TABLE 7

KAS 5b: For elementary and middle school–aged children (age 6 years to the 12th birthday) with ADHD, the PCC should prescribe US Food and Drug Administration (FDA)–approved medications for ADHD, along with PTBM and/or behavioral classroom intervention (preferably both PTBM and behavioral classroom interventions). Educational interventions and individualized instructional supports, including school environment, class placement, instructional placement, and behavioral supports, are a necessary part of any treatment plan and often include an Individualized Education Program (IEP) or a rehabilitation plan (504 plan). (Grade A: strong recommendation for medications; grade A: strong recommendation for PTBM training and behavioral treatments for ADHD implemented with the family and school.)

Aggregate evidence qualityGrade A for Treatment with FDA-Approved Medications; Grade A for Training and Behavioral Treatments for ADHD With the Family and School.
BenefitsBoth behavioral therapy and FDA-approved medications have been shown to reduce behaviors associated with ADHD and to improve function.
Risks, harm, costBoth therapies increase the cost of care. Psychosocial therapy requires a high level of family and/or school involvement and may lead to increased family conflict, especially if treatment is not successfully completed. FDA-approved medications may have some adverse effects and discontinuation of medication is common among adolescents.
Benefit-harm assessmentGiven the risks of untreated ADHD, the benefits outweigh the risks.
Intentional vaguenessNone.
Role of patient preferencesFamily preference, including patient preference, is essential in determining the treatment plan and enhancing adherence.
ExclusionsNone.
StrengthStrong recommendation.
Key referencesEvans et al25; Barbaresi et al73; Jain et al103; Brown and Bishop104; Kambeitz et al105; Bruxel et al106; Kieling et al107; Froehlich et al108; Joensen et al109