Article Figures & Data
Figures
- Fig. 1.
Clinical algorithm.
Tables
A. Either 1 or 2 1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention a) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities b) Often has difficulty sustaining attention in tasks or play activities c) Often does not seem to listen when spoken to directly d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) e) Often has difficulty organizing tasks and activities f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or home- work) g) Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools) h) Is often easily distracted by extraneous stimuli i) Is often forgetful in daily activities 2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity a) Often fidgets with hands or feet or squirms in seat b) Often leaves seat in classroom or in other situations in which remaining seated is expected c) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) d) Often has difficulty playing or engaging in leisure activities quietly e) Is often “on the go” or often acts as if “driven by a motor” f) Often talks excessively Impulsivity g) Often blurts out answers before questions have been completed h) Often has difficulty awaiting turn i) Often interrupts or intrudes on others (eg, butts into conversations or games) B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before 7 years of age. C. Some impairment from the symptoms is present in 2 or more settings (eg, at school [or work] or at home). D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, or personality disorder). Code based on type: 314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both criteria A1 and A2 are met for the past 6 months 314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if criterion A1 is met but criterion A2 is not met for the past 6 months 314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive, Impulsive Type: if criterion A2 is met but criterion A1 is not met for the past 6 months 314.9 Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV).Copyright 1994. American Psychiatric Association.
Developmental Variation Common Developmental Presentations V65.49 Hyperactive/impulsive variation Early childhood Young children in infancy and in the preschool years are normally very active and impulsive and may need constant supervision to avoid injury. Their constant activity may be stressful to adults who do not have the energy or patience to tolerate the behavior. The child runs in circles, doesn't stop to rest, may bang into objects or people, and asks questions constantly. During school years and adolescence, activity may be high in play situations and impulsive behaviors may normally occur, especially in peer pressure situations. Middle childhood High levels of hyperactive/impulsive behavior do not indicate a problem or disorder if the behavior does not impair function. The child plays active games for long periods. The child may occasionally do things impulsively, particularly when excited. Adolescence The adolescent engages in active social activities (eg, dancing) for long periods, may engage in risky behaviors with peers. Special Information Activity should be thought of not only in terms of actual movement, but also in terms of variations in responding to touch, pressure, sound, light, and other sensations. Also, for the infant and young child, activity and attention are related to the interactions between the child and caregiver, eg, when sharing attention and playing together. Activity and impulsivity often normally increase when the child is tired or hungry and decrease when sources of fatigue or hunger are addressed. Activity normally may increase in new situations or when the child may be anxious. Familiarity then reduces activity. Both activity and impulsivity must be judged in the context of the caregiver's expectations and the level of stress experienced by the caregiver. When expectations are unreasonable, the stress level is high, and/or the parent has an emotional disorder (especially depression), the adult may exaggerate the child's level of activity/impulsivity. Activity level is a variable of temperature. The activity level of some children is on the high end of normal from birth and continues to be high throughout their development. Taken from: American Academy of Pediatrics. The Classification of Child and Adolescent Mental Diagnoses in Primary Care. Diagnostic and Statistical Manual for Primary Care (DSM-PC), Child and Adolescent Version. Elk Grove Village, IL: American Academy of Pediatrics; 1996
Developmental Variation Common Developmental Presentations V65.49 Inattention variation Early childhood A young child will have a short attention span that will increase as the child matures. The inattention should be appropriate for the child's level of development and not cause any impairment. The preschooler has difficulty attending, except briefly, to a storybook or a quiet task such as coloring or drawing. Middle childhood The child may not persist very long with a task the child does not want to do such as read an assigned book, homework, or a task that requires concentration such as cleaning something. Adolescence The adolescent is easily distracted from tasks he or she does not desire to perform. Special Information Infants and preschoolers usually have very short attention spans and normally do not persist with activities for long, so that diagnosing this problem in younger children may be difficult. Some parents may have a low tolerance for developmentally appropriate inattention. Although watching television cartoons for long periods of time appears to reflect a long attention span, it does not reflect longer attention spans because most television segments require short (2- to 3-minute) attention spans and they are very stimulating. Normally, attention span varies greatly depending upon the child's or adolescent's interest and skill in the activity, so much so that a short attention span for a particular task may reflect the child's skill or interest in that task. Taken from: American Academy of Pediatrics. The Classification of Child and Adolescent Mental Diagnoses in Primary Care. Diagnostic and Statistical Manual for Primary Care (DSM-PC), Child and Adolescent Version. Elk Grove Village, IL: American Academy of Pediatrics; 1996
