New Guidelines for Childhood Diagnoses

Pediatricians, psychiatrists, psychologists, mental health therapists and other behavioral health providers rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make accurate diagnoses of mental health disorders such as ADHD, learning disabilities, autism spectrum disorder (ASD), anxiety, and depression. While the DSM-5 lists the symptoms that must be present for a diagnosis to occur, it does not help professionals know how to conduct thorough assessments to reach the correct diagnostic conclusions. This gap is particularly important for pediatricians. Due to a shortage of mental health providers in the U.S., they are on the front lines of providing mental health services to millions of children and families. In fact, according to a recent survey, more than half of all children diagnosed with ADHD in the U.S. are diagnosed by their pediatricians, who are often the primary source of treatment, too.

Given new insights from research and clinical practice, the American Academy of Pediatricians (AAP) recently published updated guidelines for diagnosing ADHD and ASD in children.

The AAP published new guidelines in October 2019 for diagnosing and treating children and adolescents with ADHD. This new framework makes five important recommendations:

1. Look for co-occurring conditions, such as anxiety, depression, sleep apnea or autism. This suggestion reflects the frequency of co-existing conditions along with ADHD and minimizes the likelihood of misdiagnosis.
2. Team up with schools by helping families work with their child’s teachers. This suggestion emphasizes the importance of seeking teacher input on a child’s behavior when assessing someone for ADHD, given that behaviors at home and school may look different.
3. Provide ongoing care as the child ages. In most cases, the symptoms of ADHD do not go away as a child transitions to adulthood. Medications may need to be fine-tuned as the young person ages and enters different educational or occupational environments.
4. With preschoolers, try behavior therapy first. Parents often benefit from some training to know how to focus on behaviors, rather than understandable frustration with what can be viewed a “poor choices” by the child who struggles with self-regulation. If this early intervention doesn’t work, then consider medication(s).
5. Help families avoid treatments that are not evidence-based. While practices such as diet, biofeedback, mindfulness and the use of CBD oil may be popular with many families, they lack scientific proof that they work.

More recently, the AAP published new clinical recommendations for diagnosing and treating individuals with autism spectrum disorder (ASD). This report was released in January 2020 and emphasizes the important of early detection, since autism can now be diagnosed in children as young as 18 months of age. Similar to ADHD, ASD often co-exists with other disorders. Common examples include intellectual disability, anxiety disorders, ADHD, sleep disorders, and feeding and sleep issues. This document offers four broad recommendations to evaluators:

1. Conduct developmental and behavioral surveillance during all well visits, developmental screenings at the 9-, 18-, and 30 month visits, and ASD screenings at 18 and 24 months.
2. Encourage families to seek out evidence-based services that address social, academic and behavioral needs at home and school along with appropriate mental health, respite and leisure services.
3. Work with families of adolescents on the spectrum to develop a transition plan to adult care and services.
4. Inform families of the scientific evidence for various forms of treatment and encourage families to seek out support organizations and participate in clinical research programs.

It is our privilege and practice, here at CRG, to engage in these clinical practices when providing diagnostic and treatment services. We strive to conduct thorough evaluations to help families and individuals fully understand the range of strengths and weaknesses they are experiencing. This assessment work helps us form an individualized plan that guides families as they pursue evidence-based treatment services. We greatly value our close collaborations with pediatricians, educators, family members and others as we gather information and make recommendations to help our clients thrive.