New guidelines for ADHD to help improve effective diagnosis and treatment

In July, the Journal for the American Academy of Child and Adolescent Psychiatry released a comprehensive document discussing almost every aspect of attention-deficit/hyperactivity disorder (ADHD). Taking information from over 5,000 articles and summarising them in one place, it provides guidelines for doctors that can be incredibly useful in keeping up-to-date with what the research says is the best way of evaluating and treating ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a very common childhood psychiatric condition. While it may surprise some people, due to the high amount of negative media coverage the condition receives, ADHD is actually very heavily researched and there is much more evidence for it than many other medical conditions. So much evidence in fact, that finding the best way to evaluate and treat patients with ADHD can sometimes become confusing for doctors.

To remedy this, the American Academy of Child and Adolescent Psychiatry recently released some ‘practice parameters’ on the issue of ADHD treatment. These parameters take all the available evidence (in this case around 5,000 articles from medical journals) and pool the information together to work out how doctors can best assess and treat the condition. This helps doctors provide the best possible care for their patients without having to spend their entire lives digging through the 5,000 articles themselves.

These parameters also contain the most up-to-date information about ADHD. It contains lots of statistics about how many people in different parts of the world suffer with the condition, what other problems often happen at the same time as ADHD, the theories about what the underlying cause might be as well as the most recent advances in treatment.

Following this information, the Academy produced 13 recommendations regarding ADHD. Among them are:

• That a screening for ADHD should be done on every patient, as part of their mental health assessment.
• If a child or adolescent is diagnosed with ADHD, it is important to look closely for the presence of other psychiatric disorders that often occur at the same time.
• The initial drug treatment should be with either, dexamphetamine, methylphenidate (eg Concerta) or atomoxetine (Strattera).
• If the initial type of medication does not work, then using other medications such as antidepressants can also help.
• Patients should be very closely monitored for side-effects when on medications so that they can be kept to an absolute minimum.
• Frequent assessment should be done to see whether or not there is still a need for treatment or if the symptoms have stopped. Treatment should continue for as long as the symptoms are present.

Along with these recommendations are large tables of information showing just how effective different medications are. Comparisons are made between the medications, showing which ones may have benefits over others.

Discussion is also made of various side-effects of drug treatment: for example it seems that the use of stimulant medications does not increase aggression. The above examples are just tiny snippets in what is a very detailed article, and it covers almost every aspect of the condition.

This article can be an invaluable tool for any doctor who is in charge of treating patients with ADHD, as it summarises all the latest information about the best ways of evaluating and treating it. It is hoped that by providing such a compact assessment of all the piles of evidence that are available regarding ADHD, doctors will be able to provide the absolutely best care for all of their patients leading to a better treatment and improved quality of life for the sufferers of ADHD and their families.

Reference:

1. Pliszka, S et al. ‘Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder’. Journal of the American Academy of Child and Adolescent Psychiatry, 2007;46(7).