Pediatrics academy issues first ADHD guidelines

CHICAGO - The American Academy of Pediatrics on Monday issued its first guidelines for diagnosing attention deficit/hyperactivity disorder, hoping to prevent merely rambunctious youngsters from being overmedicated while ensuring other children get the help they need.

Recent research shows dramatic increases in the use of drugs like Ritalin to treat children with ADHD, suggesting the disorder is either becoming more common or is being overdiagnosed. Many experts worry that some doctors and parents are treating typical childhood misbehavior as an illness.

The academy, the nation's largest group of pediatricians, said it is unclear whether the disorder is being overdiagnosed, because there are such wide variations nationwide in how doctors define and treat it.

The academy said it believes the new guidelines will standardize the diagnosis and make it easier to identify which children really need help. Guidelines for treating ADHD are still being developed.

''We'd like to help us all (diagnose) more accurately,'' said Dr. James M. Perrin, an author of the guidelines and an associate professor of pediatrics at Harvard Medical School.

Between 4 percent and 12 percent of school-age children - or as many as 3.8 million youngsters, most of them boys - are believed to have ADHD. Symptoms include short attention span, impulsive behavior, and difficulty focusing and sitting still.

Ritalin is often prescribed to increase a child's alertness. But many experts have pointed out that its long-term effects on children are unknown.

For a diagnosis of ADHD under the new guidelines, a child must exhibit symptoms in at least two settings, such as at home and at school. The symptoms must harm the child's academic or social functioning for at least six months.

The guidelines are for children 6 through 12. Most ADHD research has involved that age group, and the academy also said it recognizes that some symptoms can be chalked up to normal rambunctiousness and contrariness in preschoolers.

This is the first time the academy has drawn up guidelines for a behavioral ailment. The academy began developing them three years ago, said Dr. Martin T. Stein, co-author and a pediatrics professor at the University of California at San Diego.

The guidelines also suggest that pediatricians and family doctors take a leading role in addressing the disorder, with information about the child's behavior from parents and teachers. Doctors also should use criteria from the American Psychiatric Association's diagnostic manual of mental disorders.

Involving pediatricians in the diagnosis of ADHD is ''really exciting because they're seeing these kids more than child psychiatrists,'' said Dr. Karen Pierce, a child psychiatrist in Chicago who helped develop the standards. ''It will add a new dimension and actually be able to help a lot more kids.''

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