Bradley Expert: New National Guidelines for ADHD
Wednesday, October 19, 2011
What will the new regulations mean for RI kids?
This represents a substantial shift from AAP's previous guidelines, which targeted children between the ages of 6 and 12. According to the AAP's report, increasing evidence suggests that ADHD can be diagosed and treated as early as the age of 4 and as late as the age of 18.
Will broadening the age group for evaluation create overdiagnosis and overmedication? GoLocalProv spoke to Dan Dickstein, MD, director of the PEDI-MIND program at Bradley Hospital about the change.
How many Rhode Island children are diagnosed with ADHD?
The 2007 Centers for Disease Control (CDC) National Survey of Children's Health showed that 11.1% of RI children ages 4-17 were ever diagnosed with ADHD. The range across the US is from 5-15%.
What's the wisdom of extending the age range? What is gained? What are potential pitfalls?
Several features of the American Academy of Pediatrics (AAP)'s recently issued ADHD guidelines are "new". First, they have revised the earliest age at which ADHD should be considered possible. In the past, it was age 6; now it is age 4 years.
The AAP says that this change is based on research showing that ADHD (which has 3 subtypes--ADHD with hyperactivity, ADHD with inattention, and ADHD with both hyperactivity and inattention) can be accurately diagnosed in kids as young as 4.
The advantage is that by making the diagnosis earlier, treatment can start earlier, thus reducing the impairment associated with ADHD. The potential pitfall is that more kids may get diagnosed with ADHD when something else is going on.
How will this affect the practice of physicians here in Rhode Island?
It is hard to say how this will affect the practice of physicians in Rhode Island. Figuring out if a kid has ADHD requires a combination of great skill, great experience, and sufficient time to determine if the child's concerning behavior is ADHD or not. That includes the need to figure out if the concerning behaviors are just normal development, OR are another psychiatric problem (such as a specific learning disability--math, writing, or reading problem) OR are another psychiatric disorder (depression).
Besides information provided by parents during their visit, primary medical doctors (PMDs) may use rating forms completed by parents and teachers. Many of these have norms/cut-offs that go down to the new ADHD cut-off of 4 years old.
One big concern would be that these new recommendations will result in kids under 6 getting starting on ADHD medications. However, the AAP recommendations suggest that children ages 4-6 with ADHD should start first with behavioral treatments, rather than starting medications first. So, hopefully this will not result in too many children under 6 years old starting with ADHD medications right off the bat.
All in all, I think these new recommendations may help some kids get help sooner, but will require care to implement.
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