KAS 1

The pediatrician or other primary care clinician should initiate an evaluation for ADHD for any child or adolescent age 4 years to their 18th birthday who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.

KAS 2

To make a diagnosis of ADHD, the primary care clinician should determine that Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria have been met, including documentation of symptoms and impairment in more than 1 major setting (ie, social, academic, or occupational), with information obtained primarily from reports from parents or guardians, teachers, other school personnel, and mental health clinicians who are involved in the child or adolescent’s care. The primary care clinician should also rule out any alternative cause.

KAS 3

In the evaluation of a child or adolescent for ADHD, the primary care clinician should include a process to at least screen for comorbid conditions, including emotional or behavioral conditions (eg, anxiety, depression, oppositional defiant disorder, conduct disorders, substance use), developmental conditions (eg, learning and language disorders, autism spectrum disorders), and physical conditions (eg, tics, sleep apnea).

KAS 4

ADHD is a chronic condition; therefore, the primary care clinician should manage children and adolescents with ADHD in the same manner that they would children and youth with special health care needs, following the principles of the chronic care model and the medical home.

KAS 5a

For preschool-aged children (age 4 years to the 6th birthday) with ADHD, the primary care clinician should prescribe evidence-based parent training in behavior management (PTBM) and/or behavioral classroom interventions as the first line of treatment, if available.

Methylphenidate may be considered if these behavioral interventions do not provide significant improvement and there is moderate to severe continued disturbance in the 4- through 5-year-old child’s functioning. In areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication before the age of 6 years against the harm of delaying treatment.

KAS 5b

For elementary- and middle-school-aged children (age 6 years to the 12th birthday) with ADHD, the primary care clinician should prescribe FDA-approved medications for ADHD along with PTBM and/or behavioral classroom intervention (preferably both PTBM and behavioral classroom interventions). Educational interventions and individualized instructional supports—including school environment, class placement, instructional placement, and behavioral supports—are a necessary part of any treatment plan and often include an Individual Education Program (IEP) or a rehabilitation plan (504 plan).

KAS 5c

For adolescents (age 12 years to the 18th birthday) with ADHD, the primary care clinician should prescribe FDA-approved medications for ADHD with the adolescent’s assent. The primary care clinician is encouraged to prescribe evidence-based training interventions and/or behavioral interventions as treatment for ADHD, if available. Educational interventions and individualized instructional supports—including school environment, class placement, instructional placement, and behavioral supports—are a necessary part of any treatment plan and often include an Individual Education Program (IEP) or a rehabilitation plan (504 plan).

KAS 6

The primary care clinician should titrate doses of medication for ADHD to achieve maximum benefit with tolerable side effects.