Study Behavior Rating Scale Age Gender Effect Size 95% Confidence Limits Conners (1997) CPRS-R:L-ADHD Index
(Conners Parent Rating Scale—1997
Revised Version: Long Form, ADHD Index Scale)6 –17 MF 3.1 2.5, 3.7 Conners (1997) CTRS-R:L-ADHD Index
(Conners Teacher Rating Scale—
1997 Revised Version: Long Form, ADHD Index Scale)6 –17 MF 3.3 2.8, 3.8 Conners (1997) CPRS-R:L-DSM-IV Symptoms
(Conners Parent Rating Scale—1997
Revised Version: Long Form, DSM-IV Symptoms Scale)6 –17 MF 3.4 2.8, 4.0 Conners (1997) CTRS-R:L-DSM-IV Symptoms
(Conners Teacher Rating Scale—1997
Revised Version: Long Form, DSM-IVSymptoms Scale)6 –17 MF 3.7 3.2, 4.2 Breen (1989) SSQ-O-I
Barkley's School Situations Questionnaire-Original Version, Number of Problem Settings Scale6 –11 F 1.3 0.5, 2.2 Breen (1989) SSQ-O-II
Barkley's School Situations Questionnaire-Original Version, Mean Severity Scale6 –11 F 2.0 1.0, 2.9 Combined 2.9 2.2, 3.5 Taken from: Green M, Wong M, Atkins D, et al. Diagnosis of Attention Deficit/Hyperactivity Disorder. Technical Review 3.Rockville, MD: US Department of Health and Human Services, Agency for Health Care Policy and Research; 1999. AHCPR publication 99-0050
Study Behavior Rating Scale Age Gender Effect Size 95% Confidence Limits Achenbach (1991b) CBCL/4-18-R, Total Problem Scale
(Child Behavior Checklist for Ages 4–18, Parent Form)4–11 M 1.4 1.3, 1.5 Achenbach (1991b) Same as above 4–11 F 1.3 1.2, 1.4 Achenbach (1991c) CBCL/TRF-R, Total Problem Scale
(Child Behavior Checklist, Teacher Form)5–11 M 1.2 1.0, 1.4 Achenbach (1991c) Same as above 5–11 F 1.1 1.0, 1.3 Naglieri, LeBuffe, Pfeiffer (1994) DSMD-Total Scale
(Devereaux Scales of Mental Disorders)5–12 MF 1.0 0.8, 1.3 Conners (1997) CPRS-R:L-Global Problem Index
(1997 Revision of Conners Parent Rating Scale, Long Version)— MF 2.3 1.9, 2.6 Conners (1997) CTRS-R:L-Global Problem Index
(1997 Revision of Conners Teacher Rating Scale, Long Version)— MF 2.0 1.7, 2.3 Combined 1.5 1.2, 1.8 Taken from: Green M, Wong M, Atkins D, et al. Diagnosis of Attention Deficit/Hyperactivity Disorder. Technical Review 3.Rockville, MD: US Department of Health and Human Services, Agency for Health Care Policy and Research; 1999. AHCPR publication 99-0050.
Comorbid Disorder Estimated
Prevalence (%)Confidence
Limits for
Estimated
Prevalence (%)Oppositional defiant disorder 35.2 27.2, 43.8 Conduct disorder 25.7 12.8, 41.3 Anxiety disorder 25.8 17.6, 35.3 Depressive disorder 18.2 11.1, 26.6 Taken from: Green M, Wong M, Atkins D, et al. Diagnosis of Attention Deficit/Hyperactivity Disorder. Technical Review 3.Rockville, MD: US Dept of Health and Human Services. Agency for Health Care Policy and Research; 1999. AHCPR publication 99-0050
In this issue
Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder
Jump to section
Related Articles
Cited By...
- ADHD Diagnosis and Treatment Guidelines: A Historical Perspective
- Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology
- Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis
- Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions
- Variability in ADHD Care in Community-Based Pediatrics
- Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial
- Use of a Computerized Decision Aid for ADHD Diagnosis: A Randomized Controlled Trial
- Poverty, maltreatment and attention deficit hyperactivity disorder
- Clinical Practice Pathways for Evaluation and Medication Choice for Attention-Deficit/Hyperactivity Disorder Symptoms in Autism Spectrum Disorders
- Use of an Internet Portal to Improve Community-Based Pediatric ADHD Care: A Cluster Randomized Trial
- ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
- Written-Language Disorder Among Children With and Without ADHD in a Population-Based Birth Cohort
- Computer-Assisted Management of Attention-Deficit/Hyperactivity Disorder
- Learning Disabilities, Dyslexia, and Vision
- Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007
- Contrasting Parents' and Pediatricians' Perspectives on Shared Decision-Making in ADHD
- Clinical Utility of the Vanderbilt ADHD Rating Scale for Ruling Out Comorbid Learning Disorders
- Gender, Attention-Deficit/Hyperactivity Disorder, and Reading Disability in a Population-Based Birth Cohort
- Electronic Health Record Decision Support and Quality of Care for Children With ADHD
- Enhancing Pediatric Mental Health Care: Strategies for Preparing a Primary Care Practice
- Enhancing Pediatric Mental Health Care: Algorithms for Primary Care
- Taking the stress out of individualizing ADHD drug therapy
- The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care
- Attention-Deficit/Hyperactivity Disorder: How Much Responsibility Are Pediatricians Taking?
