ADHD: Pediatric Mental Health Minute Series

Attention deficit hyperactivity disorder (ADHD) is a disorder that manifests in childhood with two categories of core symptoms: hyperactivity/impulsivity and inattention.  The symptoms affect cognitive, academic, behavioral, emotional, and social functioning.

Scope in Pediatrics

• ADHD is the most common neurobehavioral disorder in pediatrics, with a prevalence of 7-15%. The disorder is twice as common in boys than in girls 

• The diagnosis of ADHD can be made from preschool years through adulthood. ADHD is a chronic condition and the clinical profile may change over time. 

Teaching Points

• All children presenting with academic or behavioral problems and symptoms of inattention, hyperactivity and/or impulsivity should be evaluated for ADHD. 
• Children and adolescents should be evaluated across more than one setting (e.g. home and school) using standardized rating scales from parents/caregivers and collateral sources (e.g. teachers, other school personnel).  Diagnoses should be based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. 
• Co-existing conditions are the rule, not the exception. Pediatric health care providers should screen all children with ADHD regularly for coexisting conditions and manage them or refer to subspecialists. The most common coexisting conditions are language and learning disorders but there are also high rates of internalizing and externalizing psychiatric comorbidities.  
• Boys are more likely than girls to have externalizing behaviors (eg, aggression, oppositional-defiant behaviors). Girls are more likely than boys to have internalizing symptoms (eg, anxiety and depression). 
• Treatment should include parent training in behavior management (PTBM) and school supports for children 4-6 years old; PTBM, school supports and medication for children 6 to 12 years old; and school supports, medication, and transition supports for children and adolescents > 12 years old. Adolescents should be screened for substance use.  
• Stimulants continue to be the first line medications for ADHD.