Chapter 10: Special Population: Children and Adolescents

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

• –USPSTF. Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care. 2013.

• –https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/

• –Ann Fam Med. 2010;8(6):484-492.

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 criteria^a 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)