IV)
- For children and adolescents 6-18 years old
- 90 items
- 10 minutes to complete
- Parent and teacher complete questionnaire
- Free
- Contains items pertaining to DSM criteria for ADHD; measures impairment and functioning at home and at school
Parent Information and Handouts
- National Resource Center on ADHD (a program of CHADD) (Children and Adults with Add)
- ADHD Medication Guide (PDF)
- AACAP Facts for Families: ADHD