Amid growing worry about increasing diagnosis of attention deficit hyperactivity disorder -- and related fears that too many young children are receiving prescription medication for it -- the nation's pediatricians have issued guidelines aimed at standardizing the diagnosis and helping doctors identify which children need help.
The new guidelines, published recently in the journal Pediatrics, are based on the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, an 846-page bible of behaviors published in 1994 by the American Psychiatric Association.
To meet the diagnosis of ADHD, a child must show at least six forms of marked inattention or hyperactivity in at least two settings, such as home and school. The symptoms must harm the child's school performance or social functioning for six months or more.
''What we're hoping for is closer teamwork among parents, teachers and doctors'' in applying the diagnostic criteria for ADHD, said James Perrin, a pediatrician at Harvard Medical School who was co-chairman of a panel of experts that developed the new guidelines. One reason the panel was formed is that the DSM-IV criteria are ''not user-friendly to primary-care physicians,'' Perrin said. As a result, he said, pediatricians and family doctors often are unfamiliar with the precise ADHD criteria. That causes some children to be inaccurately labeled as having ADHD, while others with symptoms are overlooked.
The new guidelines emphasize the importance of rigorously documenting symptoms both at home and at school, and they note that overlapping conditions, such as depression or learning disabilities, can complicate diagnosis. Treatment guidelines, still under consideration by the panel, are expected by early next year.
Recent surveys estimate that between 4 percent and 12 percent of school-age children -- three-quarters of them boys -- have ADHD. Symptoms include short attention span, impulsive behavior and inability to focus and hold still.
Prescription of stimulant drugs such as Ritalin has increased dramatically in the past decade, prompting concern about overdiagnosis of ADHD in children who are merely rambunctious or inattentive. Wide variations in the frequency of ADHD diagnosis from community to community have added to the controversy.
The pediatric guidelines are intended for use by primary-care doctors evaluating children 6 to 12 years old ''in relatively uncomplicated cases.'' They are not for use in victims of child abuse or children with mental retardation, serious vision or hearing impairment or chronic disorders treated with medication that affects behavior.
No simple test exists for ADHD. Screening for lead levels in the blood, brain scans and tests for abnormal thyroid hormone -- sometimes erroneously considered positive indicators of ADHD -- are ineffective in diagnosing the disorder, the panel found.
For the full ADHD guidelines, see the American Academy of Pediatrics Web site: www.aap.org.
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