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The decision of primary care providers to initiate treatment for attention-deficit/hyperactivity disorder (ADHD) in child and adolescent populations is a difficult choice that will be encountered often. ADHD is the most chronic health condition affecting school-aged children, with a prevalence of 8% in children and youth. Beyond academic underachievement and increased risk for accidental injury, children with ADHD may experience troublesome interpersonal relationships with family members and peers that contribute to the development of low self-esteem. More importantly, children left untreated for ADHD are at risk of developing substance abuse. Assessment, management, and treatment of ADHD can improve the educational and psychosocial development of most afflicted children and youth. The American Academy of Pediatrics (AAP) recognizes that younger ages, coexisting conditions, and other concerns make the decision to treat increasingly pertinent, yet difficult for outpatient providers to perform. Specifically, intellectual disability, autistic spectrum disorder, moderate to severe sensory deficits, and physical, emotional, or sexual abuse, represent patient populations that would benefit from specialist referral or collaboration (see Table 1). There is also a high prevalence of coexisting conditions such as Oppositional Defiant Disorder (ODD) (35%), mood disorder (18%), anxiety disorder (25%), and learning disabilities (12-60%), which require evaluation, but do not preclude treatment for ADHD if diagnostically present. The aim of this article is to provide a synopsis of the recommended changes and process of care algorithm developed by the AAP Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, recently developed to streamline the diagnosis and treatment of ADHD by either family physicians or pediatricians on an outpatient basis.

Evaluating and Treating ADHD in Primary Care Settings with Updated AAP Guidelines