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Pediatrics. 2019 Oct;144(4). pii: e20192528. doi: 10.1542/peds.2019-2528.

Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.

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Section of Developmental and Behavioral Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma.
Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont, Burlington, Vermont.
Hagan, Rinehart, and Connolly Pediatricians, PLLC, Burlington, Vermont.
Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts.
Harvard Medical School, Harvard University, Boston, Massachusetts.
Children and Adults with Attention-Deficit/Hyperactivity Disorder, Lanham, Maryland.
Dale Davison, LLC, Skokie, Illinois.
Community Care of North Carolina, Raleigh, North Carolina.
School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Department of Psychology, Ohio University, Athens, Ohio.
Center for Intervention Research in Schools, Ohio University, Athens, Ohio.
American Academy of Pediatrics, Alexandria, Virginia.
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Swope Health Services, Kansas City, Kansas.
American Academy of Family Physicians, Leawood, Kansas.
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, Tennessee.
The Children's Medical Group, Poughkeepsie, New York.
American Academy of Pediatrics, Itasca, Illinois.
American Academy of Child and Adolescent Psychiatry, Washington, District of Columbia.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Atlanta, Georgia; and.
Holderness, New Hampshire.


Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the American Academy of Pediatrics board of directors. Dr Allan reports a relationship with ADDitude Magazine; Dr Chan reports relationships with TriVox Health and Wolters Kluwer; Dr Lehmann reports relationships with International Medical Informatics Association, Springer Publishing, and Thieme Publishing Group; Dr Wolraich reports a Continuing Medical Education trainings relationship with the Resource for Advancing Children’s Health Institute; the other authors have indicated they have no potential conflicts of interest to disclose.

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