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Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders in children. This chronic, often lifelong condition can negatively affect academic achievement, well-being, and social interactions. Symptoms will continue into adolescence for the majority, and into adulthood for about half of diagnosed children. Adults with ADHD are more likely to experience comorbid psychiatric disorders, display higher rates of antisocial behaviors, and may be at an increased risk of death.1 West Virginia (WV) is particularly affected by this disorder; the West Virginia prevalence of ADHD in children is well over the national average (13.2% versus 8.6%), as is use of prescription stimulant medications.2 To further its effect, WV also has a shortage of pediatricians and mental health providers to treat patients with ADHD. Nationally, the American Academy of Pediatrics notes the prevalence of ADHD is higher than can be managed by the current mental health system, so general clinicians are heavily relied on for treatment, especially in a state where there is a shortage of specialists and an increased prevalence.

Treatment of ADHD can be complex and often lifelong in many cases, particularly because patients often have coexisting conditions. This complex treatment requires a skilled clinical team that provides continuous care for patients and their families throughout their lifespan and across various conditions. Many patients in WV live in rural areas, geographically limiting their access to specialists and/or regular clinical monitoring of the ongoing treatment of their condition. Unless patient-specific factors present, prescription stimulants are first-line treatment of ADHD in patients 6 years of age and older. While these medications have a high level of evidence to support their use, prescription stimulants can cause dependence and have a potential for misuse and diversion. In fact, 1.8%, or approximately 5.1 million, of the U.S. population aged 12 years and older misused prescription stimulants in 2020, and 0.3%, or about 758,000 people, had a prescription stimulant use disorder.3 This growing misuse of prescription stimulants should not deter clinicians from their use in patients with a legitimate medical need and appropriate diagnosis, but rather it should highlight the importance and need for adequate education and training on the evaluation, diagnosis, and treatment of ADHD.

In an effort to assist with ensuring West Virginia clinicians have adequate resources to evaluate and manage ADHD across the lifespan, a panel of experts from across the state convened to author guidelines for the evaluation, diagnosis and treatment of ADHD in children, adolescents, and adults. These guidelines are available online for easy access to diagnostic flow charts, treatment options (pharmacological and nonpharmacological), conversion charts, risk reduction strategies, and more.


1. Barbaresi, W.J., Colligan, R.C., Weaver, A.L., et al. 2013. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics. 131(4): 637-44. https://doi.org/10.1542/peds.2012-2354.

2. National Center for Health Statistics. Health, United States, 2019. Hyattsville, Maryland. 2021. https://www.cdc.gov/ncbddd/adhd/data/diagnosis-treatment-data.html

3. U.S. Department of Health and Human Services. 2021. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. SAMHSA. 17-18. Available at:https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/

General disclaimer:
This content is not intended to address all possible diagnosis methods, treatments, follow up, drugs or their related contraindications or side effects. Standards of practice change as new data becomes available. Therefore, it is strongly recommended that practitioners independently assess and verify diagnosis, treatments and drugs for each individual patient. The authors of the WV ACC guidelines assume no liability for any aspect of treatment administered by a practitioner with the aid of this publication.

Drug disclaimer:
The authors do not endorse or recommend the use of any particular drug mentioned in this publication. Before prescribing a new drug to a patient, practitioners are advised to check the product information accompanying each drug to ensure it is appropriate for a specific patient and to identify appropriate dosage, contraindications, side effects and drug-to-drug interactions.

Standard of care disclaimer:
This publication is not intended to establish a standard of care applicable to practitioners who treated patients diagnosed with ADHD. “Standard of care” is a legal term, not a medical term, which refers to the degree of care a reasonable practitioner would exercise under the same or similar circumstances. The standard of care is a continuum and does not imply optimal care. Practitioner discretion and clinical judgment are paramount and this publication is only intended to aid practitioners’ judgment, not to serve as a substitute for said judgment.