Overview

Prevalence

Genetics

Prognosis

Practice Guidelines

Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W.
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
Pediatrics. 2019;144(4). PubMed abstract / Full Text

Roles of the Medical Home

• Monitor and update family knowledge and understanding of ADHD.
• Offer counseling to help support the family manage the child’s condition.
• Provide developmentally appropriate education for the child about ADHD and updates as the child grows.
• Be available to answer the family's questions.
• Ensure coordination of health and other services, including therapies, school-based services, and supporting transition to adult services when appropriate.
• Help families set specific goals in areas related to the child's condition and its effects on daily activities.
• When appropriate, connect families with other families who have children with similar chronic conditions.

Pearls & Alerts for Assessment

Children with inattentive presentation may go undiagnosed for longer than the hyperactive/impulsive presentation, presumably because the symptoms are less bothersome to others. Among girls, the inattentive type is more common and may present simply as poor school performance that worsens when higher-level problem solving is required, typically in upper elementary grades.

When family and teacher ratings of ADHD symptoms differ, additional sources, such as former teachers and coaches, may be helpful. Also, consider the setting: A teacher in a very structured classroom may not note symptoms easily observed in a less structured classroom or busy home. A child who expends a lot of effort to pay attention and behave appropriately at school may “fall apart” at home, resulting in more severe parent ratings.

Frequently re-evaluate to prevent under-treatment, monitor for side effects, and screen for comorbidities. [Wolraich: 2019]

The risk of serious cardiovascular events from stimulant and non-stimulant medications for ADHD is very low. The AAP does not recommend routine electrocardiogram or echocardiogram screening for heart disease prior to starting. Obtain additional evaluation if there are cardiac symptoms present or a concerning cardiac family history.

Children with autism may present with symptoms of ADHD during early elementary school, or earlier. If earlier, it may be difficult to differentiate from the autism symptoms. Children with autism spectrum disorder who present with significant hyperactivity, inattention, or impulsivity, despite adequate supports, should be evaluated for comorbid ADHD; 30-50% of children with ASD also suffer from ADHD symptoms. See Autism Spectrum Disorder for more about the diagnosis and treatment of ASD and comorbid conditions.

For the Condition

• Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) ( 1.1 MB): These 2002 versions are forms for initial and follow-up assessments for teacher and parent informants. Includes scoring instructions, no fee required.
• NICHQ Vanderbilt Assessment Scale - Parent Informant - Online Version (Spanish) ( 3.9 MB) and NICHQ Vanderbilt Assessment Follow-Up - Parent Informant - Online Version (Spanish) ( 3.6 MB): These 2002 forms, in Spanish (with English translation), are for assessing and quantifying the impact of attention problems at home. Includes scoring instructions, no fee required. Newer Vanderbilt scales are available for purchase at Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians, 3rd Ed. (AAP); however, the 2002 forms still meet the new diagnostic criteria and are standard of practice among pediatrician and child psychiatrists.
• Conners 3rd Edition: Administered to parents and teachers of children and adolescents 6–18 years old; self-report, 8–18 years old, and updated to align with DSM-5 diagnostic criteria for ADHD. According to [Wolraich: 2019], this tool also may be useful for preschoolers. Available for a fee.
• ADHD Rating Scale-5 for Children and Adolescents: Contains 14, 5-minute scales with child (ages 5-10) and adolescent versions for teachers and parents (English and Spanish). Updated to DSM-5 diagnostic criteria for ADHD, and includes normative data for preschoolers based on DSM-IV. Available for a fee.

For Complications

• Screen for Child Anxiety Related Disorders (SCARED) (University of Pittsburgh) ( 218 KB): Child self-assessment with 41 (brief) questions that have fill-in circles for possible answers. Contains scoring information, no fee required.
• Generalized Anxiety Disorder Scale (GAD-7): A 7-question screening tool about anxiety, completed by patient. General population screen, can be used in teens. Free at Patient Health Questionnaire (PHQ) Screeners (select screen from drop-down menu on right).
• Pediatric Symptom Checklist (PSC) and Youth Report (Y-PSC) ( 47 KB): Psychosocial screen to facilitate the recognition of cognitive, emotional, and behavioral problems. Includes a 35-item checklist for parents or youth to complete, and scoring instructions. No fee required.
• Patient Health Questionnaire-9 (PHQ-9): Nine-question depression screen with scoring information that can be used with adolescents. Questions are based on DSM-IV diagnostic criteria for major depressive disorder. Free at Patient Health Questionnaire (PHQ) Screeners (select screen from drop-down menu on right).
• Severity Measure for Depression - Ages 11–17 ( 228 KB): Adolescent-focused, 9-question, depression screen with scoring information. No fee required.
• Center for Epidemiological Studies Depression Scale for Children (CES-DC) ( 37 KB): Depression screening tool, with 20 questions, takes about 10 minutes to complete. No fee required.
• DSM-5 Parent-Rated Level 1 Symptom Measure—Age 6–17 (APA) ( 367 KB) and DSM-5 Self-Rated Level 1 Symptom Measure—Age 11–17 (APA) ( 250 KB): Free, 25-question assessments for initial patient interview and monitoring treatment progress. Includes scoring instructions.
• Achenbach System of Empirically Based Assessment (ASEBA): A variety of screening tools are available for a fee. (Child Behavior Checklist (CBCL))
• SEEK Parent Screening Questionnaire (PSQ-R): Parent questionnaire that screens for child maltreatment and toxic stress using 15 yes/no questions; free to download in English, Chinese, Spanish, and Vietnamese.
• Behavior Assessment System for Children, Third Edition (BASC-3): Assessment for children 2-21 years of age that takes about 15 minutes to complete; available for purchase.
• Car, Relax, Alone, Friends, Forget, Trouble (CRAFFT 2.1): A 6-question behavioral health screening tool recommended by the American Academy of Pediatrics' Committee on Substance Abuse to screen adolescents for high-risk alcohol and other drug use disorders. Available for free download in 13 languages.

Presentations

Diagnostic Criteria

ADHD and DSM-5 (APA) ( 259 KB)

1. Predominantly inattentive presentation: Six or more symptoms of inattention (listed below) for children up to age 16, or 5 or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
   • Fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
   • Has trouble holding attention on tasks or play activities
   • Does not seem to listen when spoken to directly
   • Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked)
   • Has trouble organizing tasks and activities
   • Avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period (such as schoolwork or homework)
   • Loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
   • Is easily distracted
   • Is forgetful in daily activities
2. Predominantly hyperactive-impulsive presentation: Six or more symptoms of hyperactivity-impulsivity (listed below) for children up to age 16, or 5 or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
   • Fidgets with or taps hands or feet, or squirms in seat
   • Leaves seat in situations when remaining seated is expected
   • Runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
   • Is unable to play or take part in leisure activities quietly
   • Is "on the go" acting as if "driven by a motor"
   • Talks excessively
   • Blurts out an answer before a question has been completed
   • Has trouble waiting for his/her turn
   • Interrupts or intrudes on others (e.g., butts into conversations or games)
3. ADHD combined type: If enough symptoms of both inattention and hyperactivity-impulsivity criteria were present for the past 6 months.
   
