New AAP Guideline: ADHD Evaluation Can Begin at Age 4

Children may be evaluated for attention deficit hyperactivity disorder (ADHD) beginning at age 4, according to updated clinical guidelines from the American Academy of Pediatrics.
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"Primary care physicians should initiate an ADHD evaluation for any child 4 through 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity."

This is guideline Number One in the American Academy of Pediatrics' new clinical guideline for diagnosing and managing attention deficit in children. Released October 16, the updated guideline represents a significant expansion; the previous document addressed children ages 6 to 12 only.

"There was enough evidence that we could feel comfortable about the criteria being appropriate for preschoolers and that the process for making the diagnosis was similar enough to what primary care physicians were doing with the elementary school-age children that it would be appropriate to recommend their diagnosing to four years of age," said Mark Wolraich, MD, of the University of Oklahoma in Oklahoma City, and chair of the writing committee for the updated guideline.

The guideline recommends behavioral interventions first for preschool-age children, then drug therapy only if deemed necessary and safe by a physician.

Also new: The AAP now addresses diagnosis, evaluation, and treatment all in one document. It also calls on physicians to "rule out any alternative causes for the child's behavior and symptoms."

"The clinical evaluation should include assessment of conditions that might coexist with ADHD, including emotional or behavioral, developmental, and physical conditions," says the new guideline.

The guideline plainly calls ADHD a "chronic condition," and stipulates that "patients with the condition should be considered special needs children and adolescents."

For more information about the new AAP guideline, visit, MedPageToday, and the American Academy of Pediatrics.

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