Attention deficit hyperactivity disorder (ADHD) affects an estimated 1.5-3.5 million children in the US alone. The main symptoms of ADHD are inattention, hyperactivity, and inability to control impulses. Because ADHD is the most common childhood neurobehavioral disorder, it is of particular concern for pediatricians. The American Academy of Pediatrics (AAP) published a set of guidelines in the May 2000 issue of Pediatrics to assist doctors in identifying the disorder in children ages 6-12 years. Because diagnosing ADHD in children younger than 6 years of age is difficult, the guidelines only apply to school-aged children.

The guidelines are the result of work by experts in medicine, mental health, and education. They analyzed thousands of studies on ADHD and searched for common indicators of the disorder. Although the Diagnostic and Statistical Manual-IV (DSM-IV), published by the American Psychiatric Association, lists ADHD among its disorders, the new guidelines from the AAP are designed to be user-friendly for primary care providers (physicians who do not specialize in mental disorders).

The guidelines, in brief, include:

1. A primary care provider (a pediatrician, for example) should evaluate a child who is having school or behavioral problems. These include difficulties with teachers, family, or peers.

2. The criteria in the DSM-IV for frequency of symptoms and the settings where they occur should be followed. These criteria are that the symptoms have a negative impact on the child's academic performance or social interactions for at least six months, and that the symptoms be present in at least two places, such as school and home.

3. Information about the symptoms should be obtained directly from the child's parent/guardian/caregiver, teacher, or school administrator. This information should include how long the symptoms last, in what settings they occur, and how much they affect the child's day-to-day functioning.

4. Co-existing conditions, such as language and learning problems, aggression, anxiety or depression should be determined. In as many as one-third of the children diagnosed with ADHD, these other conditions also occur, complicating the plan for treatment and management of the symptoms.

The goal of the new guidelines is to help physicians make an early and accurate diagnosis of ADHD, so children get treatment and support at school and home. Next, the American Academy of Pediatrics plans to compose guidelines for the treatment of ADHD.