   In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in 2 or more settings (e.g., at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with or reduce the quality of social, school, or work functioning.
• The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Clinical Classification

• ADHD predominantly inattentive presentation
• ADHD predominantly hyperactive-impulsive presentation
• ADHD combined type

• Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.
• Moderate: Symptoms of functional impairment between "mild" and "severe" are present.
• Severe: Many symptoms in excess of those required to make diagnosis, or severe symptoms that are particularly severe and result in marked impairment in social or school functioning.

Differential Diagnosis

• Seizures/Epilepsy, particularly Childhood Absence Epilepsy
• Hearing Loss and Deafness, including middle ear infections causing hearing loss or auditory processing disorder, may contribute to inattention. Any suspicious symptoms or findings should trigger evaluation for hearing deficits.
• Sleep Issues may cause daytime difficulties, such as hyperactivity and inattention. Consider further evaluation if history and physical exam (e.g., large tonsils) suggest obstructive sleep apnea.
• Visual Impairment, including visual processing disorders, may present as inattention. An ophthalmological exam is warranted if there is any concern, or if the child has any difficulty passing screening tests.
• Tourette Syndrome could lead to speaking out inappropriately or repetitive noises, which could be confused with the impulsiveness or repetitive noises seen with ADHD.
• Learning disabilities may be the etiology of poor school performance and may accompany ADHD. If these are a concern, refer for psychological testing. Children with learning disabilities will often score significantly higher on IQ testing compared to achievement testing.
• Depression or anxiety are similar psychiatric problems that may occur with ADHD or cause symptoms of ADHD that may resolve when the primary disorder is treated. If concerned, consider a referral to child psychiatry or psychology. Ask about life changes causing anxiety or difficulty concentrating, such as a parent's death, divorce, etc.
• Autism Spectrum Disorder may present like ADHD, including difficulties with focus on non-preferred activities. Children with ADHD may also present with social skill deficits. [Kotte: 2013] ADHD and autism spectrum disorder may be genetically linked. [Rommelse: 2010]
• Substance Use Disorders can present like ADHD with both inattention and hyperactivity, although the pattern is more likely to occur sporadically, timed with the substance use.
• Side effects of medication can cause changes in behaviors; however, symptoms may align with the start of a new medication or a dose change.
• Trauma/childhood adverse events can lead to hypervigilance and arousal that can be mistaken for ADHD or can overlap with actual ADHD. [Kaya: 2008] Screening for adverse events in childhood can help in the differential diagnosis as well as provide insight into ways to tailor support for struggling families. See Toxic Stress Screening and the Foster Care module for more information.
• Hyperthyroidism can cause nervousness, weight loss, decreased concentration, mood swings and outbursts, and other symptoms; however, most symptoms are reversible with appropriate treatment.

Medical Conditions Causing Condition

• Fetal alcohol or nicotine exposures can contribute to ADHD symptoms. See Fetal Alcohol Spectrum Disorders for more information. Prenatal methamphetamine exposure has been associated with reduced executive function and processing speed in children. [Smith: 2015] [Brinker: 2019]
• Traumatic Brain Injury or post-concussive attention problems
• Prematurity
• Environmental toxins such as lead, organophosphates, or pyrethroid pesticides can be linked to behaviors, although toxins are rarely thought to be the sole cause of ADHD. [Weydert: 2018]
• ADHD has not been found to be caused by: immunizations, allergies, excessive sugar intake, or food additives, or maternal iodine status during pregnancy. [Levie: 2020]

Comorbid & Secondary Conditions

• Tourette Syndrome
• Oppositional Defiant Disorder, Conduct Disorder, and ADHD
• Anxiety Disorders & Attention Deficit Hyperactivity Disorder (ADHD)
• Mood Disorders and ADHD
• Specific Learning Disability (SLD) and ADHD
• Coordination Disorders and ADHD
• Language disorders
• Substance Use Disorders

• Lack of improvement in behavioral symptoms despite appropriate treatment and services for ADHD
• Persistent school underachievement or school avoidance
• Parental concern for a comorbid condition
• Low self-esteem, anxiety, irritability, sleep disturbance, or sadness
• Negative/oppositional behaviors
• Suspected or reported substance use

Current & Past Medical History

• Previous illnesses or accidents that may contribute to attention problems
• Recent medical problems, growth, appetite, and possible side effects of medication for ADHD
• History of mood or anxiety disorders
• Adherence to prescribed medication or therapies
• Staring, brief eye-blinking, or other automatisms - consider absence seizures if “spacing out” events are occurring multiple times per day with a clear interruption of activity, such as speaking, walking, or drinking
• Sleep onset and duration, as well as the presence of snoring or restless sleep
• Toileting and elimination

Family History

Pregnancy/Perinatal History

Developmental & Educational Progress

• ADHD DSM-5 criteria by parent interview or by use of a specific checklist, such as the Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) ( 1.1 MB)
• Specific symptoms by use of a checklist by teacher, found in Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) ( 1.1 MB)
• Age at which the problem behaviors began, the settings in which the behaviors occur, and to what degree the child is impaired by the symptoms

Social & Family Functioning

• Recent changes in the family that may be causing anxiety or depression
• Behavior and functioning within the family and elsewhere (e.g., church or during extracurricular activities)
• Consistency or changes of medication
• Use of complementary/alternative treatments
• Parenting challenges

Physical Exam

Sensory Testing

Laboratory Testing

Imaging

Other Testing

Overview

• Preschool children (4-5 years old) should first receive parent training in behavior management (PTBM) and/or behavioral classroom interventions. If this is not successful and function continues to be moderately to severely impaired, methylphenidate may be considered.
• For school-aged children 6-11 years old, FDA-approved medication therapy, PTBM, and educational supports are recommended. First-line pharmacotherapy includes stimulant medications. For those that cannot tolerate stimulants or if parents are hesitant to start a stimulant, second-line therapy includes alpha-agonists such as clonidine and guanfacine as well as atomoxetine. Tricyclic antidepressants (TCAs) and bupropion have been shown to have some efficacy as well on inattention. Educational interventions include structuring the school environment, class placement, instructional placement, and behavioral supports, and may necessitate a 504 rehabilitation plan or individualized educational plan (IEP) to be implemented (see Education & Schools for more information).
• For adolescents, similar treatments are recommended, but the consent should be obtained before medicating. Long-acting guanfacine, atomoxetine, or clonidine, or stimulants that have lower abuse potential, such as lisdexamfetamine (Vyvanse) and OROS extended-release methylphenidate (Concerta), can be considered. [Wolraich: 2019] Involve the adolescent in the treatment plan.

• Anxiety Disorders & Attention Deficit Hyperactivity Disorder (ADHD)
• Coordination Disorders and ADHD
• Mood Disorders and ADHD
• Oppositional Defiant Disorder, Conduct Disorder, and ADHD
• Specific Learning Disability (SLD) and ADHD

Pearls & Alerts for Treatment & Management

AAP guidelines indicate that evidence does not clearly demonstrate an increased risk of serious cardiovascular events, such as MI, QT prolongation, sudden death, or ventricular arrhythmias, in children using stimulant medication.

