Key points
- The American Academy of Pediatrics (AAP) developed a clinical practice guideline. It provides recommendations for diagnosing and treating ADHD in children and adolescents.
- These AAP guidelines are based on the best available evidence and is intended for use by primary care providers. This includes pediatricians, family physicians, and other healthcare providers.
Treatment eligibility
Healthcare providers use the guidelines in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5) 1to help diagnose ADHD.
This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD, and how public health is impacted by this condition.
The number of symptoms required for an ADHD diagnosis (by age group) are as follows:
- Six or more symptoms of inattention and/or Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, OR
- Five or more symptoms of inattention and/or Five or more symptoms of hyperactivity-impulsivity for individuals ages 17 years or older.
DSM-5 criteria for ADHD diagnosis
Included below are the DSM-5 criteria for ADHD diagnosis in shortened form. Please note that they are presented just for your information. Only trained healthcare providers can diagnose or treat ADHD.
People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development, symptoms include:
Inattention*
Hyperactivity-impulsivity*
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted.
- Is often forgetful in daily activities.
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor.”
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting their turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
*Symptoms of inattention and/or hyperactivity-impulsivity have been present for at least 6 months, and they are inappropriate for the person's developmental level.
In addition to the above criteria, the following conditions must also be met:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
- Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
- The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
Diagnosis and evaluation of ADHD
The AAP guidelines for diagnosis and evaluation of ADHD recommend that healthcare providers complete these steps:
Steps to take
- Get reports on the child's symptoms from parents or guardians, school staff, and mental health workers involved with their care, and get information from the child or adolescent as well.
- Use rating scales and other sources to document the symptoms and ensure that DSM-5 criteria1 have been met.
- Rule out any other possible conditions that can cause similar symptoms.
- Screen for other conditions that might coexist with ADHD, including emotional or behavioral disorders (such as anxiety, depression, and behavior problems), developmental disorders (such as learning and language disorders or autism spectrum disorder), and physical conditions (such as tics, sleep disorders, or apnea).
- Refer children to a specialist if they detect co-occurring conditions that they are not experienced in treating or diagnosing.
Some children have "complex ADHD" symptoms
Primary care providers evaluate and diagnose ADHD based on the best available evidence which usually include these steps:
- Rule out any other possible conditions that can cause similar symptoms.
- Screen for other conditions that might coexist with ADHD, including emotional or behavioral disorders (such as anxiety, depression, and behavior problems), developmental disorders (such as learning and language disorders or autism spectrum disorder), and physical conditions (such as tics, sleep disorders, or apnea).
Identifying and Managing ADHD with Co-occurring Conditions
This free AAP PediaLink® online course supports pediatricians and other healthcare providers. It offers practical knowledge and resources to identify and manage ADHD. It also addresses ADHD that co-occurs with other conditions. Register here.
Treatment recommendations
The AAP guidelines for treatment of ADHD recommend that2
- Children and adolescents with ADHD should be treated the same as would any other child or adolescent with special healthcare needs, following the principles of the chronic care model and the medical home.
AAP treatment guidelines by age group:
The first line of treatment should include:
- Parent training in behavior management; and/or
- Behavioral classroom interventions (if available).
ADHD medications for children ages 4-6 years
Methylphenidate (a stimulant medication also known as "Ritalin") may be used in children 4-6 years of age if behavioral interventions do not provide significant improvement and the child continues to have serious problems.
Recommended treatment for children (6+ years) and adolescents includes:
- FDA-approved medications along with
- Parent training in behavior management; and/or
- Behavioral classroom interventions (if available).
Treatments often work best when used together.
For all children attending school, the school is a necessary part of any treatment plan. These plans can include:
- Educational interventions; and
- Individual school supports, such as school environment and behavioral supports.
School treatment plans often include an Individualized Education Program (IEP) or a 504 plan that describes accommodations.
The AAP guidelines for treatment of ADHD recommend that2
- The healthcare provider adjusts the patient's medication dose as needed to achieve the most benefit with the least amount of tolerable side effects.
Important note on medication prescribing and use
For adolescents, medications should be used with patient approval.
See Also
Medication for ADHD
Content Source:
National Center on Birth Defects and Developmental Disabilities
- Inattention. Not being able to carefully complete a task, think about, listen to, or watch someone or something.
- Hyperactivity. Having an abnormally high level of activity or excitement that interferes with the ability to concentrate or interact with others.
- Impulsivity. Acting on sudden desires, whims, or feelings rather than from careful thought.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision. Washington DC: American Psychiatric Association, 2022. https://doi.org/10.1176/appi.books.9780890425787
- Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W; SUBCOMMITTEE ON CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVE DISORDER. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019 Oct;144(4):e20192528. doi: 10.1542/peds.2019-2528. Erratum in: Pediatrics. 2020 Mar;145(3).
- Agency for Healthcare Research and Quality (AHRQ). Defining the Patient Centered Medical Home. Available at: https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/define.html. Accessed on October 15, 2024.
- U.S. Food & Drug Administration (FDA). Treating and dealing with ADHD. Available at: https://www.fda.gov/consumers/consumer-updates/dealing-adhd-what-you-need-know. Accessed on November 20, 2023.