Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic childhood disorders. Current estimates indicate that 4% to 12% of all school-aged children may be affected.
ADHD is a neurobehavioral disorder that usually appears in children before age seven.
Children with ADHD may have difficulty controlling their behavior in school and social settings and often fail to achieve their full academic potential.
Clinically, the child may present with varying symptoms of hyperactivity, impulsivity, and/or inattention. The child may be easily distracted, be unable to pay attention and follow directions, be overactive, and/or have poor self-control.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), characterizes the following 3 subtypes of ADHD:
- Inattentive only (ADHD-IA) (formerly known as attention-deficit disorder [ADD]) Children with this form of ADHD are not overly active.Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is most common. Approximately 30% to 40% of children with ADHD have this subtype.
- Hyperactive/Impulsive (ADHD-H/I) Children with this type of ADHD show hyperactive and impulsive behavior but can pay attention. This subtype accounts for a small percentage, approximately 10%, of children with ADHD.
- Combined Inattentive/Hyperactive/Impulsive ?Children with this type of ADHD show all 3 symptoms. This is the most common type of ADHD. The majority of children with ADHD have this subtype, approximately 50% to 60%.
The diagnosis of ADHD relies on the documentation of symptoms that are associated with functional impairment from multiple environments.
Because of this, school personnel, families, and primary care clinicians need to work collaboratively to document specific symptoms and their effect on a child's functioning. School personnel and families also need to be aware that there currently are no biological markers or computerized tests that allow for diagnostic specificity.
Once a diagnosis of ADHD has been made with confidence, the primary care clinician can approach the issue of treatment of the child with ADHD.This involves developing a management plan that incorporates the appropriate medication and/or behavior therapy to meet target outcomes. The care of most children with ADHD can be managed in a primary care setting.
The role of the primary care clinician is to:
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Synthesize and interpret information about a child?s behavior.
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Identify other medical or psychosocial problems that might be causing and/or exacerbating the child's symptoms.
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Refer for further evaluation where needed.
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Arrange other treatment (eg, educational, psychological) as needed.
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Provide appropriate medical treatment.
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Monitor progress.
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Support parents in their role as advocates for the child.
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