Recent studies suggest that use of stimulants and other psychotropic medications for ADHD do not increase tics in most people and may reduce tics. Alpha agonists, including guanfacine and clonidine, have beneficial effects on both tics and ADHD. For those whose tics are exacerbated by stimulants, treatment with atomoxetine or an alpha agonist may be considered. Treatment with desipramine can lower tics but has other safety concerns, so it is generally avoided. [Osland: 2018] Do not expect medications to resolve tics fully. [Pringsheim: 2019]

Frequent or early requests for stimulant refills may suggest misuse. Prescribers should carefully monitor their prescription refill requests.

Systems

Pharmacy & Medications

Stimulant medications are known to decrease symptoms of ADHD [Chavez: 2009] and are recommended as first-line treatment for children 6 years of age and older by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. [Wolraich: 2019] [Pliszka: 2007] Stimulants work on dopamine and norepinephrine receptors in the brain. Approximately 75% of children with ADHD will respond to stimulant treatment if dosing is correct. Start at a low dose in either stimulant class (methylphenidates or amphetamines), and then every week increase the dose until the optimum effect is achieved. The maximum dose is reached for the child's age and weight or until side effects intervene. Side effects tend to be dose dependent, so if side effects occur, lower the dose to the last dose where the patient did not experience those side effects. Consider using a longer-acting stimulant for school-aged children to avoid re-dosing at school. A short-acting stimulant can be given in the early afternoon if a longer-acting formulation wears off too early to complete homework or other activities after school. Shorter-acting stimulants may be useful if appetite is significantly impaired; for example, school personnel may dispense a second dose to a student after lunch if authorized in the health care plan. If one stimulant is not effective at the highest tolerable dose, try another stimulant in the other class. Most children will respond favorably to either the first or second stimulant class. Stimulants may be prescribed for some children for school days or during the school year only, depending on circumstances and child or family preference. Medication holidays can be useful for children who have an excessive decline in weight or height percentiles, e.g., crossing 2 or more percentile lines on the growth chart.

Prescribers should carefully monitor their prescription refill requests; frequent or early requests for stimulant refills may suggest misuse. Stimulants with relatively less abuse potential include lisdexamfetamine (Vyvanse), methylphenidate patch (Daytrana), or OROS extended-release methylphenidate (Concerta). Consult your state’s controlled substance database to verify how frequently patients fill prescriptions and who else has prescribed their medications.

Medication tables for stimulants and non-stimulants can be found at:

• ADHD Medication Tables ( 152 KB)

The tables provides information about different classes of medications, dosing options, estimated duration of effect, and timing of immediate vs. longer-acting medication release (when available). They also includes formulations, such as chewable, liquid, patch, capsules with contents that can be sprinkled, and tablets that can be divided, flavors, generic and brand options for prescribing, and FDA-approval status.

Non-stimulant medications approved by the FDA for ADHD, such as atomoxetine (Strattera), extended-release clonidine (Kapvay), and extended-release guanfacine (Intuniv) may also be considered. The AAP recommends their use if stimulants (one from each class) have been tried and are not successful. Atomoxetine is a selective norepinephrine reuptake inhibitor and can cause nausea and sleepiness. Guanfacine and clonidine are norepinephrine receptor type alpha-2 agonists that can cause sedation and hypotension (more so in clonidine), and both are available in short and long-acting formulations. These medications need to be used daily without medication holidays. Extended-release guanfacine and clonidine have been shown to have efficacy as add-on therapies with stimulants. These non-stimulant medications for ADHD can take several weeks for full effect.

Side effects for both stimulant medications classes include mild stomachaches and headaches, depressed appetite and weight loss, difficulty sleeping, increased blood pressure and heart rate, and irritability/anxiety. FDA labels for stimulants include warnings and precautions for those with a cardiac abnormality or condition or significant side effects (e.g., poor growth, tic exacerbation, psychosis, and peripheral vasculopathy, seizures, serotonin syndrome, and visual disturbances. (See Pearls and Alerts section, above.) Rare side effects can also occur; the FDA warns that methylphenidates and atomoxetine can cause priapism, and atomoxetine can cause suicidality. Rarely, psychiatric symptoms, such as manic symptoms, paranoia, and hallucinations, may occur. Use of stimulant patches can result in changes to underlying skin pigmentation. For more information, see Safety Review of Medications Used to Treat ADHD in Children and Young Adults (FDA).

Effects of stimulants on comorbid conditions need further study. Some of what is known are as follows:

• Cardiac problems: The FDA (Safety Review of Medications Used to Treat ADHD in Children and Young Adults (FDA)) advises that “stimulant products and atomoxetine should generally not be used in patients with serious heart problems, or for whom an increase in blood pressure or heart rate would be problematic.” Regular monitoring of heart rate and blood pressure is advised. While one large retrospective study showed no increase in serious cardiac events associated with stimulants used to treat ADHD, a previous study associated these medications with a small to moderate risk of sudden cardiac death, which the FDA has not excluded.
• Fetal alcohol spectrum disorders (FASD): Children with FASD often have problems with attention and impulsivity; stimulant treatment may help, or it could make symptoms worse.
• Tics/Tourette syndrome: FDA package labeling for stimulants indicates that tics may be exacerbated by stimulants; however, recent studies suggest that use of stimulants and other psychotropic medications for ADHD do not increase tics in most people and can be helpful in some tic disorders. [Osland: 2018] Untreated ADHD may be more troubling to the child than the tics themselves. [Erenberg: 2005] However, monitoring of tics before and after starting stimulants is warranted due to individual variation. [Tourette's: 2002] Consider alternatives such as atomoxetine or alpha agonists if tics are exacerbated while on stimulants.
• Autism: Children with autism spectrum disorder have a decreased response rate to ADHD medications and an increased rate of reported side effects. Despite these concerns, recent information suggests that medication may be helpful. Given their sensitivities to side effects, a general rule of thumb regarding psychotropic medication for those with autism spectrum disorder is to 'start low and go slow.' Cautious monitoring for unexpected effects on the child's functioning (e.g., an increase in anxiety symptoms) should be maintained. [Posey: 2007] There is growing evidence that ADHD and autism spectrum disorder may be linked genetically. [Rommelse: 2010] [Ronald: 2008] See Evaluation and Medication Choice for ADHD Disorder Symptoms in Autism Spectrum Disorders (AAP) for treatment of comorbid ADHD and autism spectrum disorder. [Mahajan: 2012]
• Other neurologic conditions: ADHD symptoms are often observed in children with neurologic conditions, such as neural tube defects, muscular dystrophy, cerebral palsy, intellectual disability, and various genetic syndromes. Stimulants are often helpful for these symptoms in children with intellectual disability [Aman: 2003], but not necessarily in children with velocardiofacial syndrome (22q11.2 Deletion Syndrome). [Antshel: 2007] Treatment for ADHD symptoms in neurologic and other conditions should be accompanied by close monitoring to assure response and limit side effects.

