Guess how many kids with ADHD are diagnosed by their primary care provider rather than by a specialist? The answer, according to a national survey, is more than half. For many kids, pediatricians are their main source of ADHD treatment, too.
The U.S. doesn’t have enough mental health specialists for kids. But the American Academy of Pediatrics (AAP) has been taking steps to help fill this gap.
For the first time since 2011, the AAP has updated its guidelines for treating kids with ADHD. Changing these guidelines is a big deal. Thousands of pediatricians rely on them to help diagnose and treat kids with ADHD.
The new guidelines were published in the October issue of Pediatrics. The changes reflect the latest research on ADHD. They also build on the DSM-5 criteria for diagnosing ADHD.
Here are five updated recommendations from the AAP that you and your child’s doctor need to know.
1. Look for co-occurring conditions.
The new guidelines say a majority of kids with ADHD have at least one other mental health condition. This is true for both boys and girls. That’s why the AAP is emphasizing the need to look for co-occurring conditions.
It lists examples ranging from sleep apnea to developmental coordination disorder to autism. The new guidelines also explain what to look for in kids 12 and older.
At a minimum, the guidelines say doctors should look for signs of learning disabilities, anxiety, depression, and substance abuse in kids in this age group who were recently diagnosed with ADHD. All four often co-occur with ADHD. And all four can affect how doctors treat ADHD.
Co-occurrence is a big concern. So is misdiagnosis. The new guidelines say that when doctors diagnose kids with ADHD, they need to rule out other causes of ADHD-like symptoms.
2. Team up with schools.
The new guidelines stress that pediatricians should help families partner with schools. Working together can help kids manage their ADHD.
Teaming up with schools starts with asking teachers for input when kids are evaluated for ADHD. This can be tricky for families with older kids who have multiple teachers. But the AAP says it’s really important to do this when evaluating kids 12 and up.
Why? For starters, they may not be at home as much as younger kids. That means families may have less time to keep an eye on their behaviors.
The AAP also says that during the evaluation process, kids in this older age group tend to underestimate how much they’re struggling with certain behaviors.
The new guidelines say for kids 12 and up, doctors should try to get input from at least two teachers. Feedback from coaches and other sources can help, too. The AAP also says it’s essential for kids in this age group to agree to take part in the evaluation.
3. Give ongoing care.
Long-term studies have found many kids stop getting treated for ADHD. This puts them at higher risk for things like car crashes and substance abuse. The AAP says doctors should monitor ADHD the same way they monitor other lasting conditions.
The guidelines also talk about taking time to fine-tune ADHD medication. The right dose isn’t simply a matter of age, weight, or height. Responses vary from child to child. Over time, doctors can find the lowest dose that helps kids manage ADHD symptoms with few or no side effects.
4. With preschoolers, try behavior therapy first.
For 4- and 5-year-olds, the guidelines say to try behavior therapy first. If it doesn’t help, then consider ADHD medication.
The guidelines talk a lot about parents getting trained in behavior management. This type of behavior therapy trains caregivers to prevent problem behaviors and respond to them when they happen. School staff can get this training, too.
(This kind of behavior therapy is very different from cognitive behavioral therapy. CBT asks kids to think about their feelings and actions.)
The AAP still recommends medication as the first treatment for older kids with ADHD. But it says the best care for kids 6 and up may be medication and behavior management.
The guidelines also say educational interventions and behavior supports “are a necessary part of any treatment plan.” The guidelines say these “often include” an or a .
5. Help families avoid therapies unlikely to help with ADHD.
Mindfulness. Diet. Biofeedback. CBD oil. Nerve stimulation. The new guidelines say that, as of 2019, there isn’t enough evidence to show these help treat kids with ADHD.
A companion article to the guidelines digs deeper. It says some treatments, like play therapy, have been shown to help with other disorders. But they haven’t been shown to help with ADHD.
It also says there is “some, but not strong, evidence” that CBT helps kids 7 and older with ADHD. But CBT has not been shown to help younger kids with ADHD.
The companion article says doctors “should discourage” using therapies that are less likely than others to help with ADHD. The AAP warns the risk isn’t just wasting time and money. If one treatment doesn’t work, some families may think none of them will work.
Barriers to ADHD Treatment
A second companion article to the new guidelines looks at what can get in the way of treating kids with ADHD. It also suggests how to work around these barriers.
One barrier is that many primary care providers don’t receive much training in ADHD. One way to help is to devote more time to ADHD in pediatric training programs.
Another barrier is that insurers don’t cover all the services that kids with ADHD need. This problem is harder to solve.
“Hopefully the new guidelines can start an ongoing discussion,” says Understood expert Elizabeth Harstad, MD. “Focusing on these barriers is the first step to overcoming them.”
Learn more about IEPs and 504 plans and classroom accommodations for ADHD. And read about organizational coaches and other professionals who can help kids with ADHD.
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About the author
Julie Rawe is the special projects editor at Understood.