Following systematic literature reviews and expert opinion, the Canadian Paediatric Society has developed three position statements on ADHD in children and adolescents. The objectives of these position statements are threefold: (i) to provide a summary of the current clinical ADHD evidence base; (ii) to establish a standard for ADHD care; and (iii) to facilitate clinicians in making well-informed, evidence-based decisions to promote optimal management of ADHD in children and adolescents.
Position statement 1 – ADHD in children and youth: aetiology, diagnosis and comorbidity
In the first position statement, the symptoms, features and impairments associated with ADHD are first discussed, with focus on the highly heritable nature of the condition and the role of neurological, environmental and psychosocial factors in maintaining and worsening any associated impairments.
Furthermore, practical advice is also provided to facilitate optimal assessment procedures and clinical diagnosis, including the following practice points (Bélanger et al. 2018):
- Schedule several office visits to complete diagnostic evaluation
- Obtain information regarding prenatal and perinatal events
- Obtain developmental/behavioural history
- Evaluate family medical and mental health
- Evaluate for comorbid psychiatric, neurodevelopmental and physical disorders
- Review academic progress
- Obtain any standardised behaviour rating scale that evaluates Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5TM) from primary caregivers, teachers and the adolescent being assessed.
Position statement 2 – ADHD in children and youth: treatment
In the second position statement, the authors provide a summary of the evidence-based treatments for ADHD, with a focus on patient and parent choice (Feldman et al. 2018):
- Non-pharmacological treatment: often used as adjunct treatment options for symptoms not amenable to treatment. Current guidelines recommend the use of behaviour therapy over the use of medication in pre-school–aged children with ADHD. Despite this, the authors stated that further research is necessary into the long-term clinical effectiveness of non-pharmacological interventions, both as stand-alone interventions and in combination with medication.
- Pharmacological treatment: both stimulant and non-stimulant medications play an important role in the ADHD multimodal treatment approach. Psychostimulant medications are considered most effective, while non-stimulants represent an alternative option to manage clinically significant ADHD symptoms.
Position statement 3 – ADHD in children and youth: assessment and treatment with autism spectrum disorder (ASD), intellectual disability or prematurity
In the third position statement, the authors discussed how ADHD demonstrates clinical and genetic overlap with other childhood neurodevelopmental disorders, including ASD, intellectual disability and prematurity (Clark and Bélanger 2018). Although there is an increase in the prevalence of these populations, the authors expressed the opinion that there is a need for long-term follow-up studies on the safety and efficacy of medications in children or adolescents with ADHD and ASD, those with intellectual disability or those born premature. Furthermore, it is important that clinicians are aware of high comorbidity and assess for ADHD symptoms in children and adolescents with these conditions. To ensure these objectives are met, training programmes for paediatricians and family physicians must incorporate behavioural, developmental and mental health training, including ADHD diagnosis and treatment.
Bélanger SA. Canadian Paediatric Society clinical practice recommendations for children and adolescents with attention-deficit hyperactivity disorder. Paediatr Child Health 2018; 23: 431-432.
Bélanger SA, Andrews D, Gray C, et al. ADHD in children and youth: Part 1 – Etiology, diagnosis, and comorbidity. Paediatr Child Health 2018; 23: 447-453.
Clark B, Bélanger SA. ADHD in children and youth: Part 3 – Assessment and treatment with comorbid ASD, ID or prematurity. Paediatr Child Health 2018; 23: 485-490.
Feldman ME, Charach A, Bélanger SA. ADHD in children and youth: Part 2 – Treatment. Paediatr Child Health 2018; 23: 462-472.