Clinical Care of ADHD

Key points

  • The American Academy of Pediatrics (AAP) has developed a clinical practice guideline that provides recommendations for the diagnosis and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD).
  • This guideline is based on the best available evidence, and is intended for use by primary care providers, such as pediatricians, family physicians, and other healthcare providers.
A doctor meeting with parents and their son

Diagnosis and evaluation of ADHD

The AAP guidelines for diagnosis and evaluation of ADHD recommend that healthcare providers complete these steps:

  • Evaluate children and adolescents ages 4 to 18 years for ADHD if they are having academic or behavioral problems and show inattention,A hyperactivity, B or impulsivity.C
  • 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 criteria 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.

Treatment recommendations

The AAP guidelines for treatment of ADHD1 recommend that

  • 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.

Did you know?‎

Behavior therapy is an effective treatment for ADHD. It is most effective in young childrenwhen it is delivered by parents.

AAP treatment guidelines by age group

Children ages 4-6 years

The first line of treatment should include:

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.

School-age children and adolescents

Recommended treatment for children (6+ years) and adolescents includes:

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.

Healthcare providers supporting children with special healthcare needs ‎

Healthcare providersplay an important part in supporting the health and well-being of children and adolescents in all settings, includingearly intervention, preschool, and school environments.

Any child or adolescent who is taking medication

The AAP guidelines for treatment of ADHD recommend that

  • 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.
  1. Inattention. Not being able to carefully complete a task, think about, listen to, or watch someone or something.
  2. Hyperactivity. Having an abnormally high level of activity or excitement that interferes with the ability to concentrate or interact with others.
  3. Impulsivity. Acting on sudden desires, whims, or feelings rather than from careful thought.
  1. 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).