Send to

Choose Destination
Pediatrics. 2019 Oct;144(4). pii: e20191682. doi: 10.1542/peds.2019-1682.

ADHD Diagnosis and Treatment Guidelines: A Historical Perspective.

Author information

University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma;
Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Mayo Clinic, Rochester, Minnesota; and.
University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma.
University of Vermont Children's Hospital, Burlington, Vermont.


Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral condition and the second most common chronic illness in children. The observance of specific behaviors in multiple settings have remained the most successful method for diagnosing the condition, and although there are differences in specific areas of the brain, and a high heritability estimate (∼76%), they are not diagnostically specific. Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy dating back to the 1970s. Likewise, behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy during the same time period. Both medication and behavioral interventions are symptomatic treatments. The availability of only symptomatic treatments places ADHD in the same category as other chronic conditions such as diabetes and asthma. Successful treatment of most individuals requires ongoing adherence to the therapy. Improved communication between patients and their families, primary and mental health providers, and school personnel is necessary for effective ADHD treatment. Further enhancement of electronic systems to facilitate family, school, and provider communication can improve monitoring of ADHD symptoms and functional performance. The American Academy of Pediatrics ADHD guidelines were initially developed to help primary care clinicians address the needs of their patients with ADHD and were further refined with the second revision in 2019.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Chan has a potential conflict of interest, in that she is a coinventor of the TriVox Health health information technology referenced in this article. In the future, it is possible that this technology will be sold commercially. If this were to occur, Dr Chan and Boston Children’s Hospital might receive financial benefits in the form of compensation. As in all research studies, the hospital has taken steps designed to ensure that this potential for financial gain does not endanger research subjects or undercut the validity and integrity of the information learned by this research; the other authors have indicated they have no potential conflicts of interest to disclose.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center