--- title: 'The AAP’s new ADHD guidelines: 5 things you and your child’s doctor need to know' description: How did the American Academy of Pediatrics update its 2019 guidelines for diagnosing and treating ADHD in children? See 5 updates to the AAP's ADHD guidelines. slug: 5-updates-to-diagnosing-and-treating-adhd-that-you-and-your-childs-doctor-need-to-know author: Julie Rawe published: '2019-11-04T20:41:05.100Z' thumbnail: https://cdn-images.understood.org/p0qf7j048i0q/4H3qMJXHfMRdP5BXRmxst6/cdfa2caee47c90dbe11143c5b8422bd1/G820807568.jpg source_url: https://www.understood.org/en/articles/5-updates-to-diagnosing-and-treating-adhd-that-you-and-your-childs-doctor-need-to-know lang: en --- # The AAP’s new ADHD guidelines: 5 things you and your child’s doctor need to know 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](https://www.understood.org/en/articles/adhd-comorbidity). It lists examples ranging from [sleep apnea](https://www.understood.org/en/articles/adhd-or-sleep-disorder) to [developmental coordination disorder](https://www.understood.org/en/articles/understanding-developmental-coordination-disorder-dcd) to [autism](https://www.understood.org/en/articles/ive-heard-that-autism-and-adhd-are-related-is-that-true). 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](https://www.understood.org/en/articles/adhd-and-dyslexia-comorbidity), [anxiety](https://www.understood.org/en/articles/adhd-and-anxiety-what-you-need-to-know), [depression](https://www.understood.org/en/articles/adhd-depression), and [substance abuse](https://www.understood.org/en/articles/why-teens-with-adhd-take-more-risks) 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](https://www.understood.org/en/articles/how-can-i-find-out-if-my-child-was-misdiagnosed-with-adhd). 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](https://www.understood.org/en/articles/what-goes-into-your-childs-adhd-evaluation). 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](https://www.understood.org/en/articles/signs-adhd-medication-needs-fine-tuning). 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](https://www.understood.org/en/articles/adhd-and-behavior-therapy-what-you-need-to-know) first. If it doesn’t help, then consider [ADHD medication](https://www.understood.org/en/articles/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](https://www.understood.org/en/articles/faqs-about-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 IEP or a 504 plan. ## 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 The new guidelines also look 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](https://www.understood.org/en/articles/the-difference-between-ieps-and-504-plans) and [classroom accommodations for ADHD](https://www.understood.org/en/articles/classroom-accommodations-for-adhd). And read about [organizational coaches](https://www.understood.org/en/articles/organizational-coaches-what-you-need-to-know) and other [professionals who can help kids with ADHD](https://www.understood.org/en/articles/different-professionals-who-help-kids-with-adhd). *Understood is not affiliated with any pharmaceutical company.* --- ## Explore related topics and articles - [ADHD and co-occurring conditions by the numbers](https://www.understood.org/en/articles/adhd-comorbidity) - Its common for kids with ADHD to also have other conditions. \(You may hear this called comorbidity.\) Research shows that learning disabilities and mental health issues impact kids with ADHD at higher rates than kids who dont have ADHD. We worked with Understood Expert Thomas Brown to break down the - [ADHD and aggression](https://www.understood.org/en/articles/adhd-aggression) - Many kids with ADHD are quick to get angry. They feel emotions intensely and can have trouble managing them. Kids with ADHD tend to have outbursts more often than other kids their age. Much of the time, these flare-ups arent threatening. Kids might yell or slam doors. But sometimes, they lose contr - [How can I find out if my child was misdiagnosed with ADHD?](https://www.understood.org/en/articles/how-can-i-find-out-if-my-child-was-misdiagnosed-with-adhd) - Q. Im concerned that my 8-year-old may have been misdiagnosed with ADHD. How can I know for sure, and what should I do next? A. Before I get into the answer, I just want to say how great it is that youre following your instincts and looking into your childs diagnosis of ADHD \(also known as ADD\). 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