For preschool-age children, the only stimulant approved for use by the FDA is dextroamphetamine; however, methylphenidate is the medication class recommended in this age group by the AAP in the latest guidelines. [Wolraich: 2019] Depending on the functioning of the child and symptoms of ADHD, some providers will use stimulant medications "off-label" for younger children. Parent training in behavior management (PTBM) or educational behavior interventions are recommended as first-line management, and medications should be used only if not successful. None of the non-stimulant medications is currently licensed for use in preschoolers.

Off-label medications are occasionally used to manage ADHD, particularly in patients with comorbidities, such as depression, include bupropion (Wellbutrin), modafinil (Provigil or Nuvigil), and tricyclic antidepressants, such as desipramine (Norpramin) and imipramine (Tofranil). [American: 2013]

If treatment fails, consider:

• Under-treatment: Medications should be titrated to maximum doses without adverse side effects instead of relying on milligram-per-kilogram recommendations to ensure adequate treatment of symptoms.
• Noncompliance with medication: This may be more common in families where parents also have symptoms of ADHD. [Wolraich: 2019]
• A comorbid condition

For more information and updates on FDA-approved medications for ADHD, see FDA-Approved Drugs in Attention Deficit/Hyperactivity Disorder (ADHD - Pediatric) (CenterWatch), and scroll to bottom of the page. ADHD: Parents' Medication Guide (AACAP) ( 1.1 MB) may be helpful for parents. Medications used for ADHD, along with dosing guidelines and pharmacokinetics, can be found at Algorithm for the Evaluation, Diagnosis, Treatment, and Monitoring of ADHD (AAP) ( 406 KB) on page S12. Finally, The Child Medication Fact Book for Psychiatric Practice (2018) is an excellent resource for information about psychiatric medications.

Specialty Collaborations & Other Services

Developmental - Behavioral Pediatrics (see UT providers [8])

Consult for guidance on managing more complex cases, such as for children who have comorbid conditions, intellectual disability, or difficult-to-treat ADHD.

Psychiatry/Medication Management (see UT providers [60])

Consult to help with diagnosis and management of situations complicated by underlying medical issues.

Clinical Assessment

Eyes/Vision

Learning/Education/Schools

Mental Health/Behavior

On the Web

National Resource Center on ADHD (NRC)
A clearinghouse for the latest evidence-based information on ADHD; funded by the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.

Helpful Articles

PubMed search for ADHD in children, last 1 year.

AAP.
American Academy of Pediatrics/American Heart Association clarification of statement on cardiovascular evaluation and monitoring of children and adolescents with heart disease receiving medications for ADHD: May 16, 2008.
J Dev Behav Pediatr. 2008;29(4):335. PubMed abstract

Atkinson M, Hollis C.
NICE guideline: attention deficit hyperactivity disorder.
Arch Dis Child Educ Pract Ed. 2010;95(1):24-7. PubMed abstract
Guidelines that the cover diagnosis, treatment, and management of ADHD; National Institute for Health and Care Excellence (UK).

Brimble MJ.
Diagnosis and management of ADHD: a new way forward?.
Community Pract. 2009;82(10):34-7. PubMed abstract

Corkum P, Begum EA, Rusak B, Rajda M, Shea S, MacPherson M, Williams T, Spurr K, Davidson F.
The Effects of Extended-Release Stimulant Medication on Sleep in Children with ADHD.
J Can Acad Child Adolesc Psychiatry. 2020;29(1):33-43. PubMed abstract / Full Text
Although stimulant medications, such as methylphenidate hydrochloride (MPH), are effective at reducing the core symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), they may also disrupt children's sleep. This study aimed to investigate the acute impact of extended-release MPH on sleep using both actigraphy and polysomnography (PSG).

Houghton R, de Vries F, Loss G.
Psychostimulants/Atomoxetine and Serious Cardiovascular Events in Children with ADHD or Autism Spectrum Disorder.
CNS Drugs. 2020;34(1):93-101. PubMed abstract / Full Text
Using large US claims data, this study found no evidence of increased serious cardiovascular risk in children and adolescents with ADHD or ASD exposed to ADHD medications (i.e., stimulants and atomoxetine).

Humphreys KL, Eng T, Lee SS.
Stimulant Medication and Substance Use Outcomes: A Meta-analysis.
JAMA Psychiatry. 2013;70(7):740-9. PubMed abstract / Full Text

Kim JW, Kim BN, Cho SC.
The dopamine transporter gene and the impulsivity phenotype in attention deficit hyperactivity disorder: a case-control association study in a Korean sample.
J Psychiatr Res. 2006;40(8):730-7. PubMed abstract

Moen MD, Keam SJ.
Dexmethylphenidate extended release: a review of its use in the treatment of attention-deficit hyperactivity disorder.
CNS Drugs. 2009;23(12):1057-83. PubMed abstract

Murphy TK, Lewin AB, Storch EA, Stock S.
Practice parameter for the assessment and treatment of children and adolescents with tic disorders.
J Am Acad Child Adolesc Psychiatry. 2013;52(12):1341-59. PubMed abstract / Full Text

Nikles J, Mitchell GK, de Miranda Araújo R, Harris T, Heussler HS, Punja S, Vohra S, Senior HEJ.
A systematic review of the effectiveness of sleep hygiene in children with ADHD.
Psychol Health Med. 2020;25(4):497-518. PubMed abstract
The objective of this systematic review of the literature is to evaluate the effectiveness of sleep hygiene interventions for sleep difficulties in children with ADHD.

Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK.
Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial.
Lancet. 2011;377(9764):494-503. PubMed abstract

Perrin JM, Friedman RA, Knilans TK.
Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder.
Pediatrics. 2008;122(2):451-3. PubMed abstract / Full Text

Pringsheim T, Steeves T.
Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children with comorbid tic disorders.
Cochrane Database Syst Rev. 2011(4):CD007990. PubMed abstract

Punja S, Shamseer L, Hartling L, Urichuk L, Vandermeer B, Nikles J, Vohra S.
Amphetamines for attention deficit hyperactivity disorder (ADHD) in children and adolescents.
Cochrane Database Syst Rev. 2016;2:CD009996. PubMed abstract
A systematic review to assess the efficacy and safety of amphetamines for ADHD in children and adolescents

Reed VA, Buitelaar JK, Anand E, Day KA, Treuer T, Upadhyaya HP, Coghill DR, Kryzhanovskaya LA, Savill NC.
The Safety of Atomoxetine for the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Comprehensive Review of Over a Decade of Research.
CNS Drugs. 2016;30(7):603-28. PubMed abstract
The aim of this paper was to comprehensively review publications that addressed one or more of seven major safety topics relevant to atomoxetine treatment of children and adolescents (aged ≥6 years) diagnosed with ADHD.

Rushton JL, Fant KE, Clark SJ.
Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder.
Pediatrics. 2004;114(1):e23-8. PubMed abstract

Salmeron PA.
Childhood and adolescent attention-deficit hyperactivity disorder: diagnosis, clinical practice guidelines, and social implications.
J Am Acad Nurse Pract. 2009;21(9):488-97. PubMed abstract / Full Text

Shrestha M, Lautenschleger J, Soares N.
Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review.
Transl Pediatr. 2020;9(Suppl 1):S114-S124. PubMed abstract / Full Text
Medication and non-pharmacological treatments are evidence-based interventions for ADHD in various age groups, and this article will elaborate on the psychosocial, physical and integrative medicine interventions that have been studied in ADHD.

Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira-Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C.
Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies.
Cochrane Database Syst Rev. 2018;5:CD012069. PubMed abstract / Full Text
This systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events.

Thomas R, Sanders S, Doust J, Beller E, Glasziou P.
Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.
Pediatrics. 2015;135(4):e994-1001. PubMed abstract

Vaidya CJ, Stollstorff M.
Cognitive neuroscience of Attention Deficit Hyperactivity Disorder: current status and working hypotheses.
Dev Disabil Res Rev. 2008;14(4):261-7. PubMed abstract

Warikoo N, Faraone SV.
Background, clinical features and treatment of attention deficit hyperactivity disorder in children.
Expert Opin Pharmacother. 2013. PubMed abstract / Full Text

Weydert JA, Brown ML, McClafferty H.
Integrative Medicine in Pediatrics.
Adv Pediatr. 2018;65(1):19-39. PubMed abstract
Keywords: ADHD; Abdominal pain; Acupuncture; Complementary & alternative medicine (CAM); Integrative medicine; Massage; Mind–body therapy; Nutrition.

Assessment Tools/Scales

Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) ( 1.1 MB)
Helps to diagnose ADHD in children between the ages of 6 and 12; also screens for anxiety, depression, oppositional-defiant, and conduct disorders. Includes questionnaires for the initial and follow-up assessments for teachers and parents - and scoring instructions. No fee is required.

NICHQ Vanderbilt Assessment Scale - Parent Informant - Online Version (Spanish) ( 3.9 MB)
Spanish (with English translation) online fillable, self-calculating form for assessing and quantifying the impact of attention problems at home. Includes scoring instructions, no fee required; NICHQ

NICHQ Vanderbilt Assessment Follow-Up - Parent Informant - Online Version (Spanish) ( 3.6 MB)
Spanish (with English translation) follow-up forms for assessing and quantifying the impact of attention problems at home. Includes scoring instructions, no fee required; NICHQ

NICHQ Vanderbilt ADHD Primary Care Initial Evaluation Form ( 1.7 MB)
2-page evaluation template includes scoring for the initial Vanderbilts, plus checkboxes for relevant medical history, physical examination, diagnostic assessment and plan, and related screenings; American Academy of Pediatrics.

Conners 3rd Edition
Screens for ADHD and comorbid disorders such as oppositional defiant disorder and conduct disorder. Administered to parents and teachers of children and adolescents age 6-18 and self-report for youth ages 8-18, English and Spanish. Updated for DSM-5. Proprietary/for purchase.

ADHD Rating Scale-5 for Children and Adolescents
Child and adolescent versions with parent and teacher questionnaires, ages 5-17, the scales take <5 minutes to complete. Scoring is linked directly to DSM-5 diagnostic criteria for ADHD. Available for purchase.

Achenbach System of Empirically Based Assessment (ASEBA)
A variety of screening tools are available for a fee.

Pediatric Symptom Checklist (PSC) and Youth Report (Y-PSC) ( 47 KB)
Psychosocial screen to facilitate the recognition of cognitive, emotional, and behavioral problems. Includes a 35-item checklist for parents or youth to complete, and scoring instructions. No fee required.

DSM-5 Parent-Rated Level 1 Symptom Measure—Age 6–17 (APA) ( 367 KB)
Free, 25-question assessment for initial patient interview and for monitoring treatment progress. Includes scoring instructions; American Psychiatric Association.

Patient Health Questionnaire (PHQ) Screeners
Free screening tools in many languages with scoring instructions to be used by clinicians to help detect mental health disorders. Select from right menu: PHQ, PHQ-9, GAD-7, PHQ-15, PHQ-SADS, Brief PHQ, PHQ-4, PHQ-8.

Care Processes & Protocols

ADHD Resources (Intermountain Healthcare)
This care process model (CPM) and accompanying tools (forms, data, patient education) were developed in cooperation with several other organizations, including the Intermountain Pediatric Society, the American Academy of Pediatrics Utah Chapter, and Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) of Utah.

UW General Pediatrics Guidelines: Attention Deficit and Hyperactivity Disorder ( 252 KB)
University of Washington's 7-page pediatric guideline on diagnosis and treatment of ADHD; contact Julie Bledsoe, MD, 2017.

Medication Guides

ADHD Medication Tables ( 152 KB)
Provides information about different classes of medications, dosing options, estimated duration of effect, and timing of immediate vs. longer-acting medication release (when available). It also includes formulations, such as chewable, liquid, patch, capsules with contents that can be sprinkled, and tablets that can be divided, flavors, generic and brand options for prescribing, and FDA-approval status; Medical Home Portal, last updated April 2020.

Stimulant Equivalency Table (UACAP) ( 505 KB)
One-page table of key differences in stimulant medications used to treat ADHD. Author Matt Swenson, MD; Utah Academy of Child & Adolescent Psychiatry.

Toolkits

Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians, 3rd Ed. (AAP)
his framework of tools and forms, templates, scales, and coding references is a complementary resource to the 2019 American Academy of Pediatrics (AAP) Clinical Practice Guideline, to enable and empower the clinician to provide needed care to children with ADHD from birth to adulthood. Available for purchase from the AAP.

Caring for Children with ADHD Toolkit, 2nd Ed. (AAP)
This links to some free resources associated with the older edition of the American Academy of Pediatrics (AAP)'s toolkit, including commonly used screening tools, treatment and monitoring guidance, and parent information.

Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit (AAP)
CD-ROM of clinical tools provide step-by-step decision support for assessment and care of children with the most common mental health symptoms, available for a fee; American Academy of Pediatrics.

mehealth for ADHD
This integrated assessment and treatment-planning tool is an evidence-based, comprehensive, and easy-to-use online platform for improving the quality of ADHD care. Efficacy is proven by randomized controlled research. This quality improvement tool provides a means of communication between the clinician, family, and teachers to assess, monitor interventions, and guide behavioral supports, and it integrates Vanderbilt screens (2nd Edition). Free if participating in their NIH-funded research study; subscription required otherwise; Cincinnati Children’s Hospital Medical Center.

Other

Letter Requesting Assessment from Teacher (AAP)
Sample letter requesting that a teacher complete a behavior assessment for their student. The AAP suggests that a release of information form, signed by parent, accompanies this letter; American Academy of Pediatrics.

Monarch eTNS (external Trigeminal Nerve Stimulation) System
This medical device, approved in 2019 for treatment of ADHD in children ages 7-12 who are not taking prescription ADHD medication, delivers low-level electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. Prescription required.

EndeavorRx
EndeavorRx™ is the first-and-only prescription treatment of ADHD, delivered through a video game. Evidence-based, it was cleared by the FDA in 2020.

Patient Education & Instructions

ADHD: Parents' Medication Guide (AACAP) ( 1.1 MB)
Forty-five page booklet that helps youngsters and their families better understand the treatments for ADHD; prepared by the American Academy of Child & Adolescent Psychiatry and American Psychiatric Association (2013).

