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==Overview==
==Overview==
*Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral brain disorder marked by an ongoing pattern of [[inattention]] and/or [[hyperactivity]]-[[impulsivity]] that interferes with functioning or [[development]]. It may negatively impact the patient’s academic or professional performance and/or social interactions.
Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral brain disorder marked by an ongoing pattern of [[inattention]] and/or [[hyperactivity]]-[[impulsivity]] that interferes with functioning or [[development]]. It may negatively impact the patient’s academic or professional performance and/or social interactions. ADHD has a strong component of [[heritability]]. ADHD is more commonly diagnosed in boys than in girls, though this may be because the symptoms of the disorder are less easily recognized in girls.<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>
*ADHD has a strong component of [[heritability]].
*ADHD is more commonly diagnosed in boys than in girls, though this may be because the symptoms of the disorder are less easily recognized in girls.<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>


==Historical Perspective==
==Historical Perspective==
*ADHD symptoms have been recognized in children and described in medical texts since the nineteenth century, though the formal diagnosis had not yet been devised.
*ADHD symptoms have been recognized in children and described in medical texts since the nineteenth century, though the formal diagnosis had not yet been devised.
*ADHD was first included in some form in the [[DSM]] in its second edition, when it was referred to as “hyperkinetic reaction of childhood.” It was not until the third edition of the DSM was released in 1980 that the disorder was formally identified as “ADD (Attention-Deficit Disorder) with or without hyperactivity.”<ref name="ADHD History #4">Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 2(4), 241–255. http://doi.org/10.1007/s12402-010-0045-8.</ref>
*ADHD was first included in some form in the [[DSM]] in its second edition, when it was referred to as “hyperkinetic reaction of childhood.” It was not until the third edition of the DSM was released in 1980 that the disorder was formally identified as “ADD (Attention-Deficit Disorder) with or without hyperactivity.”<ref name="ADHD History #4">Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 2(4), 241–255. http://doi.org/10.1007/s12402-010-0045-8.</ref>
*Rhode Island physician Dr. Charles Bradley pioneered the use of medications to treat ADHD in 1937. Since that time, the prescription of [[stimulants]] has become a first-line treatment for ADHD.<ref name="Bradley #21">Strohl, M. P. (2011). Bradley’s Benzedrine Studies on Children with Behavioral Disorders. The Yale Journal of Biology and Medicine, 84(1), 27–33.</ref>
*In 1937, Rhode Island physician Dr. Charles Bradley pioneered the use of medications to treat ADHD. The prescription of [[stimulants]] has since become a first-line treatment for ADHD.<ref name="Bradley #21">Strohl, M. P. (2011). Bradley’s Benzedrine Studies on Children with Behavioral Disorders. The Yale Journal of Biology and Medicine, 84(1), 27–33.</ref>


==Classification==
==Classification==
ADHD may be classified according to the DSM-V criteria into three subgroups:
ADHD may be classified according to the [[DSM]] V criteria into three subgroups:
*predominantly inattentive type,
*predominantly inattentive type;
*predominantly [[hyperactive]]-[[impulsive]] type, and
*predominantly [[hyperactive]]-impulsive type; and
*combined type.<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*combined type.<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


==Pathophysiology==
==Pathophysiology==
Attention deficit hyperactivity disorder appears to be highly heritable, although one-fifth of all cases are estimated to be caused from [[trauma]] or [[toxic exposure]]. Evidence suggests that hyperactivity has a strong heritable component, and in all probability ADHD is a heterogeneous disorder, meaning that several causes could create very similar symptomology.<ref>{{cite web|url=http://www.continuingedcourses.net/active/courses/course003.php|title=Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity|last=Barkley|first=Russel A.|accessdate=2006-06-26}}</ref>. Although there is evidence for dopamine abnormalities in ADHD, it is not clear whether abnormalities of the [[dopamine]] system are the molecular abnormality of ADHD or a secondary consequence of a problem elsewhere.
*ADHD is highly [[heritable]], although one-fifth of all cases are estimated to be caused by [[trauma]] or exposure to [[toxins]].
*ADHD is a [[heterogeneous]] disorder, meaning that several causes could create very similar symptomology.<ref>{{cite web|url=http://www.continuingedcourses.net/active/courses/course003.php|title=Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity|last=Barkley|first=Russel A.|accessdate=2006-06-26}}</ref>
*Although there is evidence for dopamine abnormalities in ADHD, it is not clear whether abnormalities of the [[dopamine]] system are a molecular abnormality of ADHD or a secondary consequence of ADHD.
 
