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ALCOHOL ABUSE AND DEPENDENCE

Population

  • –Children and adolescents.

Recommendation

AAFP 2010, USPSTF 2013, ICSI 2010

  • –Insufficient evidence to recommend for or against screening or counseling interventions to prevent or reduce alcohol misuse by adolescents.

Sources

Comments

  1. AUDIT and CAGE questionnaires have not been validated in children or adolescents.

  2. Reinforce not drinking and driving or riding with any driver under the influence.

  3. Reinforce to women the harmful effects of alcohol on fetuses.

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Population

  • –Children age 4–18 y with academic or behavioral problems and inattention, hyperactivity, or impulsivity.

Recommendations

AAFP 2016, AAP 2011, NICE 2018

  • –Do not screen routinely

  • –Initiate an evaluation for ADHD for any child 4–18 y who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. Diagnosis requires that the child meets DSM-IV criteriaa and direct supporting evidence from parents or caregivers and classroom teacher.

  • –Evaluation of a child with ADHD should include assessment for coexisting disorders and alternative causes of the behavior.

Sources

  • –AAFP. Clinical Recommendation: ADHD in Children and Adolescents. 2016.

  • Pediatrics. 2011;128(5):1007.

  • Pediatrics. 2000;105(5):1158.

  • –NICE. Attention Deficit Hyperactivity Disorder: Diagnosis and Management. 2018. nice.org.uk/guidance/ng87

Comments

  1. Stimulant prescription rates continue to rise. (Lancet. 2016.387(10024);1240-1250)

  2. Current estimates are that 7.2% of children/adolescents meet criteria for ADHD. (Pediatrics. 2015;135(4):e994.)

  3. The U.S. Food and Drug Administration (FDA) approved a “black box” warning regarding the potential for cardiovascular side effects of ADHD stimulant drugs. (N Engl J Med. 2006;354:1445)

aDSM-IV Criteria for ADHD:

I: Either A or B.

A: Six or more of the following symptoms of inattention have been present for at least 6 mo to a point that is disruptive and inappropriate for developmental level. Inattention: (1) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. (2) Often has trouble keeping attention on tasks or play activities. (3) Often does not seem to listen when spoken to directly. (4) Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). (5) Often has trouble organizing activities. (6) Often avoids, dislikes, or does not want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). (7) Often loses things needed for tasks and activities (eg, toys, school assignments, pencils, books, or ...

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