ADHD guidelines issued for children four and up

BOSTON (Newscore) - Attention deficit hyperactivity disorder can be diagnosed in children as young as age four, according to new treatment guidelines released Sunday by the American Academy of Pediatrics.

The guidelines, revealed at the academy's annual meeting in Boston, provide instructions for pediatricians on diagnosing and managing ADHD in children four to 18.

They say behavioral management techniques should be the first treatment approach for preschool age children. But they also suggest doctors consider prescribing methylphenidate, commonly known by the brand name Ritalin, in preschool age children with moderate to severe symptoms when behavior interventions do not provide significant improvement.

It is a potentially controversial recommendation, because these medicines are not approved by the Food and Drug Administration for use in that age group.

Many ADHD medications are approved for use in people six and older. The prior set of ADHD treatment guidelines from the academy, issued about a decade ago, gave recommendations for children six to 12. Along with preschool age children, the new recommendations also address teenagers who might not have been diagnosed at a younger age.

Once drugs are approved, the FDA does not regulate how doctors prescribe the medications, allowing them to prescribe them for uses beyond the FDA-approved label.

ADHD is the most common neurobehavioral disorder in children, occurring in about eight percent of children, according to the academy. The condition is often marked by the inability to focus or pay attention, hyperactivity and impulsive behavior. The behavior problems are so frequent they interfere with the ability to adequately function on a daily basis without treatment.

Mark Wolraich, the lead author of the ADHD clinical practice guidelines and a professor of pediatrics at the University of Oklahoma Health Sciences Center, said ADHD in a preschool age child was very different from the typically active behavior seen in most young children. A child with ADHD often does not play well with other children, is prone to accidents and is overactive much of the time.

To properly diagnose a child with ADHD, the guidelines said, the overactive, impulsive behavior needs to be seen consistently for four to six months in both the home and another environment, like school.

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