The National Center for Evidence-Based Practice
in Communication Disorders
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Summary of Clinical Practice Guideline

Institute for Clinical Systems Improvement

ADHD, Attention Deficit Hyperactivity Disorder in Primary Care for School-Age Children and Adolescents, Diagnosis and Management
Dobie, C., Donald, W. B., et al. (2012).
Bloomington (MN): Institute for Clinical Systems Improvement, 80 pages.

AGREE Rating: Highly Recommended

Description:
This guideline provides recommendations for assessment and treatment of school-age children and adolescents with attention-deficit hyperactivity disorder (ADHD). The target audience of this guideline is the primary clinician. Levels of evidence are provided and defined as:

  • High quality evidence - further research is very unlikely to change our confidence in the estimate of effect.

  • Moderate quality evidence - further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

  • Low quality evidence - further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate or any estimate of effect is very uncertain.

Recommendations:

Social Communication Disorders

  • Assessment/Diagnosis/Screening

    • Assessment Areas

      • Cognition/Language

        • Patient Perspectives: Learning/behavior problems associated with ADHD as identified by parents include social/emotional “immaturity,” as identified by school personnel include social interaction problems (impulsivity and intrusiveness), and as identified by children and adolescents include lack of close or long-term friendships (pp. 12-13).

        • “During evaluation and management visits, take into consideration medical, psychosocial [e.g., social functioning], and educational factors” (p. 44).

        • Differential diagnosis and assessment of comorbidity in children with ADHD should include family/psychosocial problems (e.g., social skills deficits) and speech/language problems (e.g., expressive/receptive language disorder) (p. 19).

        • “It is not uncommon for children with autism spectrum disorders [a disorder in which qualitative impairment in social interaction is the hallmark] to present with ADHD features” (p. 23).

        • “Children with difficulties in the pervasive developmental disorder [PPD]/autism spectrum can sometimes present with symptoms similar to ADHD.  Identifying features of PDD/autism from the speech/language standpoint include socially inappropriate behaviors (e.g., screaming, interrupting) and loss of previously acquired language skills” (p. 27).

        • “If speech and language problems suggestive of a pervasive developmental disorder are present, referral should be made to a developmental or mental health professionals with a speech and language pathologist as a part of the diagnostic team” (p. 27).

    • Screening Areas

      • Cognition/Language

        • “If screening indicates concerns about a child’s speech and/or language-including expressive and receptive language, speech fluency, pragmatic language, prosody, or phonology/articulation-a referral should be made to a pediatric speech and language pathologist” (p. 26).

        • “Screen for comorbid conditions that occur commonly with ADHD [such as speech/language, family/psychosocial, and academic/learning problems]” (p. 30).

  • Treatment

    • Cognition/Language

      • General Findings

        • The various target skills may include maintaining eye contact, initiating and maintaining conversation, sharing, and cooperating” (p. 42).

        • “During evaluation and management visits, take into consideration medical, psychosocial [e.g., social functioning], and educational factors” (p. 44).

      • Pragmatic/Social Skills

        • General Findings

          • “Consider the need for social skills training to improve peer relationships that are often negatively affected by ADHD symptoms (e.g., impulsivity)" (p. 41).

  • Service Delivery

    • Format

      • "Social skills training (group or individual) instructs children in the execution of specific prosocial behaviors" (Low Quality Evidence; High Quality Evidence) (p. 42).

Keywords:
Autism Spectrum Disorders

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