Attention-deficit/hyperactivity disorder: evidence-based diagnosis and management for primary care clinicians.

Attention-deficit/hyperactivity disorder (ADHD) is a disorder characterized by persistent hyperactivity, impulsivity and inattention that impairs educational achievement and/or social development. Families seek an evaluation for children with these behaviors due to the high prevalence of ADHD and potential personal, social, and economic burdens. This review covers the current state of knowledge regarding the epidemiology, etiology, diagnosis, treatment, and prognosis for ADHD. It concludes with recommendations for future research.

The child with ADHD: using the AAP Clinical Practice Guideline. American Academy of Pediatrics.

The American Academy of Pediatrics developed an evidence-based clinical practice guideline that provides recommendations for the assessment and diagnosis of school-aged children with attention-deficit/hyperactivity disorder (ADHD). This guideline, the first of two guidelines to provide recommendations on this condition, is intended for use by primary care clinicians. The second set of guidelines will address the treatment of children with ADHD. The guideline contains six recommendations for the diagnosis of ADHD: (1) in a child six to 12 years of age who presents with inattention, hyperactivity, impulsivity, academic underachievement or behavior problems, primary care clinicians should initiate an evaluation for ADHD; (2) the diagnosis of ADHD requires that a child meet the criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders; (3) the assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms and degree of functional impairment; (4) the assessment of ADHD also requires evidence directly obtained from a teacher (or other school professional) regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment and associated conditions; (5) evaluation of the child with ADHD should include assessment for coexisting conditions; and (6) other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD but may be used for the assessment of coexisting conditions.

Beyond infant colic.

Some of the most interesting cases in pediatric practice evolve through time. What may begin as a clear, well defined problem with a predictable natural history and an accepted intervention strategy may develop into a more complex, multi-faceted set of problems. It is these children who potentially provide clinicians with new insights into behaviors. This case of a colicky infant illustrates the wide spectrum of behavioral and physiological symptoms that emerge from a specific underlying behavioral phenomenon. It also emphasizes the significant benefit derived from a longitudinal perspective of developmental events.