==Causes==
There are no established causes of ADHD. Studies suggest that ADHD results from a complex interaction between genetic and environmental factors.<ref name="#18">OurMed. (2010). "Attention-deficit hyperactivity disorder."</ref>
 
==Differentiating Attention Deficit Hyperactivity Disorder from other Diseases==
==Differentiating Attention Deficit Hyperactivity Disorder from other Diseases==
Attention deficit hyperactivity disorder (ADHD) can be differentiated from other psychiatric disorders by following DSM-IV criteria. Aspects of ADHD that make it distinguishable, is that some symptoms must be present before the age of 7 years old. Also, the symptoms of [[inattention]], [[hyperactivity]], and distractability are consistently present over time, which is unlike [[mania]] in [[bipolar disorder]], or drug use. Symptoms of ADHD are characterized by a persistent pattern of inattention and/or [[hyperactivity]], as well as [[forgetting|forgetfulness]], poor impulse control or impulsivity, and [[distraction|distractibility]].<ref name=DSM-IV-TR>Diagnostic and Statistical Manual of [American Psychiatric Association, 2000.</ref><ref>[http://www.behavenet.com/capsules/disorders/adhd.htm Psychiatric Association|the American Psychiatric Association], Fourth Edition, htm Attention-Deficit/Hyperactivity Disorder (ADHD).] Behavenet.com. Retrieved on December 11, 2006.</ref>, although the symptoms may be less apparent in females.  Symptoms are not usually severe, however they can cause a significant impairment in social and occupational functioning.
*ADHD must be differentiated from other diseases that cause behavioral issues and anxiety such as [[anxiety disorder]], [[dissociative disorder]], [[conduct disorder]], and [[oppositional defiant disorder]].
*ADHD must also be differentiated from the other psychiatric disorders with which it shares common genetic roots, including [[autism]], [[bipolar disorder]], [[major depression]], and [[schizophrenia]].<ref name="#8">Cross-Disorder Group of the Psychiatric Genomics Consortium. (2013). Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet, 381(9875), 1371–1379. http://doi.org/10.1016/S0140-6736(12)62129-1.</ref>
 
==Epidemiology and Demographics==
==Epidemiology and Demographics==
A review of 102 studies estimated ADHD's worldwide [[prevalence]] in people under the age of 19 to be 5.29%. 10% of males, and 4% of females have been diagnosed in the U.S.<ref> {{PDFlink|[http://www.cdc.gov/nchs/data/series/sr_10/sr10_221.pdf "National Health Interview survey, 2002"]|3.71&nbsp;[[Mebibyte|MiB]]<!-- application/pdf, 3892622 bytes -->}}. Centers for Disease Control (March, 2004). Retrieved on [[December 11]], [[2006]].</ref>
*The prevalence of attention-deficit hyperactivity disorder (ADHD) is estimated to be 5,000 per 100,000 (5%) children and 2,500 per 100,000 (2.5%) adults.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*Boys are more commonly affected by ADHD than girls. The male to female ratio is 2 to 1.<ref name="#10">Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The Journal of Pediatric Pharmacology and Therapeutics : JPPT, 21(3), 192–206. http://doi.org/10.5863/1551-6776-21.3.192.</ref>
 
==Risk Factors==
==Risk Factors==
Several factors have been implicated as risk factors in the development of ADHD. Maternal [[smoking]] and [[alcohol]] use have had an association to the development of ADHD in the child. In addition, high blood [[lead levels]] have been linked to ADHD.
Common risk factors in the development of attention-deficit hyperactivity disorder (ADHD) are:<ref name= DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*[[child abuse]]
*[[infections]] of the [[CNS]]
*[[epilepsy]]
*[[traumatic brain injury]]
 
