Physical examination: includes complete cardiac and neurologic examinations, vision and hearing screeningīehavioral ratings: validated ADHD screening test or assessment from parent, teacher, or self-report (see Table 4 for screening tools)Ī. Social: family social and financial support, family stressorsįamily: history of ADHD, other mental health or legal concerns Medical: birth history and early developmental progression, medical and mental health evaluation and treatment, past and current medications School or work performance: progress reports, absenteeism, grade retention, special education services, referrals for behavioral or legal problemsĬonsider coexisting or mimicking conditions (Table 3) Patient report of symptoms and degree of impact on current functioning particularly helpful for older children and adolescents School/community report of symptoms outside of the home Parent/caretaker report of symptoms for ADHD and other disorders (e.g., learning, mental health, sleep problems) in the home setting Interview: report of ADHD symptoms across contexts (see Table 2 for diagnostic criteria) The physical examination should be thorough and include hearing and vision screenings. 18 Medical, social, and family histories should be reviewed for medical, contextual or environmental, and genetic risk factors. 17 One-third of individuals with ADHD have a comorbid diagnosis. For instance, sleep problems can affect daytime functioning and account for mild ADHD symptoms. The physician should also evaluate for other possible conditions that may mimic or coexist with ADHD 8, 10, 11 ( Table 3 8, 9 ). 16 The physician should ask about the presence and duration of core ADHD symptoms and the degree of functional impairment from the perspective of the patient, family, and school. The evaluation of ADHD in children and adolescents ( Figure 1 8 – 11 ) includes a history and physical examination, review of information across home and community settings ( Table 1 8, 9 ), and application of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., (DSM-5) diagnostic criteria ( Table 2). Height, weight, heart rate, blood pressure, symptoms, mood, and treatment adherence should be recorded at follow-up visits. There are fewer supporting studies for atomoxetine, guanfacine, and clonidine, and they are less effective than the psychostimulants. Psychostimulants, such as methylphenidate and dextroamphetamine, are most effective for the treatment of core ADHD symptoms and have generally acceptable adverse effect profiles. Medications are recommended as first-line therapy for older children. Effective behavioral therapies include parent training, classroom management, and peer interventions. Behavioral treatments are recommended for preschool-aged children and may be helpful at older ages. Coexisting conditions (e.g., anxiety, learning, mood, or sleep disorders) should be identified and treated. Physicians who inherit a patient with a previous ADHD diagnosis should review the diagnostic process, and current symptoms and treatment needs. Physicians should evaluate for ADHD in children with behavioral concerns (e.g., inattention, hyperactivity, impulsivity, oppositionality) or poor academic progress using validated assessment tools with observers from several settings (home, school, community) and self-observation, if possible. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder in children, and the prevalence is increasing.
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