The American Academy of Pediatrics released guidelines last week for treating children with attention deficit hyperactivity disorder, emphasizing that behavioral therapies should be used alongside medication.
Its guidance is part of an effort to help pediatricians and other doctors properly diagnose and treat ADHD, a complicated and often misunderstood condition.
Following up on recommendations the academy released last year for identifying ADHD symptoms, the document urges doctors to work with educators to help craft a comprehensive, long-term plan for each child for managing the condition. The article was published in this month’s issue of Pediatrics, the peer-reviewed journal of the academy.
ADHD has become one of the most commonly diagnosed conditions seen in schoolchildren. It affects between 4 percent and 12 percent of the school-age population, according to AAP estimates. Three times more boys than girls are diagnosed with the disorder.
Symptoms include difficulties in controlling behavior in school and social settings. Those symptoms range from mild problems to those severe enough to qualify as a disability. As a result, many schools have seen increasing enrollments and budgets for special education.
The report, written by eight pediatricians who serve on the academy’s subcommittee on ADHD, notes that educators are essential to successful implementation of behavioral therapies and monitoring of the effects of stimulant medications used in treatment.
“Ongoing communication with parents, teachers, and other school- based professionals is necessary to monitor the progress and effectiveness of specific interventions,” the doctors wrote.
In an interview, Dr. James M. Perrin, a co-chairman of the panel, said the academy has received an increasing number of requests from other doctors and school officials for more information on ADHD. But while his panel recommends regular communication with school officials, that can sometimes be difficult to schedule.
“There’s been a lot of frustration,” Dr. Perrin said. “Teachers feel it’s hard to get the information they need from physicians.”
He recommends that a teacher speak with a student’s parents to get information, and that the teacher ask for permission to get in touch with the student’s physician. Because of teachers’ and doctors’ busy schedules, written notes sometimes are the best approach, he said.
Doctors and Teachers
Lynda Van Kuren, the spokeswoman for the Council for Exceptional Children, a Reston, Va.-based group for special educators, praised the report’s emphasis on communication, which she agreed traditionally has been a problem for teachers.
“We should educate parents and children about the ways ADHD can affect them, both academically and socially,” she said. Furthermore, she said, physicians, parents, and school officials should ensure that the proper behavioral therapies are being consistently applied both in school and at home.
Other experts, such as psychologists and neurologists, may need to be called on to evaluate a child’s needs, and the parents should also inform the family’s physician of changes in the child’s behavior outside of school, according to the report.
The guidelines, which are based on extensive reviews of available medical, psychological, and educational literature on ADHD, are designed for the treatment of children ages 6 to 12. They include:
•Doctors should consider ADHD a chronic condition when establishing a treatment program, and should set up systems to monitor the effects of the treatments and changes in behavior over a long period.
•The physician, parents, and child should work with school officials to set goals for behavior management, taking into consideration the child’s academic performance in school and any problems interacting with classmates.
•If needed, the physician should recommend behavioral therapy and medication for specific ADHD symptoms.
•The physician should regularly monitor the child’s goals, using information from parents, teachers, and the child to determine future treatments and outcomes.
•If the child’s goals are not met, the physician should re-evaluate the diagnosis and treatments, and check for any coexisting conditions, such as learning disabilities.
FOLLOW-UP: More information about the project is available on the group’s Web site at http://www.aap.org/policy/s0120.html.