DOI: 10.11648/j.frontiers.20260903.11 ISSN: 2994-7197

Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Contemporary Advances in Diagnosis and Management-A Clinical Update

Vicente Cardenas
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Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and is associated with substantial academic, behavioral, social, emotional, and health-related burdens. Contemporary care extends beyond symptom identification to include developmentally informed assessment, recognition of comorbidities, shared decision-making, and measurement-based multimodal treatment. Objective: To provide an updated, clinically oriented synthesis of current evidence on the epidemiology, neurobiology, diagnosis, differential diagnosis, comorbidities, treatment, monitoring, and long-term management of ADHD in children and adolescents. Methods: This narrative clinical review used a focused PubMed/MEDLINE search covering January 1, 2018, through August 22, 2026, supplemented by foundational publications and authoritative guidance from the American Academy of Pediatrics, National Institute for Health and Care Excellence, US Food and Drug Administration, Centers for Disease Control and Prevention, and National Institute of Mental Health. The search identified 183 records for initial consideration. Evidence was selected purposively according to pediatric relevance, methodological rigor, clinical applicability, and regulatory status. Results: ADHD is a heterogeneous disorder arising from complex genetic, neurobiological, and environmental influences. Diagnosis remains clinical and requires developmentally inappropriate symptoms, functional impairment, childhood onset, and manifestations in more than one setting, while excluding alternative explanations. Rating scales support but do not replace comprehensive clinical assessment. Comorbid learning, anxiety, depressive, oppositional, autism spectrum, tic, sleep, and substance-use disorders can substantially influence presentation and management. Behavioral parent training is recommended as first-line treatment for preschool-aged children. For most school-aged children and adolescents with clinically significant impairment, stimulants provide the strongest evidence for reducing core symptoms, whereas atomoxetine, extended-release guanfacine, extended-release clonidine, and extended-release viloxazine are appropriate alternatives for selected patients. Effective management integrates medication when indicated with psychoeducation, behavioral strategies, school-based interventions, and treatment of comorbidities. Monitoring should address symptoms, functioning, adherence, appetite, growth, sleep, blood pressure, heart rate, mood, and medication misuse or diversion. Digital interventions may offer adjunctive benefits, but current evidence does not support replacing established treatments. Conclusions: Pediatric ADHD should be managed as a chronic, developmentally evolving condition. Accurate diagnosis, individualized multimodal treatment, systematic monitoring, and planned transition to adult services can improve symptoms and functioning. Objective biomarkers, pharmacogenomics, neurostimulation, microbiome-directed therapies, and most digital interventions remain adjunctive or investigational.

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