National Institute on Minority Health and Health Disparities (Dr. Wonnum); Uniformed Services University (Dr. Krassow), Bethesda, MD sundania.wonnum@nih.gov
The authors reported no potential conflict of interest relevant to this article.
The opinions of the authors do not represent the opinions of the National Institute on Minority Health and Health Disparities, the National Institutes of Health, the Department of Health and Human Services, the Department of Defense, or the federal government.
James is one of more than 6 million children, ages 3 to 17 years, in the United States who live with ADHD.1,2 ADHD is the most common neurodevelopmental disorder among children, and it affects multiple cognitive and behavioral domains throughout the lifespan.3 Children with ADHD often initially present in primary care settings; thus, PCPs are well positioned to diagnose the disorder and provide longitudinal treatment. This Behavioral Health Consult reviews clinical assessment and practice guidelines, as well as treatment recommendations applicable across different areas of influence—individual, family, community, and systems—for PCPs and IBHCs to use in managing ADHD in children.
ADHD features can vary by age and sex
ADHD is a persistent pattern of inattention or hyperactivity and impulsivity interfering with functioning or development in childhood and functioning later in adulthood. ADHD symptoms manifest prior to age 12 years and must occur in 2 or more settings.4 Symptoms should not be better explained by another psychiatric disorder or occur exclusively during the course of another disorder (TABLE 1).4
Psychostimulants are preferred for ADHD. However, a variety of medications are available and may prove efficacious as children grow and their symptoms and the capacity to manage them change.
The rate of heritability is high, with significant incidence among first-degree relatives.4 Children with ADHD show executive functioning deficits in 1 or more cognitive domains (eg, visuospatial, memory, inhibitions, decision making, and reward regulation).4,5 The prevalence of ADHD nationally is approximately 9.8% (2.2%, ages 3-5 years; 10%, ages 6-11 years; 13.2%, ages 12-17 years) in children and adolescents; worldwide prevalence is 7.2%.1,6 It persists among 2.6% to 6.8% of adults worldwide.7
Research has shown that boys ages 6 to 11 years are significantly more likely than girls to exhibit attention-getting, externalizing behaviors or conduct problems (eg, hyperactivity, impulsivity, disruption, aggression).1,6 On the other hand, girls ages 12 to 17 years tend to display internalized (eg, depressed mood, anxiety, low self-esteem) or inattentive behaviors, which clinicians and educators may assess as less severe and warranting fewer supportive measures.1
The prevalence of ADHD and its associated factors, which evolve through maturation, underscore the importance of persistent, patient-centered, and collaborative PCP and IBHC clinical management.
Continue to: Begin with a screening tool, move to a clinical interview
