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“The Guideline…is a first important step toward a more systematic approach to the diagnosis and treatment of children and adolescents with complex ADHD that embodies the philosophy of our interdisciplinary field.”1

  • William J Barbaresi, MD

“The Guideline…is a first important step toward a more systematic approach to the diagnosis and treatment of children and adolescents with complex ADHD that embodies the philosophy of our interdisciplinary field.”1

  • William J Barbaresi, MD
Need for a clinical practice guideline for complex ADHD

Attention-deficit/hyperactivity disorder (ADHD) has evolved from that of a discrete behavioral condition to a complex neurobiologic disorder with various associated comorbidities.2-4 It is now recognized that ADHD is usually accompanied by coexisting disorders and other complicating factors that may or may not be identified and adequately treated.5

  • Further, coexisting disorders that give rise to greater severity of functional impairments place children with ADHD at greater risk for adverse long-term outcomes5

In light of this, the American Academy of Pediatrics (AAP) practice update of 2019 concluded that the majority of pediatric patients with ADHD also meet the criteria for another mental health disorder.6

SDBP clinical practice guideline represents a new paradigm in complex ADHD management1

In January 2020, the Society for Developmental and Behavioral Pediatrics (SDBP), a panel of developmental-behavioral pediatricians, psychologists, and nurse practitioners, introduced the first-ever clinical practice guideline for patients with complex ADHD.5

The guideline was developed specifically to help guide diagnosis and treatment decisions in complex ADHD.5

  • It provides a broader perspective on conditions that define complex ADHD, including neurodevelopmental disorders, mental health disorders, and socioeconomic factors5
  • It also helps identify current gaps in disease research and management1,5
“The SDBP guideline is intended to complement the 2019 AAP guideline and to be useful for clinicians from multiple disciplines, as well as for educational professionals who have specialized training and/or expertise that equips them to provide care for children and adolescents with complex ADHD.”7

– Dr. Frank Lopez, MD

Behavior Disorders and ADHD

Key recommendations of the SDBP guideline5

Recommendation
Strength of Evidence
Recommendation

Development of a multimodal treatment plan for children and adolescents with suspected complex ADHD initiated by clinicians with specialized expertise/training

Strength of Evidence

Grade B—Strong Recommendation

Recommendation

Use of an evidence-based approach to assess for comorbid conditions, including their severity and associated functional impairment

Strength of Evidence

Grade B—Strong Recommendation

Recommendation

Psychoeducation to address all functional domains (behavioral, social, and academic)

Strength of Evidence

Grade B—Strong Recommendation

Recommendation

Treatment of complex ADHD focused not only on symptom management, but on prevention of adverse outcomes (eg, depression and anxiety)

Strength of Evidence

Grade C to B—Recommendation to Strong Recommendation

Recommendation

Monitoring of patients throughout their lives, with emphasis on key developmental periods (eg, school transitions), given chronic nature of ADHD

Strength of Evidence

Grade B—Strong Recommendation

“We need a paradigm shift, and it is my hope that the Guideline and the continued efforts of everyone who cares for and about children and adolescents with ADHD will help to make this change for the benefit of children and their families.”1

– William J Barbaresi, MD

How will this new SDBP guideline inform your practice?

The SDBP guideline underscores that assessment and treatment of children with complex ADHD require a multimodal approach from multiple systems (eg, healthcare, education, etc) to ensure the best possible outcomes.5 Learn more about psychiatric comorbidities here.

More to ADHD

Visit our patient site for resources designed for parents of children and adolescents with ADHD.

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References:1. Barbaresi WJ. The SDBP Complex ADHD Clinical Practice Guideline: it’s about time. J Dev Behav Pediatr. 2020;41 Suppl 2S:S33–S34. 2. Koolwijk I, Stein DS, Chan E, Powell C, Driscoll K, Barbaresi WJ. “Complex” attention-deficit hyperactivity disorder, more norm than exception? Diagnoses and comorbidities in a developmental clinic. J Dev Behav Pediatr. 2014;35:591–597. 3. Brown TE. Developmental complexities of attentional disorders. In: Brown TE, Ed. ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults; Arlington, VA: American Psychiatric Publishing Inc; 2009:3-23. 4. Shaw P, Polanczyk GV. Combining epidemiological and neurobiological perspectives to characterize the lifetime trajectories of ADHD. Eur Child Adolesc Psychiatry. 2017;26(2):139-141. 5. Barbaresi WJ, Campbell L, Diekroger EA, et al. The Society for Developmental and Behavioral Pediatrics Clinical Practice Guidelines for the Assessment and Treatment of Children and Adolescents With Complex Attention-Deficit Disorder: process of care algorithms. J Dev Behav Pediatr. 2020;41(suppl 2S):S58–S74. 6. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement Management, Wolraich M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144(4):e20192528. 7. Data on file. Supernus Pharmaceuticals.