- Reexamining the Emperor's New Clothes: Ambiguities in Current Cardiac Screening Recommendations for Youth With Attention Deficit Hyperactivity Disorder
- Cardiovascular Monitoring and Stimulant Drugs for Attention-Deficit/Hyperactivity Disorder
- Does Connection to Primary Care Matter for Children With Attention-Deficit/Hyperactivity Disorder?
- Community-wide Intervention to Improve the Attention-Deficit/Hyperactivity Disorder Assessment and Treatment Practices of Community Physicians
- Psychiatric Disorders in Children and Adolescents Who Have Epilepsy
- Hematologic and Blood Biochemistry Monitoring During Methylphenidate Treatment in Children With Attention-Deficit/Hyperactivity Disorder: 2-Year, Open-Label Study Results
- Methylphenidate may improve symptoms but does not increase response compared with placebo in preschool children with ADHD
- ADHD's toll: Research papers at AAP conference paint a picture of the disorder's debilitating social, educational and financial challenges
- Stimulant-Drug Therapy for Attention-Deficit Disorder (With or Without Hyperactivity) and Sudden Cardiac Death
- An Evaluation of the Cytochrome P450 Inhibition Potential of Lisdexamfetamine in Human Liver Microsomes
- Gestational age, birth weight, and the risk of hyperkinetic disorder
- Who Receives a Diagnosis of Attention-Deficit/ Hyperactivity Disorder in the United States Elementary School Population?
- FDA panel recommends black box warning on ADHD stimulant medications
- Acceptability of a Web-based Attention-deficit/Hyperactivity Disorder Scale (T-SKAMP) by Teachers: A Pilot Study
- Scope of Health Care Benefits for Children From Birth Through Age 21
- Effect of methylphenidate formulation on treatment patterns and use of emergency room services
- Efficacy and Safety of Modafinil Film-Coated Tablets in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Results of a Randomized, Double-Blind, Placebo-Controlled, Flexible-Dose Study
- Effectiveness of Iron Supplementation in a Young Child With Attention-Deficit/Hyperactivity Disorder
- Worse Quality of Life for Children With Newly Diagnosed Attention-Deficit/Hyperactivity Disorder, Compared With Asthmatic and Healthy Children
- Smoking During Pregnancy and the Risk for Hyperkinetic Disorder in Offspring
- ASHP Therapeutic Position Statement on the Appropriate Use of Medications in the Treatment of Attention-Deficit/Hyperactivity Disorder in Pediatric Patients
- Treatment of Attention-Deficit/Hyperactivity Disorder: Overview of the Evidence
- The Assessment of Attention-Deficit/Hyperactivity Disorder in Rural Primary Care: The Portability of the American Academy of Pediatrics Guidelines to the "Real World"
- A Process for Developing Community Consensus Regarding the Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder
- Attention-Deficit/Hyperactivity Disorder: The Diagnostic Process From Different Perspectives
- Health-Related Quality of Life in Children and Adolescents Who Have a Diagnosis of Attention-Deficit/Hyperactivity Disorder
- An 8-Year-Old Boy With School Difficulties and "Odd Behavior"
- Implementing the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder Diagnostic Guidelines in Primary Care Settings
- Use of Practice Guidelines in the Primary Care of Children With Attention-Deficit/Hyperactivity Disorder
- Early Television Exposure and Subsequent Attentional Problems in Children
- Snoring
- Diagnosis and Treatment of ADHD in School-age Children in Primary Care Settings: A Synopsis of the AAP Practice Guidelines
- Sleep and Neurobehavioral Characteristics of 5- to 7-Year-Old Children With Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder
- A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study of SLI381 (Adderall XR) in Children With Attention-Deficit/Hyperactivity Disorder
- Getting your arms around ADHD: New tools help pediatricians implement Academy's recent diagnostic guidelines
- How to Diagnose and Treat ADHD: New AAP Guidelines
- Service innovations: attention-deficit hyperactivity disorder -- development of a multi-professional integrated care pathway
- Quality in Pediatrics: A Progress Report for the American Academy of Pediatrics
- How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis
- The New Morbidity: Where the Rubber Hits the Road or the Practitioner's Guide to the New Morbidity
- Atomoxetine in the Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: A Randomized, Placebo-Controlled, Dose-Response Study
- The New Morbidity Revisited: A Renewed Commitment to the Psychosocial Aspects of Pediatric Care
- Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder
- Guideline: Treat ADHD as a chronic disease : AAP issues evidence-based recommendations
- Managing Stimulant Medication for Attention-deficit/Hyperactivity Disorder
- Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder
- Prevalence and Assessment of Attention-Deficit/Hyperactivity Disorder in Primary Care Settings
- Ritalin Poisoning
- Questioning the Treatment for ADHD
- Placebo-Controlled Evaluation of Amphetamine Mixture{---}Dextroamphetamine Salts and Amphetamine Salts (Adderall): Efficacy Rate and Side Effects
- ADHD: New Practice Guidelines
- ADHD: A new practice guideline from the American Academy of Pediatrics
- ADHD: New Practice Guidelines