==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
ADHD is currently considered to be a persistent and [[chronic (medicine)|chronic]] condition for which no medical cure is available. ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. About 60% of children diagnosed with ADHD retain the condition as adults.<ref>[http://www.webmd.com/content/article/89/100385.htm Attention-Deficit / Hyperactivity Disorder: ADHD in Adults.] WebMd.com. Retrieved on December 11, 2006.</ref> Adults are able to hide the symptoms more easily. Children who are not medicated for ADHD have higher rates of [[substance abuse]] in adulthood. Paradoxically, [[stimulant]] medications are intoxicants, and [[substance dependence]] may develop.
If left untreated, patients with ADHD may experience negative social consequences, such as isolation from and difficulty communicating with friends and loved ones. Patients are unlikely to experience any physical problems as a direct result of ADHD.<ref name="#7">Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The Journal of Pediatric Pharmacology and Therapeutics : JPPT, 21(3), 192–206. http://doi.org/10.5863/1551-6776-21.3.192</ref>
 
==Diagnosis==
==Diagnosis==
The diagnosis of ADHD is made based on the [[DSM]] V criteria, which can be found on the [[Attention-deficit hyperactivity disorder diagnostic criteria]] page.
Practice guidelines are available<ref name="pmid37254562">{{cite journal| author=May T, Birch E, Chaves K, Cranswick N, Culnane E, Delaney J | display-authors=etal| title=The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder. | journal=Aust N Z J Psychiatry | year= 2023 | volume= 57 | issue= 8 | pages= 1101-1116 | pmid=37254562 | doi=10.1177/00048674231166329 | pmc=10363932 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37254562  }} </ref><ref name="pmid30453134">{{cite journal| author=Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J | display-authors=etal| title=Updated European Consensus Statement on diagnosis and treatment of adult ADHD. | journal=Eur Psychiatry | year= 2019 | volume= 56 | issue=  | pages= 14-34 | pmid=30453134 | doi=10.1016/j.eurpsy.2018.11.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30453134  }} </ref><ref name="pmid37878798">{{cite journal| author=Baughman DJ, Watson CM, Beich JW, Herboso MNJ, Cuttie LK, Marlyne AC| title=Recommendation for Long-term Management of Adult Attention-Deficit/Hyperactivity Disorder in Military Populations, Veterans, and Dependents: A Narrative Review. | journal=Mil Med | year= 2023 | volume=  | issue=  | pages=  | pmid=37878798 | doi=10.1093/milmed/usad403 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37878798  }} </ref>.
===History and Symptoms===
===History and Symptoms===
Diagnosis of ADHD is based on [[DSM IV]] criteria. These are very specific criteria which assess the patient's functioning and the impact of their symptoms on their life, in various settings. History includes symptoms of innattentiveness, [[hyperactivity]], [[impulsivity]], difficulty functioning at school and at an occupational level, and difficulty with organization. Symptoms may also affect relationships in the social setting.
*The most common symptoms of ADHD include [[chronic]] and long-lasting [[hyperactivity]], [[impulsivity]], and [[inattention]].<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>
*It is particularly important to collect a [[family history]] with regard to psychiatric disorders, as ADHD has a strong genetic component.<ref name="#x">Cross-Disorder Group of the Psychiatric Genomics Consortium. "Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs." Nat Genet. (2013). 45(9):984-94. doi: 10.1038/ng.2711. Epub 2013 Aug 11.</ref>
*It is also vital to understand how long the patient has been experiencing symptoms of ADHD, as the [[DSM]] V stipulates that symptoms must have been present for at least 6 months in order for a diagnosis of ADHD to be made. Similarly, an adult cannot be diagnosed with ADHD unless his/her symptoms were present prior to the age of 12 years.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
 
