Drop age of ADHD evaluation to four
Children younger than six-years-old are diagnosable and treatable for ADHD.
 A group of doctors is recommending that children as young as four be included in evaluation for ADHD, dropping the age previously used as the testing threshold by two years.

The American Academy of Pediatrics this weekend expanded its guidelines for diagnosing and treating kids with attention-deficit hyperactivity disorder, recommending that doctors evaluate all patients age four to 18 that show signs of the condition, according to Reuters.

The new guidelines update decade-old recommendations that focused on diagnosing and managing ADHD in kids age six to 12. But behavior problems, overactivity and trouble paying attention can show up earlier, researchers said, and ADHD often persists into adolescence or even adulthood.

Pediatricians should also look out for learning disabilities, anxiety and other issues that can go hand-in-hand with ADHD. And, they should tailor treatment with behavior therapy and medication based on kids' age and severity of symptoms, says a statement published in Pediatrics.

According to data from the Centers for Disease Control and Prevention, between six and nine percent of kids and teens have ADHD, with rates higher in adolescents than younger kids.
If kids are diagnosed with ADHD, those adults will also play an important role in treatment strategies, especially in young kids.

To treat four- and five-year olds, the authors recommend that parents are trained in techniques to help manage kids' behavior, including positive reinforcement and ignoring or punishing certain behaviors, when necessary. Only when that doesn't work, and moderate or severe ADHD persists, should young kids be put on medication.

J. Russell Ramsay, who studies ADHD at the University of Pennsylvania's Perelman School of Medicine, said that many young kids are overactive or have trouble focusing at times, but that for ADHD to be diagnosed, that behavior must "cause life impairments" in multiple environments - at home, at school and in relationships with peers.

In school-aged kids, teachers or parents can give kids behavior therapy using similar strategies as in preschoolers. Some may need special education plans, including less homework if it takes them a long time to complete, Ramsay said.

Stimulant medications such as Vyvanse, Ritalin and Concerta have also been shown to be effective alone or alongside therapy in this age group.

Those drugs may have side effects, the report notes, including appetite loss, sleep problems and stomach pain. Youngsters with some signs of ADHD, but not a full diagnosis, shouldn't be medicated.
Some of the guideline authors report consulting for companies that sell ADHD medications in the paper's conflict of interest section.

"Medication certainly has a stronger effect on the core behavior symptoms of ADHD, but it's a matter of what the family's preference is (and) what services are available for them," said Dr. Mark Wolraich of the University of Oklahoma Health Sciences Center, the guidelines' lead author.

"Where at all possible for school-aged kids and adolescents, trying to implement both (medication and therapy) is probably going to be most effective."

Medication and individual behavior therapy are recommended for teens with ADHD. The authors emphasize that doctors need to keep their eyes open for any signs of drug or alcohol abuse in this group - and if those problems exist, they should be a treatment priority.

Ramsay, who was not part of the guidelines committee, added that car accidents, unplanned pregnancy and sexually transmitted infections are all more common in teens with ADHD than without.
Finally, because ADHD can persist for so long, the guidelines point out that communication between families, schools and doctors over the long run will be necessary to help manage the condition.

At what age was your child  diagnosed with ADHD?

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