ABSTRACT. Research literature relating to the prevalence of attention-deficit/hyperactivity disorder (ADHD) and co-occurring conditions in children from primary care settings and the general population is reviewed as the basis of the American Academy of Pediatrics clinical practice guideline for the assessment and diagnosis of ADHD. Epidemiologic studies revealed prevalence rates generally ranging from 4% to 12% in the general population of 6 to 12 year olds. Similar or slightly lower rates of ADHD were revealed in pediatric primary care settings. Other behavioral, emotional, and learning problems significantly co-occurred with ADHD. Also reviewed were rating scales and medical tests that could be employed in evaluating ADHD. The utility of using both parent-and teacher-completed rating scales that specifically assess symptoms of ADHD in the diagnostic process was supported. Recommendations were made regarding the assessment of children with suspected ADHD in the pediatric primary care setting. Pediatrics 2001;107(3). URL: http://www.pediatrics.org/cgi/content/ full/107/3/e43; prevalence, attention-deficit/hyperactivity disorder, primary care.ABBREVIATIONS. ADHD, attention-deficit/hyperactivity disorder; TRI, Technical Resources International; DSM, Diagnostic and Statistical Manual; DISC, Diagnostic Interview Schedule for Children; EEG, electroencephalogram; ERP, event-related potential.A ttention-deficit/hyperactivity disorder (ADHD) has defining features of inattention, overactivity, and impulsivity. 1 It is the most frequently encountered childhood-onset neurodevelopmental disorder in primary care settings. Symptoms frequently co-occur with other emotional, behavioral, and learning problems, including oppositional defiant disorder, conduct disorder, depression, anxiety, and learning disabilities. The cause of ADHD is unknown, and multiple pathways may lead to the phenotypic expression of the disorder. 2 Public awareness of ADHD has increased, and the disorder represents a public health concern with significant effects on children's functioning across multiple areas. 2 Referrals to health care professionals for children suspected of having the disorder continue at a high rate, and changes in the health care system in the United States have placed increasing demands on primary care pediatricians to diagnose and manage the disorder. It is now recognized that ADHD is a chronic condition that will persist over the life span. 2 The American Academy of Pediatrics Committee on Quality Improvement Subcommittee on Attention-Deficit/Hyperactivity Disorder synthesized a clinical practice guideline for the diagnosis and evaluation of children with ADHD. 3 This report will highlight the empirical literature review on which this practice guideline is based. The subcommittee worked with Technical Resources International (TRI), Washington, DC, under the auspices of the Agency for Healthcare Research and Quality, to develop an evidence base addressing questions regarding the prevalence, co-occurring conditions, and diagnostic ...

No abstract

An accurate system of identifying and classifying suspected measles cases is critical for the measles surveillance system in the United States. To examine the performance of the clinical case definition in predicting laboratory confirmation of suspected cases of measles, we reviewed 4 studies conducted between 1981 and 1994. A clinical case definition was examined that included a generalized maculopapular rash, fever (>or=38.3 degrees C, if measured), and either a cough, coryza, or conjunctivitis. Serological confirmation of measles was done either by hemagglutination inhibition assay, complement fixation assay, or enzyme immunoassays. The positive predictive value of the clinical case definition decreased from 74% to 1% as incidence decreased from 171 cases/100000 population to 1.3 cases/100000 population. Sensitivity was high, and for the larger studies with the most precise estimates, sensitivity was 76%-88%. The low positive predictive value of the clinical case definition in settings of low incidence demonstrates that serological confirmation is essential to ensure an accurate diagnosis of measles when measles is rare.

ContextPrivate wells that tap groundwater are largely exempt from federal drinking-water regulations, and in most states well water is not subject to much of the mandatory testing required of public water systems. Families that rely on private wells are thus at risk of exposure to a variety of unmeasured contaminants.Case PresentationA family of seven—two adults and five children—residing in rural northwestern Connecticut discovered elevated concentrations of uranium in their drinking water, with levels measured at 866 and 1,160 μg/L, values well above the U.S. Environmental Protection Agency maximum contaminant level for uranium in public water supplies of 30 μg/L. The uranium was of natural origin, and the source of exposure was found to be a 500-foot well that tapped groundwater from the Brookfield Gneiss, a geologic formation known to contain uranium. Other nearby wells also had elevated uranium, arsenic, and radon levels, though concentrations varied widely. At least one 24-hr urine uranium level was elevated (> 1 μg/24 hr) in six of seven family members (range, 1.1–2.5 μg/24 hr). To assess possible renal injury, we measured urinary beta-2-microglobulin. Levels were elevated (> 120 μg/L) in five of seven family members, but after correction for creatine excretion, the beta-2-microglobulin excretion rate remained elevated (> 40 μg/mmol creatinine) only in the youngest child, a 3-year-old with a corrected level of 90 μg/mmol creatinine. Three months after cessation of well water consumption, this child’s corrected beta-2-microglobulin level had fallen to 52 μg/mmol creatinine.SignificanceThis case underscores the hazards of consuming groundwater from private wells. It documents the potential for significant residential exposure to naturally occurring uranium in well water. It highlights the special sensitivity of young children to residential environmental exposures, a reflection of the large amount of time they spend in their homes, the developmental immaturity of their kidneys and other organ systems, and the large volume of water they consume relative to body mass.

Three to 4 million children and adolescents in the United States live within 1 mile of a federally designated Superfund hazardous waste disposal site and are at risk of exposure to chemical toxicants released from these sites into air, groundwater, surface water, and surrounding communities. Because of their patterns of exposure and their biological vulnerability, children are uniquely susceptible to health injury resulting from exposures to chemical toxicants in the environment. The Superfund Basic Research Program, funded by the U.S. Environmental Protection Agency and directed by the National Institute of Environmental Health Sciences, is extremely well positioned to organize multidisciplinary research that will assess patterns of children's exposures to hazardous chemicals from hazardous waste disposal sites; quantify children's vulnerability to environmental toxicants; assess causal associations between environmental exposures and pediatric disease; and elucidate the mechanisms of environmental disease in children at the cellular and molecular level.