Consider ADHD starting at age four: doctor group

The American Academy of Pediatrics this weekend expanded its guidelines for diagnosing and treating kids with attention-deficit hyperactivity disorder, recommending that doctors evaluate all patients aged four to 18 who show signs of the condition.

The new guidelines update decade-old recommendations that focused on diagnosing and managing ADHD in kids aged six to 12. But behavior problems, over-activity and trouble paying attention can show up earlier, researchers said, and ADHD often persists into adolescence or even adulthood.

Pediatricians should also look out for learning disabilities, anxiety and other issues that can go hand-in-hand with ADHD. And, they should tailor treatment with behavior therapy and medication based on kids' age and severity of symptoms, says a statement published in Pediatrics.

According to data from the Centers for Disease Control and Prevention, between six and nine percent of kids and teens have ADHD, with rates higher in adolescents than younger kids.

"I'm glad to see the guidelines now recognize ADHD can occur both in younger children and older adolescents as well," said Aude Henin, from Massachusetts General Hospital's Child Cognitive-Behavioral Therapy Program. "I think those are things that have been ignored in the past."

Drafted by a 14-member committee, the new recommendations say pediatricians should consult with parents, teachers and other adults in the community about kids' behavior or school-related problems to help them make an accurate diagnosis - because affected children may not always show symptoms in the doctor's office.

If kids are diagnosed with ADHD, those adults will also play an important role in treatment strategies, especially in young kids.

MANAGE BEHAVIOR

To treat four- and five-year olds, the authors recommend that parents are trained in techniques to help manage behavior, including positive reinforcement and ignoring or punishing certain behaviors when necessary.

Only when that doesn't work, and moderate or severe ADHD persists, should young kids be put on medication.

J. Russell Ramsay, who studies ADHD at the University of Pennsylvania's Perelman School of Medicine, said that many young children are overactive or have trouble focusing at times, but that for ADHD to be diagnosed, that behavior must "cause life impairments" in multiple environments - at home, at school and in relationships with peers.

"The diagnosis is a process," he told Reuters Health. "There may be symptoms that are screened for in the preschool population, but (ADHD) should be tracked over time and reassessed to see if it is persisting."

In school-aged kids, teachers or parents can give behavior therapy using similar strategies as in preschoolers. Some may need special education plans, including less homework if it takes them a long time to complete, Ramsay said.