Behavior Therapy for Children with ADHD
Printable information for families about behavioral interventions and therapy for children with attention deficit/hyperactivity disorder; HealthyChildren.org/AAP.

Information on the Web

ADHD (MedlinePlus)
Provides links to high-quality sources of information about ADHD; a service of the National Library of Medicine and National Institutes of Health.

ADHD (HealthyChildren)
Links to more than 90 articles that discuss aspects of ADHD evaluation and management; developed by the American Academy of Pediatrics.

ADHD Information (NIMH)
Overview and links to more information from the National Institute of Mental Health

National & Local Support

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
A national non-profit organization, with numerous local chapters, that provides education, advocacy, and support for ADHD; includes ADHD-focused e-learning trainings for parents and teachers, information, advocacy, and support, podcasts, newsletters, and more.

Understood for Learning & Attention Issues
An organization providing resources to young adults, parents, and teachers of children with different learning styles and attention disorders. Focusses on an initiative to create inclusive workplaces by developing and implementing best-in-class disability inclusion programs so they can hire, advance, and retain people with disabilities.

Studies/Registries

Mental Health Clinical Trials (NIMH)
Links to descriptions of clinical trials related to numerous mental health conditions, including ADHD, anxiety, and depression; National Institute of Mental Health.

Clinical Trials in ADHD (clinicaltrials.gov)
Trial listings for ADHD with "completed," "recruiting," and "active" status noted.

Services for Patients & Families in Utah (UT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

AAP.
American Academy of Pediatrics/American Heart Association clarification of statement on cardiovascular evaluation and monitoring of children and adolescents with heart disease receiving medications for ADHD: May 16, 2008.
J Dev Behav Pediatr. 2008;29(4):335. PubMed abstract

Abou-Khadra MK, Amin OR, Shaker OG, Rabah TM.
Parent-reported sleep problems, symptom ratings, and serum ferritin levels in children with attention-deficit/hyperactivity disorder: a case control study.
BMC Pediatr. 2013;13:217. PubMed abstract / Full Text

Ali A, Puthusserypady S.
A 3D learning playground for potential attention training in ADHD: A brain computer interface approach.
Conf Proc IEEE Eng Med Biol Soc. 2015;2015:67-70. PubMed abstract
This paper presents a novel brain-computer-interface (BCI) system that could potentially be used for enhancing the attention ability of subjects with attention deficit hyperactivity disorder (ADHD). It employs the steady state visual evoked potential (SSVEP) paradigm.

Aman MG, Buican B, Arnold LE.
Methylphenidate treatment in children with borderline IQ and mental retardation: analysis of three aggregated studies.
J Child Adolesc Psychopharmacol. 2003;13(1):29-40. PubMed abstract

American Academy of Child & Adolescent Psychiatry and American Psychiatric Association.
ADHD: Parents' Medication Guide.
2013; 45. http://www.parentsmedguide.org/

American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders, DSM-5.
Fifth ed. Arlington, VA: American Psychiatric Association; 2013. 978-0-89042-554-1

American Psychiatric Association: DSM-5 Task Force.
Diagnostic and Statistical Manual of Mental Disorders.
Fifth ed. The American Psychiatric Publishing; 2013. http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425...

Antshel KM, Faraone SV, Fremont W, Monuteaux MC, Kates WR, Doyle A, Mick E, Biederman J.
Comparing ADHD in velocardiofacial syndrome to idiopathic ADHD: a preliminary study.
J Atten Disord. 2007;11(1):64-73. PubMed abstract

Atkinson M, Hollis C.
NICE guideline: attention deficit hyperactivity disorder.
Arch Dis Child Educ Pract Ed. 2010;95(1):24-7. PubMed abstract
Guidelines that the cover diagnosis, treatment, and management of ADHD; National Institute for Health and Care Excellence (UK).

Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV.
Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study.
Pediatrics. 2009;124(1):71-8. PubMed abstract
An encouraging 10-year case-control study of how stimulant use for treatment of ADHD decreases risk of developing comorbid mood disorders and improves academic success.

Brimble MJ.
Diagnosis and management of ADHD: a new way forward?.
Community Pract. 2009;82(10):34-7. PubMed abstract

Brinker MJ, Cohen JG, Sharrette JA, Hall TA.
Neurocognitive and neurodevelopmental impact of prenatal methamphetamine exposure: A comparison study of prenatally exposed children with nonexposed ADHD peers.
Appl Neuropsychol Child. 2019;8(2):132-139. PubMed abstract
Overall findings suggest that prenatal methamphetamine exposure is associated with a notable cognitive impact independent of polysubstance exposure to alcohol, and that the impact of this exposure on processing speed skills may become more pronounced with age.

Chavez B, Sopko MA Jr, Ehret MJ, Paulino RE, Goldberg KR, Angstadt K, Bogart GT.
An update on central nervous system stimulant formulations in children and adolescents with attention-deficit/hyperactivity disorder.
Ann Pharmacother. 2009;43(6):1084-95. PubMed abstract

Committee on Children With Disabilities.
American Academy of Pediatrics: The continued importance of Supplemental Security Income (SSI) for children and adolescents with disabilities.
Pediatrics. 2001;107(4):790-3. PubMed abstract
Provides an excellent understanding of what SSI is, what it does, what children are likely to qualify, and what the basic application process is like. Knowing this information will greatly enhance your ability to help families get into the system quickly.

Corkum P, Begum EA, Rusak B, Rajda M, Shea S, MacPherson M, Williams T, Spurr K, Davidson F.
The Effects of Extended-Release Stimulant Medication on Sleep in Children with ADHD.
J Can Acad Child Adolesc Psychiatry. 2020;29(1):33-43. PubMed abstract / Full Text
Although stimulant medications, such as methylphenidate hydrochloride (MPH), are effective at reducing the core symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), they may also disrupt children's sleep. This study aimed to investigate the acute impact of extended-release MPH on sleep using both actigraphy and polysomnography (PSG).

Cortese S, Konofal E, Bernardina BD, Mouren MC, Lecendreux M.
Sleep disturbances and serum ferritin levels in children with attention-deficit/hyperactivity disorder.
Eur Child Adolesc Psychiatry. 2009;18(7):393-9. PubMed abstract

Erenberg G.
The relationship between Tourette syndrome, attention deficit hyperactivity disorder, and stimulant medication: a critical review.
Semin Pediatr Neurol. 2005;12(4):217-21. PubMed abstract

Faraone SV, Larsson H.
Genetics of attention deficit hyperactivity disorder.
Mol Psychiatry. 2019;24(4):562-575. PubMed abstract / Full Text

Hailpern SM, Egan BM, Lewis KD, Wagner C, Shattat GF, Al Qaoud DI, Shatat IF.
Blood Pressure, Heart Rate, and CNS Stimulant Medication Use in Children with and without ADHD: Analysis of NHANES Data.
Front Pediatr. 2014;2:100. PubMed abstract / Full Text

Harstad EB, Weaver AL, Katusic SK, Colligan RC, Kumar S, Chan E, Voigt RG, Barbaresi WJ.
ADHD, stimulant treatment, and growth: a longitudinal study.
Pediatrics. 2014;134(4):e935-44. PubMed abstract / Full Text

Houghton R, de Vries F, Loss G.
Psychostimulants/Atomoxetine and Serious Cardiovascular Events in Children with ADHD or Autism Spectrum Disorder.
CNS Drugs. 2020;34(1):93-101. PubMed abstract / Full Text
Using large US claims data, this study found no evidence of increased serious cardiovascular risk in children and adolescents with ADHD or ASD exposed to ADHD medications (i.e., stimulants and atomoxetine).

