New clinical guidelines call strongly for providing psychosocial supports for children and adolescents with complex attention-deficit/hyperactivity disorder (ADHD). Developed by the Society for Developmental and Behavioral Pediatrics (SDBP) , the guideline provides a framework for diagnosing and treating complex ADHD in these age groups. Its recommendations complement existing ADHD guidelines from the American Academy of Pediatrics (AAP) . The new guideline is published in a supplemental issue of SDBP's Journal of Developmental and Behavioral Pediatrics .
"The time has come for us to take a determined step forward to improve the care and outcomes for people affected by ADHD," says William Barbaresi, MD , chief of the Division of Developmental Medicine at Boston Children's Hospital and chair of the SDBP Complex ADHD Guidance Panel. "ADHD is not just an annoying childhood behavior problem. It is a neurodevelopmental disorder that can have lifelong impact in key areas including mental health, educational and vocational outcomes, and relationships."
Approximately 7.5 percent of children and adolescents in the U.S. have ADHD, and about two-thirds of them have one or more co-existing conditions such as learning disorders or mental health problems.
Complex ADHD is characterized by the presence of other conditions along with ADHD. These can include moderate to severe learning disabilities; intellectual disability; anxiety, depression, and other mental health problems; poor responses to treatment; and initial diagnosis of ADHD before age 4 or after age 12.
The new guideline focuses on identifying and treating more than 'typical' core ADHD symptoms. It breaks new ground by recommending psychosocial treatment as an essential foundation for treatment of children and teens with ADHD, in addition to medications.
"Treatment for children and adolescents with complex ADHD should focus on improvement in function -- behaviorally, socially, academically -- over the patient's life, not just improving ADHD symptoms," says Barbaresi.
Psychosocial interventions to improve function may include:
Five key action statements
The expert panel that developed the guideline found that the need for a dual approach -- psychosocial intervention and medications -- is supported by available research. "Psychosocial interventions are not consistently provided to patients in practice," says Barbaresi, who explains that the lack of psychosocial supports has largely been driven by a lack of availability.
"One challenge has been the absence of emphatic, evidence-based recommendations by a professional organization," he says. "This guideline is intended to provide those evidence-based recommendations."
Specifically, the guideline focuses on five key action statements:
The guideline includes one-page summary diagnostic and treatment flowcharts for:
Three-year review process
"The SDBP guideline is an important first step toward a more systematic approach to the diagnosis and treatment of children and adolescents with complex ADHD," says Barbaresi. "We believe it has great potential to improve the treatment and long-term outcomes for these patients."
The new SDBP guideline - the first-ever clinical practice guideline from the group - complements existing ADHD practice guidelines from the AAP, most recently updated in October 2019. It is intended to provide a framework for assessing and treating complex ADHD in children and adolescents by clinicians with specialized training.
The guideline was developed by an expert panel over three years, with panel members including developmental behavioral pediatricians, child psychologists, and a representative of CHADD, the national nonprofit family support organization for ADHD. The panel reviewed all previous ADHD treatment guidelines from the AAP and others, as well as a large body of published research related to each action statement.
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The guideline was developed with financial support by the SDBP.
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Journal of Developmental & Behavioral Pediatrics