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Overview of the treatment and prognosis of attention deficit hyperactivity disorder in children and adolescents

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a disorder that manifests in early childhood with symptoms of hyperactivity, impulsivity, and/or inattention. The symptoms affect cognitive, academic, behavioral, emotional, and social functioning [1-3]. Prevalence and natural history data suggest that one- to two-thirds of the 3 to 10 percent of children diagnosed with ADHD (somewhere between 1 and 6 percent of the general population) continue to manifest appreciable ADHD symptoms into adult life [4]. (See "Adult attention deficit hyperactivity disorder".)

This topic will provide an overview of the treatment and prognosis of ADHD in children. The evaluation and diagnosis of ADHD in children and the pharmacotherapy for ADHD in children are discussed separately. (See "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and evaluation" and "Attention deficit hyperactivity disorder in children and adolescents: Pharmacotherapy".)

OVERVIEW

Treatment for ADHD may involve medication, behavioral/psychologic interventions, or educational interventions, alone or in combination. Decisions regarding the choice of therapy should involve the patient and his or her parents, who, in conjunction with the treating clinician, must weigh the risks and benefits to determine their preferred management strategy. Some authors advocate a trial of behavioral interventions before medical therapy is initiated [5,6]. Others recommend a multimodal approach including medication, counseling, and behavioral management, particularly for children with comorbid conditions [7,8]. (See "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and evaluation".)

The American Academy of Pediatrics (AAP), American Medical Association (AMA), and American Academy of Child and Adolescent Psychiatry (AACAP) have established guidelines or practice parameters for the evaluation and management of children with ADHD [1,6,9-11]. The guidelines recommend a management approach (pharmacotherapy and/or behavior therapy) that is designed to improve target symptoms and takes into account individual circumstances and family preferences [6,9-11].

The National Initiative for Children's Healthcare Quality (NICHQ) has developed a toolkit for primary care practitioners to assist in the evaluation and management of children with ADHD according to the AAP guidelines (www.nichq.org/adhd.html). The toolkit includes information for parents, copies of ADHD-specific questionnaires for parents and teachers, sample management plans, and guidelines for establishing a daily report card.

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Last literature review version 18.2: May 2010
This topic last updated: May 22, 2010
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