Humphreys KL, Eng T, Lee SS.
Stimulant Medication and Substance Use Outcomes: A Meta-analysis.
JAMA Psychiatry. 2013;70(7):740-9. PubMed abstract / Full Text

Kaya A, Taner Y, Guclu B, Taner E, Kaya Y, Bahcivan HG, Benli IT.
Trauma and adult attention deficit hyperactivity disorder.
J Int Med Res. 2008;36(1):9-16. PubMed abstract

Kim JW, Kim BN, Cho SC.
The dopamine transporter gene and the impulsivity phenotype in attention deficit hyperactivity disorder: a case-control association study in a Korean sample.
J Psychiatr Res. 2006;40(8):730-7. PubMed abstract

Kollins SH, Deloss DJ, Cañadas E, Lutz J, Findling RL, Keefe RSE, Epstein JN, Cutler AJ, Faraone SV.
A Novel Digital Intervention for Actively Reducing Severity of Paediatric ADHD (STARS-ADHD): A Randomised Controlled Trial.
The Lancet Digital Health. 2020;2.4(Web):E168-178. / Full Text

Kotte A, Joshi G, Fried R, Uchida M, Spencer A, Woodworth KY, Kenworthy T, Faraone SV, Biederman J.
Autistic traits in children with and without ADHD.
Pediatrics. 2013;132(3):e612-22. PubMed abstract / Full Text

Levie D, Bath SC, Guxens M, Korevaar TIM, Dineva M, Fano E, Ibarluzea JM, Llop S, Murcia M, Rayman MP, Sunyer J, Peeters RP, Tiemeier H.
Maternal Iodine Status During Pregnancy Is Not Consistently Associated with Attention-Deficit Hyperactivity Disorder or Autistic Traits in Children.
J Nutr. 2020;150(6):1516-1528. PubMed abstract
The research concludes that there is no consistent evidence to support an association of mild-to-moderate iodine deficiency during pregnancy with child ADHD or autistic traits.

Lim CG, Poh XWW, Fung SSD, Guan C, Bautista D, Cheung YB, Zhang H, Yeo SN, Krishnan R, Lee TS.
A randomized controlled trial of a brain-computer interface based attention training program for ADHD.
PLoS One. 2019;14(5):e0216225. PubMed abstract / Full Text
The use of brain-computer interface in neurofeedback therapy for attention deficit hyperactivity disorder (ADHD) is a relatively new approach. This randomized controlled trial (RCT) was performed to determine whether an 8-week brain computer interface (BCI)-based attention training program improved inattentive symptoms in children with ADHD compared to a waitlist-control group, and the effects of a subsequent 12-week lower-intensity training.

Mahajan R, Bernal MP, Panzer R, Whitaker A, Roberts W, Handen B, Hardan A, Anagnostou E, Veenstra-VanderWeele J.
Clinical practice pathways for evaluation and medication choice for attention-deficit/hyperactivity disorder symptoms in autism spectrum disorders.
Pediatrics. 2012;130 Suppl 2:S125-38. PubMed abstract / Full Text

Martinez-Raga J, Knecht C, Szerman N, Martinez MI.
Risk of serious cardiovascular problems with medications for attention-deficit hyperactivity disorder.
CNS Drugs. 2013;27(1):15-30. PubMed abstract

McDermott AF, Rose M, Norris T, Gordon E.
A Novel Feed-Forward Modeling System Leads to Sustained Improvements in Attention and Academic Performance.
J Atten Disord. 2020;24(10):1443-1456. PubMed abstract
This study tested a novel feed-forward modeling (FFM) system as a nonpharmacological intervention for the treatment of ADHD children and the training of cognitive skills that improve academic performance.

McGough JJ, Loo SK, Sturm A, Cowen J, Leuchter AF, Cook IA.
An eight-week, open-trial, pilot feasibility study of trigeminal nerve stimulation in youth with attention-deficit/hyperactivity disorder.
Brain Stimul. 2015;8(2):299-304. PubMed abstract
This study examined the potential feasibility and utility of trigeminal nerve stimulation (TNS) for attention-deficit/hyperactivity disorder (ADHD) in youth.

McGough JJ, Sturm A, Cowen J, Tung K, Salgari GC, Leuchter AF, Cook IA, Sugar CA, Loo SK.
Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder.
J Am Acad Child Adolesc Psychiatry. 2019;58(4):403-411.e3. PubMed abstract / Full Text
Trigeminal nerve stimulation (TNS), a minimal-risk noninvasive neuromodulation method, showed potential benefits for attention-deficit/hyperactivity disorder (ADHD) in an unblinded open study. This blinded sham-controlled trial was conducted to assess the efficacy and safety of TNS for ADHD and potential changes in brain spectral power using resting-state quantitative electroencephalography.

McPherson M, Weissman G, Strickland BB, van Dyck PC, Blumberg SJ, Newacheck PW.
Implementing community-based systems of services for children and youths with special health care needs: how well are we doing?.
Pediatrics. 2004;113(5 Suppl):1538-44. PubMed abstract

Moen MD, Keam SJ.
Dexmethylphenidate extended release: a review of its use in the treatment of attention-deficit hyperactivity disorder.
CNS Drugs. 2009;23(12):1057-83. PubMed abstract

Murphy TK, Lewin AB, Storch EA, Stock S.
Practice parameter for the assessment and treatment of children and adolescents with tic disorders.
J Am Acad Child Adolesc Psychiatry. 2013;52(12):1341-59. PubMed abstract / Full Text

Nikles J, Mitchell GK, de Miranda Araújo R, Harris T, Heussler HS, Punja S, Vohra S, Senior HEJ.
A systematic review of the effectiveness of sleep hygiene in children with ADHD.
Psychol Health Med. 2020;25(4):497-518. PubMed abstract
The objective of this systematic review of the literature is to evaluate the effectiveness of sleep hygiene interventions for sleep difficulties in children with ADHD.

Osland ST, Steeves TD, Pringsheim T.
Pharmacological treatment for attention deficit hyperactivity disorder (ADHD) in children with comorbid tic disorders.
Cochrane Database Syst Rev. 2018;6:CD007990. PubMed abstract

Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK.
Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial.
Lancet. 2011;377(9764):494-503. PubMed abstract

Perrin JM, Friedman RA, Knilans TK.
Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder.
Pediatrics. 2008;122(2):451-3. PubMed abstract / Full Text

Pliszka S.
Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder.
J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921. PubMed abstract
Historical ADHD guideline from 2007.

