JavaScript has to be enabled to view this site. Learn how to enable JavaScript.

ICSI Icon

ADHD, Attention Deficit Hyperactivity Disorder in Primary Care for School-Age Children and Adolescents

Revision Date: March 2014
Tenth Edition

Endorsement Summary

ICSI has endorsed with qualifications the American Academy of Pediatrics (AAP's) guideline, ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, and Supplement. Both have been reviewed by the 2014 ICSI ADHD work group, utilizing the ICSI Endorsement Process: C. Dobie, W. Donald, K.Elhai, J. Hoffman-Jecha, J Huxsahl, R. Karasov, C. Kippes, C. Myers, J. Peters, L. Steiner, M. Wild Crea.  Additional work group information, including the members declared conflicts of interest.

Access this guideline and supplement through the links below:

American Academy of Pediatrics – ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

American Academy of Pediatrics – Implementing the Key Action Statements: An Algorithm and Explanation for Process of Care for the Evaluation, Diagnosis, Treatment, and Monitoring of ADHD in Children and Adolescents

The American Academy of Pediatrics (AAP) is not a sponsor of, affiliated with nor does it endorse ICSI or the ICSI ADHD work group.  AAP has not reviewed ICSI’s process for endorsement of guidelines.  The following ICSI endorsement and conclusions are solely the consensus of the ICSI ADHD work group using the ICSI Endorsement Process.

The ICSI ADHD work group fully endorsed the following AAP recommendations:

  1. The primary care clinician should initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity (Quality of Evidence: B/Strong Recommendation – as evaluated by the AAP).

  2. In the evaluation of a child for ADHD, the primary care clinician should include assessment for other conditions that might coexist with ADHD, including emotional or behavioral (e.g., anxiety, depressive, oppositional defiant, and conduct disorders), developmental (e.g., learning and language disorders or other neurodevelopmental disorders), and physical (e.g., tics, sleep apnea) conditions (Quality of Evidence: B/Strong Recommendation – as evaluated by the AAP).

  3. The primary care clinician should recognize ADHD as a chronic condition and, therefore, consider children and adolescents with ADHD as children and youth with special health care needs. Management of children and youth with special health care needs should follow the principles of the chronic care model and the medical home (Quality of Evidence: B/Strong Recommendation – as evaluated by the AAP).

  4. Recommendations for treatment of children and youth with ADHD vary depending on the patient’s age:

    a. For preschool-aged children (4-5 years of age), the primary care clinician should prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment (Quality of Evidence:A/Strong Recommendation – as evaluated by the AAP ) and may prescribe methylphenidate if the behavior interventions do not provide significant improvement and there is moderate to severe continuing disturbance in the child’s function. In areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment (Quality of Evidence: B/Recommendation – as evaluated by the AAP).

    b. For elementary school–aged children (6-11 years of age), the primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD (quality of evidence A/strong recommendation-as evaluated by the AAP) and/or evidence-based parent and/or teacher-administered behavior therapy as treatment for ADHD, preferably both (Quality of Evidence: B/Strong Recommendation – as evaluated by the AAP).  The evidence is particularly strong for stimulant medications and sufficient but less strong for atomoxetine, extended-release guanfacine, and extended-release clonidine (in that order) (Quality of Evidence: A/Strong Recommendation – as evaluated by the AAP).  The school environment, program, or placement is a part of any treatment plan.

    c. For adolescents (12-18 years of age), the primary care clinician should prescribe Food and Drug Administration–approved medications for ADHD with the assent of the adolescent (Quality of Evidence: A/Strong Recommendation – as evaluated by the AAP) and may prescribe behavior therapy as treatment for ADHD (Quality of Evidence: C/Recommendation – as evaluated by the AAP), preferably both.

  5. The primary care clinician should titrate doses of medication for ADHD to achieve maximum benefit with minimum adverse effects (Quality of Evidence: B/Strong Recommendation – as evaluated by the AAP).

THE ICSI ADHD WORK GROUP ENDORSED with qualifications THE FOLLOWING RECOMMENDATIONS:

  1. To make a diagnosis of ADHD, the primary care clinician should determine that Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition* criteria have been met (including documentation of impairment in more than one major setting); information should be obtained primarily from reports from parents or guardians, teachers, and other school and mental health clinicians involved in the child’s care. The primary care clinician should also rule out any alternative cause (Quality of Evidence: B/Strong Recommendation – as evaluated by the AAP.

* The work group recognized the new release of the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), and recommends that the primary care clinician should use the updated criteria.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for ADHD Statement