New clinical guidelines call strongly for providing psychosocial supports for children and adolescents with complex attention-deficit/hyperactivity disorder (ADHD). Developed by the Society for Developmental and Behavioral Pediatrics (SDBP), the guideline provides a framework for diagnosing and treating complex ADHD in these age groups.
Its recommendations complement existing ADHD guidelines from the American Academy of Pediatrics (AAP). The new guideline is published in a supplemental issue of SDBP's Journal of Developmental and Behavioral Pediatrics .
The time has come for us to take a determined step forward to improve the care and outcomes for people affected by ADHD. ADHD is not just an annoying childhood behavior problem. It is a neurodevelopmental disorder that can have lifelong impact in key areas including mental health, educational and vocational outcomes, and relationships." William Barbaresi, MD, chief of the Division of Developmental Medicine, Boston Children's Hospital Barbaresi is also the chair of the SDBP Complex ADHD Guidance Panel.
Approximately 7.5 percent of children and adolescents in the U.S. have ADHD, and about two-thirds of them have one or more co-existing conditions such as learning disorders or mental health problems.
Complex ADHD is characterized by the presence of other conditions along with ADHD. These can include moderate to severe learning disabilities; intellectual disability; anxiety, depression, and other mental health problems; poor responses to treatment; and initial diagnosis of ADHD before age 4 or after age 12.
The new guideline focuses on identifying and treating more than 'typical' core ADHD symptoms. It breaks new ground by recommending psychosocial treatment as an essential foundation for treatment of children and teens with ADHD, in addition to medications.
"Treatment for children and adolescents with complex ADHD should focus on improvement in function -- behaviorally, socially, academically -- over the patient's life, not just improving ADHD symptoms," says Barbaresi.
Psychosocial interventions to improve function may include: classroom-based management tools like positive reinforcement tools, daily report card, and posted expectations and consequences parent education approaches to improve appropriate peer interactions school services, such as 504 plans and special education individualized education plans (IEPs). Five key action statements
The expert panel that developed the guideline found that the need for a dual approach -- psychosocial intervention and medications -- is supported by available research. "Psychosocial interventions are not consistently provided to patients in practice," says Barbaresi, who explains that the lack of psychosocial supports has largely been driven by a lack of availability. Related Stories
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