Pliszka SR, Matthews TL, Braslow KJ, Watson MA.
Comparative effects of methylphenidate and mixed salts amphetamine on height and weight in children with attention-deficit/hyperactivity disorder.
J Am Acad Child Adolesc Psychiatry. 2006;45(5):520-6. PubMed abstract

Posey DJ, Aman MG, McCracken JT, Scahill L, Tierney E, Arnold LE, Vitiello B, Chuang SZ, Davies M, Ramadan Y, Witwer AN, Swiezy NB, Cronin P, Shah B, Carroll DH, Young C, Wheeler C, McDougle CJ.
Positive effects of methylphenidate on inattention and hyperactivity in pervasive developmental disorders: an analysis of secondary measures.
Biol Psychiatry. 2007;61(4):538-44. PubMed abstract

Pringsheim T, Okun MS, Müller-Vahl K, Martino D, Jankovic J, Cavanna AE, Woods DW, Robinson M, Jarvie E, Roessner V, Oskoui M, Holler-Managan Y, Piacentini J.
Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders.
Neurology. 2019;92(19):896-906. PubMed abstract / Full Text

Pringsheim T, Steeves T.
Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children with comorbid tic disorders.
Cochrane Database Syst Rev. 2011(4):CD007990. PubMed abstract

Punja S, Shamseer L, Hartling L, Urichuk L, Vandermeer B, Nikles J, Vohra S.
Amphetamines for attention deficit hyperactivity disorder (ADHD) in children and adolescents.
Cochrane Database Syst Rev. 2016;2:CD009996. PubMed abstract
A systematic review to assess the efficacy and safety of amphetamines for ADHD in children and adolescents

Reed VA, Buitelaar JK, Anand E, Day KA, Treuer T, Upadhyaya HP, Coghill DR, Kryzhanovskaya LA, Savill NC.
The Safety of Atomoxetine for the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Comprehensive Review of Over a Decade of Research.
CNS Drugs. 2016;30(7):603-28. PubMed abstract
The aim of this paper was to comprehensively review publications that addressed one or more of seven major safety topics relevant to atomoxetine treatment of children and adolescents (aged ≥6 years) diagnosed with ADHD.

Rommelse NN, Franke B, Geurts HM, Hartman CA, Buitelaar JK.
Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder.
Eur Child Adolesc Psychiatry. 2010. PubMed abstract

Ronald A, Simonoff E, Kuntsi J, Asherson P, Plomin R.
Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample.
J Child Psychol Psychiatry. 2008;49(5):535-42. PubMed abstract
High levels of clinical comorbidity have been reported between autistic spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD). This study takes an individual differences approach to determine the degree of phenotypic and aetiological overlap between autistic traits and ADHD behaviours in the general population.

Rushton JL, Fant KE, Clark SJ.
Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder.
Pediatrics. 2004;114(1):e23-8. PubMed abstract

Salmeron PA.
Childhood and adolescent attention-deficit hyperactivity disorder: diagnosis, clinical practice guidelines, and social implications.
J Am Acad Nurse Pract. 2009;21(9):488-97. PubMed abstract / Full Text

Savulich G, Thorp E, Piercy T, Peterson KA, Pickard JD, Sahakian BJ.
Improvements in Attention Following Cognitive Training With the Novel "Decoder" Game on an iPad.
Front Behav Neurosci. 2019;13:2. PubMed abstract / Full Text
The study suggests that cognitive training with Decoder is an effective non-pharmacological method for enhancing attention in healthy young adults, which could be extended to clinical populations in which attentional problems persist.

Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE.
A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment.
BMC Med. 2012;10:99. PubMed abstract / Full Text

Shrestha M, Lautenschleger J, Soares N.
Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review.
Transl Pediatr. 2020;9(Suppl 1):S114-S124. PubMed abstract / Full Text
Medication and non-pharmacological treatments are evidence-based interventions for ADHD in various age groups, and this article will elaborate on the psychosocial, physical and integrative medicine interventions that have been studied in ADHD.

Smith LM, Diaz S, LaGasse LL, Wouldes T, Derauf C, Newman E, Arria A, Huestis MA, Haning W, Strauss A, Della Grotta S, Dansereau LM, Neal C, Lester BM.
Developmental and behavioral consequences of prenatal methamphetamine exposure: A review of the Infant Development, Environment, and Lifestyle (IDEAL) study.
Neurotoxicol Teratol. 2015;51:35-44. PubMed abstract / Full Text
This study reviews the findings from the Infant Development, Environment, and Lifestyle (IDEAL) study, a multisite, longitudinal, prospective study designed to determine maternal outcome and child growth and developmental findings following prenatal methamphetamine exposure from birth up to age 7.5 years.

Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira-Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C.
Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies.
Cochrane Database Syst Rev. 2018;5:CD012069. PubMed abstract / Full Text
This systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events.

Thomas R, Sanders S, Doust J, Beller E, Glasziou P.
Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.
Pediatrics. 2015;135(4):e994-1001. PubMed abstract

Tourette's Syndrome Study Group.
Treatment of ADHD in children with tics: a randomized controlled trial.
Neurology. 2002;58(4):527-36. PubMed abstract / Full Text
This study offers support for using methylphenidate and/or the combination of methylphenidate/clonidine in the treatment of ADHD with tic disorder.

Troksa K, Kovacich N, Moro M, Chavez B.
Impact of Central Nervous System Stimulant Medication Use on Growth in Pediatric Populations with Attention-Deficit/Hyperactivity Disorder: A Review.
Pharmacotherapy. 2019;39(6):665-676. PubMed abstract
This article review the newer data surrounding the effects of central nervous system stimulants on growth parameters in children with ADHD.

Vaidya CJ, Stollstorff M.
Cognitive neuroscience of Attention Deficit Hyperactivity Disorder: current status and working hypotheses.
Dev Disabil Res Rev. 2008;14(4):261-7. PubMed abstract

Vetter VL, Elia J, Erickson C, Berger S, Blum N, Uzark K, Webb CL.
Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing.
Circulation. 2008;117(18):2407-23. PubMed abstract / Full Text

Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ.
Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011.
J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46.e2. PubMed abstract

Warikoo N, Faraone SV.
Background, clinical features and treatment of attention deficit hyperactivity disorder in children.
Expert Opin Pharmacother. 2013. PubMed abstract / Full Text

Weydert JA, Brown ML, McClafferty H.
Integrative Medicine in Pediatrics.
Adv Pediatr. 2018;65(1):19-39. PubMed abstract
Keywords: ADHD; Abdominal pain; Acupuncture; Complementary & alternative medicine (CAM); Integrative medicine; Massage; Mind–body therapy; Nutrition.

Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, Biederman J.
Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents.
Arch Pediatr Adolesc Med. 2008;162(10):916-21. PubMed abstract / Full Text

Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W.
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
Pediatrics. 2019;144(4). PubMed abstract / Full Text
This guideline revision provides incremental updates to the 2011 guideline on ADHD, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations; American Academy of Pediatrics (AAP).

Zimmer M, Desch L.
Sensory integration therapies for children with developmental and behavioral disorders.
Pediatrics. 2012;129(6):1186-9. PubMed abstract / Full Text
Occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan for children with developmental and behavioral disorders. Pediatricians and other clinicians should discuss the limitations of these therapies with parents.