Treatment of Attention-Deficit/Hyperactivity Disorder: Expert Consensus Guidelines

Abstract

Objective To develop treatment guidelines for attention-deficit/hyperactivity disorder (ADHD) based upon consensus among physicians and psychologists, particularly concerning aspects of management not yet well established by controlled research. Method Eighty questions regarding preferred modes of therapy, sequencing of treatments, developmental considerations, management of comorbid conditions, and partial response to treatment were developed by the authors. The survey was modified by expert consultants in psychology, psychiatry, neurology, pediatrics, and family practice. The survey was mailed to 50 psychologists and 51 physicians, with a 94% and 86% return rate, respectively. The survey used a modified version of the Rand Corporation Delphi method, and results were expressed statistically in terms of averages and confidence intervals. Results A high level of agreement between psychologists and psychiatrists was usually reached. First-line treatments were identified for most areas surveyed. Results were similar in most instances to practices recommended in guidelines developed by more qualitative methods. Conclusions Pharmacological and behavioral treatments for ADHD under a wide variety of conditions are well agreed upon by expert clinician-researchers. The resulting guidelines will provide reasonable guidance for most practice issues in ADHD until more controlled evidence is available.