小结
定义
História e exame físico
Principais fatores diagnósticos
- inability to give close attention to details or making "careless" mistakes in schoolwork, work, or other activities
- difficulty sustaining attention in tasks or play activities
- does not seem to listen when spoken to directly
- does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
- often has difficulty organizing tasks and activities
- avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- easily distracted by extraneous stimuli
- forgetful in daily activities
- fidgets or taps with hands or feet or squirms in seat
- leaves seat in classroom or in other situations in which remaining seated is expected
- runs about or climbs excessively during inappropriate situations
- difficulty playing or engaging in leisure activities quietly
- often "on the go" or acts as if "driven by a motor"
- often talks excessively
- often blurts out answers before questions have been completed
- often has difficulty awaiting turn
- often interrupts or intrudes on others (e.g., butts into conversations or games)
Outros fatores diagnósticos
- mild mood symptoms (dysphoria, mood lability, irritability, boredom)
- anxiety
- difficulty with peer interactions
- low self-esteem
- working memory (i.e., short-term memory) impairment
- processing speed impairment (i.e., the rate at which information is dealt with)
Fatores de risco
- family history of ADHD
- male sex
- low birth weight
- epilepsy
- tic disorders
- maternal nicotine use during pregnancy
- maternal acetaminophen use during pregnancy
- obstetric complications in pregnancy or labor
- gestational exposure to stress
- psychosocial adversity
- lead exposure
- traumatic brain injury
- severe early deprivation
- iron deficiency
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- no formal laboratory or imaging studies
Tests to avoid
- hair analysis
Investigações a serem consideradas
- neuropsychological testing
Algoritmo de tratamento
preschool-age children: 4-6 years
school-age children: 6-18 years
Colaboradores
Autores
Mark Wolraich, MD
Shaun Walters Professor Emeritus, Pediatrics
Section of Developmental and Behavioral Pediatrics
University Oklahoma Health Sciences
Oklahoma City
OK
Declarações
MW is a member of the steering committee of the REACH Institute providing CME programs on child mental health.
Agradecimentos
Dr Mark Wolraich would like to gratefully acknowledge Dr Lawrence W. Brown, Dr Kristin S. Russell, Dr Howard Y. Liu, and Dr Michael S. Jellinek, previous contributors to this topic.
Declarações
LWB was reimbursed by Sunovion for participation in a Medical Advisory Board. KSR, HYL, and MSJ declare that they have no competing interests.
Revisores
Joseph F. Hagan, Jr. MD, FAAP
Clinical Professor in Pediatrics
The Larner College of Medicine at the University of Vermont
Burlington
VT
Declarações
JFH served as Vice-Chairman of the American Academy of Pediatrics' ADHD Clinical Guidelines revision alongside the author of this topic, MW, who was Chairman. They also co-authored the book "ADHD: What Every Parent Needs to Know, 3rd. Ed.", published by the AAP.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
World Health Organization. ICD-11 International statistical classification of diseases and related health problems, 11th revision. Geneva: WHO; 2022.Texto completo
Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019 Oct;144(4):e20192528.Texto completo Resumo
Faraone SV, Banaschewski T, Coghill D, et al. The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021 Sep;128:789-818.Texto completo Resumo
Barbaresi WJ, Campbell L, Diekroger EA, et al. Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr. 2020 Feb/Mar;41 Suppl 2S:S35-S57.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
鉴别诊断
- Learning/language disorder
- Oppositional defiant disorder
- Depression
Mais Diagnósticos diferenciais指南
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR)
- Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents
Mais 指南患者教育信息
ADHD: what is it?
ADHD in children: what treatments work?
更多 患者教育信息
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