American Academy of Pediatrics Supports Psych Evals for AD/HD Diagnosis

Recently, the American Academy of Pediatrics (AAP) made news in the world of parenting because they published an article on Attention Deficit/Hyperactivity Disorder (AD/HD).  Unfortunately, articles on the internet tend to boil things down beyond basic, often leaving out crucial details and making errors by misinterpreting information.  Here’s what they actually said and why it matters.
The article is entitled “ADHD:  Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.”  If you’d like to find the source material, here it is:  http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011-2654.full.pdf

Here are the 6 Key Action Statements with some interpretation and comments:

1. Children, between the ages of 4 and 18, who are exhibiting signs of academic or behavioral difficulties, including inattention, hyperactivity, or impulsivity, should be evaluated for ADHD.
   • This does NOT mean that a slew of 4-year-olds should be diagnosed and medicated.  It means that through careful exploration, gathering information from the child’s parents, preschool teachers, and other caregivers, and spending time with the child completing developmentally appropriate tasks that have norms, a child as young as 4 can be diagnosed.  
2. The AAP specifically states that the agreed upon diagnostic criteria from the DSM-IV should be met before the diagnosis is made.  This is how mental health professionals make the diagnosis.  Crucial to this diagnosis, and pointed out in the AAP article, is the requirement that the child must meet criteria in more than 1 major setting.  In other words, if a child is only acting out at school or only acting out at home, he or she should not be diagnosed with AD/HD.  In my experience, this is not well known AND is often overlooked.
   • They did not call out the part of the diagnosis that requires significant impairment in functioning, but it is included in the criteria.  If your child is NOT significantly impaired by a high activity level, inability to attend, or other behaviors, he or she does not meet criteria.  At school, when determining whether or not a school district must provide services, “significant impairment” is defined as behind by 2 grade levels.  You’ll likely find teachers calling attention to the behaviors long before that.
   • They also stated that alternative causes for the behaviors should be ruled out.  
   • While they did not expand on this, it is well known that children with undiagnosed learning disabilities and/or upset mood (such as anxiety or depression) exhibit many of the behaviors commonly associated with ADHD.  Mood disorders and learning challenges must be considered when ADHD is being evaluated.
3. The AAP now supports the evaluation of ADHD in concert with the assessment for other conditions that may coexist with ADHD, including emotional, behavioral, developmental, learning, and physical challenges.
4. ADHD should be views as a chronic health condition.  
   • Parents – that means it is a chronic stressor!
5. The AAP article states that for preschoolers, pediatricians “should prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment and may prescribe methylphenidate (the brand name is Ritalin) if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child’s function. For elementary school-aged children, medication and/or evidence-based parent or teacher-based behavior therapy are recommended, “preferably both.”
6. Medication should be prescribed and monitored so that the child is getting the most benefit with the least adverse effects.

The article is great news for children.  Instead of being easily diagnosed based simply on 1 questionnaire (and 1 reporter) and a rushed interview, this article supports thorough, norm-based, best practices for diagnosing ADHD.  Good news for me too!

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Thanks so much for sharing your beautiful