===Physical Examination===
*A psychiatric evaluation of a patient who may be suffering from [[ADHD]] consists of a behavioral assessment.
*It is common practice for clinicians to administer rating scales to those who have frequent contact with the patient, often including parents and teachers.<ref name="pmid21120096">{{cite journal| author=Gualtieri CT, Johnson LG| title=ADHD: Is Objective Diagnosis Possible? | journal=Psychiatry (Edgmont) | year= 2005 | volume= 2 | issue= 11 | pages= 44-53 | pmid=21120096 | doi= | pmc=2993524 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21120096  }} </ref> It is important that rating scales be completed by people who observe the patient in different settings, such as at home and at school, since ADHD symptoms can be situation-specific.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*Commonly used rating scales include the Vanderbilt Rating Scale, the Brown Rating Scale, and the Wender Utah Rating Scale.<ref name="pmid21120096">{{cite journal| author=Gualtieri CT, Johnson LG| title=ADHD: Is Objective Diagnosis Possible? | journal=Psychiatry (Edgmont) | year= 2005 | volume= 2 | issue= 11 | pages= 44-53 | pmid=21120096 | doi= | pmc=2993524 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21120096  }} </ref>
*These rating scales are subjective, and informants regularly differ in their reports.<ref name="pmid21120096">{{cite journal| author=Gualtieri CT, Johnson LG| title=ADHD: Is Objective Diagnosis Possible? | journal=Psychiatry (Edgmont) | year= 2005 | volume= 2 | issue= 11 | pages= 44-53 | pmid=21120096 | doi= | pmc=2993524 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21120096  }} </ref>
 
===Laboratory Findings===
*There are no laboratory findings associated with ADHD.
 
===Electrocardiogram===
*There are no ECG findings associated with ADHD.
 
===Chest X Ray===
*There are no chest x-ray findings associated with ADHD.
 
===CT Scan===
*There are no CT scan findings associated with ADHD.
 
===Electrocardiography or Ultrasound===
*There are no echocardiography or ultrasound findings associated with ADHD.
 
===Other Imaging Findings===
*Though the brains of ADHD patients follow a normal pattern of development, imaging findings indicative of ADHD may include delayed physical development of the brain. This may help explain why some adolescent ADHD patients do not experience symptoms into adulthood.<ref>[http://www.nimh.nih.gov/science-news/2007/brain-matures-a-few-years-late-in-adhd-but-follows-normal-pattern.shtml Brain Matures a Few Years Late in ADHD, But Follows Normal Pattern] NIMH Press Release, November 12, 2007 </ref>
 
==Treatment==
==Treatment==
The mainstay of therapy for ADHD is the administration of such [[stimulants]] as [[Ritalin]] and [[Adderall]]. While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Other treatment options include [[psychotherapy]], education and training, or a combination of therapies.<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>
Practice guidelines are available<ref name="pmid37254562">{{cite journal| author=May T, Birch E, Chaves K, Cranswick N, Culnane E, Delaney J | display-authors=etal| title=The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder. | journal=Aust N Z J Psychiatry | year= 2023 | volume= 57 | issue= 8 | pages= 1101-1116 | pmid=37254562 | doi=10.1177/00048674231166329 | pmc=10363932 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37254562  }} </ref><ref name="pmid30453134">{{cite journal| author=Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J | display-authors=etal| title=Updated European Consensus Statement on diagnosis and treatment of adult ADHD. | journal=Eur Psychiatry | year= 2019 | volume= 56 | issue=  | pages= 14-34 | pmid=30453134 | doi=10.1016/j.eurpsy.2018.11.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30453134  }} </ref><ref name="pmid37878798">{{cite journal| author=Baughman DJ, Watson CM, Beich JW, Herboso MNJ, Cuttie LK, Marlyne AC| title=Recommendation for Long-term Management of Adult Attention-Deficit/Hyperactivity Disorder in Military Populations, Veterans, and Dependents: A Narrative Review. | journal=Mil Med | year= 2023 | volume=  | issue=  | pages=  | pmid=37878798 | doi=10.1093/milmed/usad403 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37878798  }} </ref>.
===Medical Therapy===
===Medical Therapy===
First line treatments include stimulant medications such as [[methyphenidate]] and [[dextroamphetamine]]. More recent, less addictive medications used is [[modafinil]]. Behavioral modification and strategies have also been shown to help, as pharmacologic treatment is thought to mostly help symptoms associated with poor [[concentration]]. Methods of treatment usually involve some combination of medications, behavior modifications, life style changes, and counseling.
*[[Stimulants]] such as [[Ritalin]] and [[Adderall]] are used to increase the patient’s supply of the brain chemicals [[dopamine]] and [[norepinephrine]], which play essential roles in thinking and [[attention]].<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>
*[[Behavioral therapy]] aims to help a patient monitor and change his or her conduct.
*[[Support groups]], stress management training, and education about living with psychiatric disorders are often recommended for both the patient and his or her loved ones and family members.<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>
 
===Surgery===
Surgical intervention is not recommended for the management of ADHD.
 
