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AAP: Start Screening for ADHD @ 4 years old

Posted Oct 18 2011 3:01am
Just like the AAFP (American Academy of Family Physicians) , the AAP (American Academy of Pediatrics) gets together annually (this week in Boston) for its National Conference & Exhibition , their big continuing medical education conclave.  What hit the news yesterday morning was an early release of their latest guidelines for screening & management of children w/ADHD (attention deficit hyperactivity disorder) .  Specifically, the AAP now advocates screening for ADHD in children as young as 4yo.  Furthermore, we are to consider this diagnosis in children up to 18yo, which is a dramatic expansion from the previous 6-12yo age range.  

As far as interventions go, it's suggested that we consider behavioral modifications for the pre-schoolers.  Evidence supports use of medication plus behavioral modifications in the 6-11yo range while the evidence is weaker for behavioral modifications in the older group >12yo, where medications would be first-line.  As expected, it's suggested that we aim for maximal benefit w/minimal side effects.  No surprise there!  Nor should it be any surprise that we should look for other causes of similar symptoms & behavior.

For those who believe in conspiracy theory, most of the subcommittee members had no conflicts (or at least did not report any).  However, it should be noted that the chair of the subcommittee has a relationship w/4 pharmaceutical companies that manufacture medications aimed at ADHD.  And one co-author has performed research supported by a pharmaceutical company and has written 2 books on ADHD for which he continues to receive royalties from said book. 
In a real sense, this is similar to the controversy I stirred up last week commenting on latest findings linking multivitamins & assorted dietary supplements to increase mortality in post-menopausal women  and vitamin E to prostate cancer in men .  Critics of the lay media (read supplement industry) complained that the study was flawed and that sound bites ignore the complexity of the issue.  And you know what?  They're correct.  But I don't think we should throw out the baby with the bath water, nor should we ignore these new findings.

Likewise, just as many parents are thankful for the advent of new medications to help their children, others complain of the over-medication of our youth for a diagnosis that didn't exist several decades ago, so the argument goes.  As a physician, I think our role is to offer help to parents & children in need of assistance w/o forcing them to do something they don't want to do or believe in.  Here is our opportunity to consider doing so at a younger age.
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