New ADHD statements aimed at helping primary care providers improve diagnosis and treatmentAdapted from a commentary by Dr. Stacey Bélanger, originally published in Paediatrics & Child Health

Three new position statements on attention deficit hyperactivity disorder will help primary care providers diagnose and treat this prevalent neurodevelopmental disorder.

Developed by the CPS Mental Health and Developmental Disabilities Committee, the statements include a summary of the current clinical evidence on ADHD, and establish a standard for ADHD care so that Canadian clinicians can make well-informed, evidence-based decisions.

The clinical diagnosis of ADHD is challenging, limited by a lack of reliable diagnostic biomarkers and symptom specificity. The current gold standard for an ADHD diagnosis is based on subjective reports and observational rating scales from caregivers, teachers, and the patient. Although there are assessment tools to document DSM criteria and monitor treatment response or side effects, these measures are open to rater biases and fail to account for the developmental nature of symptoms. Impairment attributable to ADHD relates not only to the symptoms, but also to the demands of the context in which they manifest. There is an increasing need to find objective markers for the disorder to refine diagnosis, assess the efficacy of the therapies and improve follow-up strategies.

ADHD in children and youth: Etiology, diagnosis and comorbidity: This statement describes symptoms, features and impairments associated with ADHD and key points of etiology, particularly its strongly heritable nature and the role of neurological, environmental and psychosocial factors in maintaining and exacerbating its impairments.

ADHD in children and youth: Treatment:  This statement provides a summary of the evidence-based treatments for ADHD, including non-pharmacological interventions such as parent behavior training and exercise.

ADHD in children and youth: Assessment and treatment with Autism spectrum disorder (ASD), ID or prematurity: This statement describes how ADHD, a heritable neurodevelopmental disorder, shows clinical and genetic overlap with other childhood neurodevelopmental disorders.

Paediatricians and family physicians are often the first point of contact for families of children and youth with ADHD and comorbidities. The majority of patients with these conditions are diagnosed and treated in community clinics. Residency training programs for paediatricians and family physicians must incorporate behavioural, developmental and mental health training including ADHD diagnosis and treatment among its explicit learning objectives and take measures to ensure this objective is being met.

To access all the statements, visit www.cps.ca or consult the print edition of Paediatrics & Child Health (November 2018). 

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