KAS 1: The pediatrician or other PCC should initiate an evaluation for ADHD for any child or adolescent age 4 years to the 18th birthday who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. (Grade B: strong recommendation.)

Aggregate evidence qualityGrade B
BenefitsADHD goes undiagnosed in a considerable number of children and adolescents. Primary care clinicians’ more-rigorous identification of children with these problems is likely to decrease the rate of undiagnosed and untreated ADHD in children and adolescents.
Risks, harm, costChildren and adolescents in whom ADHD is inappropriately diagnosed may be labeled inappropriately, or another condition may be missed, and they may receive treatments that will not benefit them.
Benefit-harm assessmentThe high prevalence of ADHD and limited mental health resources require primary care pediatricians and other PCCs to play a significant role in the care of patients with ADHD and assist them to receive appropriate diagnosis and treatment. Treatments available have good evidence of efficacy, and a lack of treatment has the risk of impaired outcomes.
Intentional vaguenessThere are limits between what a PCC can address and what should be referred to a subspecialist because of varying degrees of skills and comfort levels present among the former.
Role of patient preferencesSuccess with treatment is dependent on patient and family preference, which need to be taken into account.
StrengthStrong recommendation.
Key referencesWolraich et al31; Visser et al28; Thomas et al8; Egger et al30