The Agency for Healthcare Research and Quality (AHRQ)(2020), created the Evidence-based
Practice Centers (EPCs) in 1997 to conduct evidence reports for the Effective Health Care (EHC)
Program. The EPCs are housed at universities, medical centers, and research institutions in the
United States. The EPCs produce evidence reports on medications, devices, and other health care
services for the EHC Program with the goal of helping consumers, health care professionals, and
policymakers make informed and evidence-based health care decisions. Each EPC is made up of
medical researchers from a broad range of clinical health and scientific backgrounds. The people
who conduct research at the EPCs are medical doctors, pharmacy doctors, psychologists,
physical therapists, and other medical specialists. In addition, they are also trained in different
types of health research such as epidemiology, health services research, and organizational
change research (Agency for Healthcare Research and Quality, 2020).
For the subject of this topic I chose to review the AHRQ’s EPC Attention Deficit Hyperactivity
Disorder: Diagnosis and Treatment in Children and Adolescents. The primary focus of this EPC
is based on the diagnosis and management of ADHD within the primary care practice setting or
other settings in which care can be coordinated by primary care providers. This includes
treatment of ADHD in childhood and adolescence, as well as, reviews outcomes in adulthood
from treatment that occurs during childhood or adolescence. This EPC is an updated review from
a 2011 EPC that focused on the effectiveness of ADHD treatment in at-risk preschoolers, the
long-term effectiveness of ADHD treatment in all ages, and the variability in ADHD prevalence,
diagnosis, and treatment, and addresses important gaps in knowledge related to the diagnosis and
labeling of ADHD, and conflicting literature about the effectiveness of treatment (Agency for
Healthcare Research and Quality, 2018).
This subject is a very personal subject for me as I have two children that have been diagnosed
with Attention Deficit Hyperactivity Disorder (ADHD). Attention deficit hyperactivity disorder
(ADHD) is a childhood-onset neurodevelopmental disorder with a prevalence of 1.4-3.0%
(Thapar & Cooper, 2016). Recent studies have shown that the number of children diagnosed with
ADHD can be as high as 15% (Roy et al., 2020). It is more common in boys than girls and is
characterized by developmentally inappropriate and impairing inattention, motor hyperactivity,
and impulsivity, with difficulties often continuing into adulthood. The diagnosis of ADHD or
hyperkinetic disorder also requires the presence of symptoms across more than one setting (eg,
home and school) and requires that the symptoms needed for diagnosis result in impairment, for
example in academic, social, or occupational functioning (Thapar & Cooper, 2016).
There are several causes that are associated with ADHD. Causes of ADHD are multifactorial.
Genes, environments, and interactions among them may all contribute to the development of
ADHD. As a highly heritable disease, maternal history of ADHD is a strong risk factor for
childhood ADHD. Among environmental risk factors, maternal and paternal age at parenthood
has been shown to play an important role (Wang et al., 2019). Other risk factors such as prenatal
(tobacco use, alcohol use, substance abuse), perinatal (low birth weight, prematurity), and early
postnatal factors (lead exposure, social environment) can contribute to this illness. It has been
suggested that as many as “35% of ADHD cases may develop from environmental factors such
as pregnancy and birth complications” (Eme, 2020; Thapar & Cooper, 2016).
Treatment strategies for ADHD can be divided into pharmacologic and nonpharmacologic
therapy. Stimulants such as methylphenidate and dexamphetamine are the first-line
pharmacological treatments for ADHD, and the noradrenaline reuptake inhibitor atomoxetine is
the second-line treatment. The only non-pharmacological interventions that currently form a core
part of treatment guidelines are behavioral interventions such as psychosocial interventions,
behavioral interventions, school interventions, and cognitive training therapies (Thapar &
Cooper, 2016).
The report’s recommendation is for testing to be performed by a primary care provider with
behavior rating scales based on two separate settings such as home and school. Confirmation of
diagnosis should be based on DSM-5 criteria and treatment should be based on a complete
diagnosis which may include one or both pharmacologic and nonpharmacologic treatments. Each
type of treatment can be adjusted based on the responsiveness of the patient. The report suggests
that behavioral interventions would be an optimal treatment plan; however, more research is
needed. “Direct your children onto the right path, and when they are older, they will not leave it”
(New International Bible, 1973/2011, Proverbs 22:6).
References
New International Bible. (2011). New International Version Online.
https://www.biblica.com/bible/ (Original work published in 1973)
Agency for Healthcare Research and Quality. (2018). Attention deficit hyperactivity disorder:
Diagnosis and treatment in children and adolescents. Effective Health Care
Program. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-203-adhd-
final_0.pdf
Agency for Healthcare Research and Quality. (2020). Evidence-based practice centers.
Effective Health Care Program. https://effectivehealthcare.ahrq.gov/about/epc
Eme, R. (2020). Are there prenatal risk factors for ADHD? The ADHD Report, 28(2), 6-
9,12. https://doi.org/10.1521/adhd.2020.28.2.6
New International Bible. (2011). New International Version Online.
https://www.biblica.com/bible/ (Original work published in 1973)
Roy, A., Garner, A. A., Epstein, J. N., Hoza, B., Nichols, J. Q., Molina, B. S., Swanson, J. M.,
Arnold, L. E., & Hechtman, L. (2020). Effects of childhood and adult persistent
attention-deficit/Hyperactivity disorder on risk of motor vehicle crashes: Results from
the multimodal treatment study of children with attention-deficit/Hyperactivity
disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 59(8),
952-963. https://doi.org/10.1016/j.jaac.2019.08.007
Thapar, A., & Cooper, M. (2016). Attention deficit hyperactivity disorder. The
Lancet, 387(10024). http://dx.doi.org.ezproxy.liberty.edu/10.1016/S0140-
6736(15)00238-X
Wang, X., Martinez, M. P., Chow, T., Walthall, J. C., Guber, K. M., & Xiang, A. H. (2019).
Attention-deficit hyperactivity disorder risk: Interaction between parental age and
maternal history of attention-deficit hyperactivity disorder. Journal of Developmental &
Behavioral Pediatrics, 40(5), 321-329. https://doi.org/10.1097/dbp.0000000000000669
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