===Prevention===
*There is no established method for the prevention of [[ADHD]]. Although there is no proven way to prevent ADHD, early identification and treatment can prevent many of the problems associated with ADHD.<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>
*Secondary prevention strategies following a diagnosis of ADHD include the administration of [[stimulants]], [[cognitive behavioral therapy]], regular psychiatric evaluations, and the maintenance of a healthy diet.<ref name="#1">National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."</ref>
 
===Psychotherapy===
*Many psychological interventions can be used to manage symptoms of attention-deficit hyperactivity disorder.
 
===Brain Stimulation Therapy===
*There is no brain stimulation therapy associated with attention-deficit hyperactivity disorder.
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WH}}
{{WS}}
{{WS}}


[[Category:Disease]]
 
[[Category:Psychiatry]]
[[Category:Psychiatry]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]

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Overview

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. It may negatively impact the patient’s academic or professional performance and/or social interactions. ADHD has a strong component of heritability. ADHD is more commonly diagnosed in boys than in girls, though this may be because the symptoms of the disorder are less easily recognized in girls.[1]

Historical Perspective

  • ADHD symptoms have been recognized in children and described in medical texts since the nineteenth century, though the formal diagnosis had not yet been devised.
  • ADHD was first included in some form in the DSM in its second edition, when it was referred to as “hyperkinetic reaction of childhood.” It was not until the third edition of the DSM was released in 1980 that the disorder was formally identified as “ADD (Attention-Deficit Disorder) with or without hyperactivity.”[2]
  • In 1937, Rhode Island physician Dr. Charles Bradley pioneered the use of medications to treat ADHD. The prescription of stimulants has since become a first-line treatment for ADHD.[3]

Classification

ADHD may be classified according to the DSM V criteria into three subgroups:

  • predominantly inattentive type;
  • predominantly hyperactive-impulsive type; and
  • combined type.[4]

Pathophysiology

  • ADHD is highly heritable, although one-fifth of all cases are estimated to be caused by trauma or exposure to toxins.
  • ADHD is a heterogeneous disorder, meaning that several causes could create very similar symptomology.[5]
  • Although there is evidence for dopamine abnormalities in ADHD, it is not clear whether abnormalities of the dopamine system are a molecular abnormality of ADHD or a secondary consequence of ADHD.

Causes

There are no established causes of ADHD. Studies suggest that ADHD results from a complex interaction between genetic and environmental factors.[6]

Differentiating Attention Deficit Hyperactivity Disorder from other Diseases

Epidemiology and Demographics

  • The prevalence of attention-deficit hyperactivity disorder (ADHD) is estimated to be 5,000 per 100,000 (5%) children and 2,500 per 100,000 (2.5%) adults.[4]
  • Boys are more commonly affected by ADHD than girls. The male to female ratio is 2 to 1.[8]

Risk Factors

Common risk factors in the development of attention-deficit hyperactivity disorder (ADHD) are:[4]

Natural History, Complications and Prognosis

If left untreated, patients with ADHD may experience negative social consequences, such as isolation from and difficulty communicating with friends and loved ones. Patients are unlikely to experience any physical problems as a direct result of ADHD.[9]

Diagnosis

The diagnosis of ADHD is made based on the DSM V criteria, which can be found on the Attention-deficit hyperactivity disorder diagnostic criteria page.

Practice guidelines are available[10][11][12].

