Time pressures prevent me from keeping up to date with current guidelines
Several international guidelines and consensus statements for the treatment of attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), are available:
- The Canadian ADHD Resource Alliance (CADDRA) Canadian ADHD Practice Guidelines (CAP-Guidelines)1
- Global Consensus on ADHD/HKD2
- American Academy of Pediatrics3
- American Academy of Child and Adolescent Psychiatry.4
CADDRA Canadian ADHD Practice Guidelines
The CADDRA guidelines base recommendations for the management of children, adolescents and adults with ADHD on five core principles that aim to deliver holistic care. These principles are as follows:1
CADDRA Canadian ADHD Practice Guidelines
It is emphasised that during childhood, a multimodal treatment approach should be implemented that addresses all social, emotional, behavioural and academic issues, as well as any challenges in the home.1
This level of support is recommended to continue through adolescence and into adulthood, where different challenges or stressors may be presented.1
Global Consensus on ADHD/HKD
The Global Consensus on ADHD/HKD Statement was developed by an international team of ADHD clinicians and researchers, and is aimed at children and adolescents with the disorder.2
The Consensus Statement comprises multiple treatment algorithms, for ADHD without comorbidity and for ADHD with common comorbidities.2
In the treatment algorithm for ADHD without comorbidities:2
- The first step is psychoeducation for the child or adolescent with ADHD, their families and their teachers2
- The initial treatment decision is based upon the age of the individual with ADHD – for those aged less than 6 years, psychosocial interventions and parent training to support them in managing their child should be implemented; if these interventions have not been successful, then it is recommended that the child be referred to a specialist2
- For individuals with ADHD aged greater than 6 years, the decision as to whether they receive non-pharmacological treatment alone, or in combination with medication, or medication alone, must take into account the severity of the ADHD symptoms, as well as the opinion of the parents or carers2
- If and/or when medication is trialled, stimulants are recommended to be first-line, and should be titrated to allow full-day coverage; if impairment still persists, options to consider include changing to a different stimulant, or trialling a non-stimulant, perhaps in combination with psychosocial therapy2
- If impairment continues to persist, or medication yields intolerable side effects, specialist referral may be necessary.2
American Academy of Pediatrics (AAP) clinical practice guideline
An AAP subcommittee on ADHD, consisting of primary care and developmental-behavioural paediatricians and other experts published updated practice guidelines for the diagnosis and treatment of children and adolescents with ADHD in 2011.3
Treatment recommendations (children aged 6‒11 years/adolescents aged 12‒18 years):3
- Food and Drug Administration-approved medications and/or behavioural therapy (preferably both)
- Dose titration of medication required to achieve maximum benefit with minimum adverse effects.
- Treatment team should include everyone involved in the care of the child/adolescent: parents, primary care clinicians, therapists, other adults (e.g. coaches, school guidance counsellors or leaders of community activities) actively engaged in supporting and monitoring treatment.
American Academy of Child and Adolescent Psychiatry (AACAP) practice parameters4
AACAP treatment recommendations are based on empirical evidence and clinical consensus:4
- Treatment plan should include parental and child psychoeducation about ADHD and treatment options
- Treatment may consist of pharmacological and/or behavioural therapy
- Behavioural therapy may be recommended as initial treatment if the ADHD symptoms are mild with minimal impairment
- Pharmacological agent should be the choice of the family and clinician; each patient’s treatment must be individualised.
- Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Toronto: CADDRA, 2011.
- Remschmidt H. Global consensus on ADHD/HKD. Eur Child Adolesc Psychiatry 2005; 14: 127-137.
- Wolraich M, Brown L, Brown RT, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128: 1007-1022.
- Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46: 894-921.