Academic journal article Indian Journal of Psychiatry

Clinical Practice Guidelines for the Assessment and Management of Attention-Deficit/hyperactivity Disorder

Academic journal article Indian Journal of Psychiatry

Clinical Practice Guidelines for the Assessment and Management of Attention-Deficit/hyperactivity Disorder

Article excerpt

Byline: Ruchita. Shah, Sandeep. Grover, Ajit. Avasthi


Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. ADHD affects around 5%-7% of school-aged children. It is a neurodevelopmental disorder that runs a chronic course and causes significant impairments across various domains of everyday functioning, such as peer and social functioning, academic functioning, and occupational functioning across the lifespan. Besides the patient, ADHD also has significant negative impact on the caregivers. This guideline seeks to lay out guidelines for effective and comprehensive assessment, diagnosis, and management of ADHD. It attempts to update the previous guidelines taking into account the current state of evidence that can inform clinical practice. These guidelines ought to be read in conjunction with the earlier version of the treatment guidelines on ADHD as developed and published by the Indian Psychiatric Society in 2007.

Scope of This Document

This guideline provides a framework for diagnosis and management of ADHD in children and adolescents aged up to 18 years. In this document, the terms 'child' and 'children' represent all individuals below 18 years of age, unless specified otherwise. The term 'adolescent' represents individuals between 13 and 18 years of age. The term 'preschoolers' is used to indicate individuals who are below 6 years of age. These guidelines may not be applicable to adult patients who have ADHD as their treatment needs may be different. Finally, it is expected that recommendations made will have to be tailored to suit the needs of individual patients.

Assessment and Evaluation

A comprehensive assessment including detailed history, mental state, and physical examination is needed to reach the diagnosis and estimate the severity and impact of the disorder on the patient and caregivers. Comorbid developmental, psychiatric, and medical disorders and psychosocial or environmental factors such as family discord, parenting, and parental substance abuse that are directly relevant to the management should be assessed as far as possible. [Table 1] presents the components of a comprehensive assessment, and [Table 2] shows the clinical questions that need to be answered while undertaking the process of assessment.{Table 1}{Table 2}

The assessment of preschoolers, children, and adolescents for ADHD comprises clinical interviews with parents and the patient, as well as obtaining information directly or indirectly (through parent accounts) from other relevant sources and settings including preschool, daycare, and school. Information from teachers may be obtained by requesting for teacher observation reports (unstructured) or teacher ratings on a structured rating scale (See Rating scales Section). Such requests should be sent through parents after explaining to them the need for such information and seeking their and the child's explicit consent and assent. Parents or the child may be reluctant to initiate such a communication for several reasons, the most important being fear of the child being stigmatized. Clinicians must, as far as possible, explain to the parents the need of teacher report and how this can aid in assessment, diagnosis, and management. If the child and parents are still reluctant, then the clinicians may satisfy themselves through parent and child accounts of symptoms and functioning in the school setting and review of school work and report cards. Further, in the Indian context, the clinician may involve other family members such as grandparents, especially if the child resides in a joint or an extended family. This will provide additional important information, opportunities to understand methods the family uses to handle the problematic behaviors, and expectations and perceptions regarding and treatment of these behaviors.

It is important to remember that the histories may vary considerably depending on the informants' own perceptions regarding and tolerance toward such behaviors, their awareness, and opportunities for observations. …

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