After six years of study, the American Academy of Pediatrics (AAP) has expanded its guidelines for the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) to cover both preschoolers and adolescents.

The previous guidelines issued a decade ago were limited to children ages 6 to 12, but advances in research have allowed the new guidelines to include children ages 4 to 18. “ADHD is a chronic condition, and it requires treatment on an ongoing basis,” says Mark Wolraich, MD, lead author of the report announcing the new guidelines. “We’re trying to provide clinicians with more specific criteria for making a diagnosis.”

The report, published in November in Pediatrics, recommends that preschoolers with ADHD receive behavioral interventions first, such as parent training in behavior management techniques. If those interventions fail, then methylphenidate (Ritalin) may be considered only for moderate to severe symptoms. There is some evidence showing benefits of methylphenidate in preschoolers with ADHD, but its effects on brain development in young children aren’t clearly understood. The Food and Drug Administration hasn’t approved the use of most stimulants for children under age 6, although physicians are allowed to prescribe the drugs off label, says Wolraich, director of the Child Study Center at the University of Oklahoma Health Sciences Center.

About 9.5 percent of kids age 4 to 17 in the United States have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. More than half of them take prescription drugs. Most children with ADHD don’t take medications for more than three years, with many youths developing coping mechanisms as they get older, Wolraich says.

The report recommends both FDA-approved medications and behavioral interventions for elementary school children and adolescents. The AAP also created a single algorithm to guide clinicians in the diagnosis and treatment of ADHD, along with the consumer guide ADHD: What Every Parent Needs to Know.

—B.L. Smith