History and Symptoms

  • The most common symptoms of ADHD include chronic and long-lasting hyperactivity, impulsivity, and inattention.[1]
  • It is particularly important to collect a family history with regard to psychiatric disorders, as ADHD has a strong genetic component.[13]
  • It is also vital to understand how long the patient has been experiencing symptoms of ADHD, as the DSM V stipulates that symptoms must have been present for at least 6 months in order for a diagnosis of ADHD to be made. Similarly, an adult cannot be diagnosed with ADHD unless his/her symptoms were present prior to the age of 12 years.[4]

Physical Examination

  • A psychiatric evaluation of a patient who may be suffering from ADHD consists of a behavioral assessment.
  • It is common practice for clinicians to administer rating scales to those who have frequent contact with the patient, often including parents and teachers.[14] It is important that rating scales be completed by people who observe the patient in different settings, such as at home and at school, since ADHD symptoms can be situation-specific.[4]
  • Commonly used rating scales include the Vanderbilt Rating Scale, the Brown Rating Scale, and the Wender Utah Rating Scale.[14]
  • These rating scales are subjective, and informants regularly differ in their reports.[14]

Laboratory Findings

  • There are no laboratory findings associated with ADHD.

Electrocardiogram

  • There are no ECG findings associated with ADHD.

Chest X Ray

  • There are no chest x-ray findings associated with ADHD.

CT Scan

  • There are no CT scan findings associated with ADHD.

Electrocardiography or Ultrasound

  • There are no echocardiography or ultrasound findings associated with ADHD.

Other Imaging Findings

  • Though the brains of ADHD patients follow a normal pattern of development, imaging findings indicative of ADHD may include delayed physical development of the brain. This may help explain why some adolescent ADHD patients do not experience symptoms into adulthood.[15]

Treatment

The mainstay of therapy for ADHD is the administration of such stimulants as Ritalin and Adderall. While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Other treatment options include psychotherapy, education and training, or a combination of therapies.[1]

Practice guidelines are available[10][11][12].

Medical Therapy

Surgery

Surgical intervention is not recommended for the management of ADHD.

Prevention

  • There is no established method for the prevention of ADHD. Although there is no proven way to prevent ADHD, early identification and treatment can prevent many of the problems associated with ADHD.[1]
  • Secondary prevention strategies following a diagnosis of ADHD include the administration of stimulants, cognitive behavioral therapy, regular psychiatric evaluations, and the maintenance of a healthy diet.[1]

Psychotherapy

  • Many psychological interventions can be used to manage symptoms of attention-deficit hyperactivity disorder.

Brain Stimulation Therapy

  • There is no brain stimulation therapy associated with attention-deficit hyperactivity disorder.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."
  2. ↑ Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 2(4), 241–255. http://doi.org/10.1007/s12402-010-0045-8.
  3. ↑ Strohl, M. P. (2011). Bradley’s Benzedrine Studies on Children with Behavioral Disorders. The Yale Journal of Biology and Medicine, 84(1), 27–33.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  5. ↑ Barkley, Russel A. "Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity". Retrieved 2006-06-26.
  6. ↑ OurMed. (2010). "Attention-deficit hyperactivity disorder."
  7. ↑ Cross-Disorder Group of the Psychiatric Genomics Consortium. (2013). Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet, 381(9875), 1371–1379. http://doi.org/10.1016/S0140-6736(12)62129-1.
  8. ↑ Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The Journal of Pediatric Pharmacology and Therapeutics : JPPT, 21(3), 192–206. http://doi.org/10.5863/1551-6776-21.3.192.
  9. ↑ Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The Journal of Pediatric Pharmacology and Therapeutics : JPPT, 21(3), 192–206. http://doi.org/10.5863/1551-6776-21.3.192
  10. ↑ 10.0 10.1 May T, Birch E, Chaves K, Cranswick N, Culnane E, Delaney J; et al. (2023). "The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder". Aust N Z J Psychiatry. 57 (8): 1101–1116. doi:10.1177/00048674231166329. PMC 10363932 Check |pmc= value (help). PMID 37254562 Check |pmid= value (help).
  11. ↑ 11.0 11.1 Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J; et al. (2019). "Updated European Consensus Statement on diagnosis and treatment of adult ADHD". Eur Psychiatry. 56: 14–34. doi:10.1016/j.eurpsy.2018.11.001. PMID 30453134.
  12. ↑ 12.0 12.1 Baughman DJ, Watson CM, Beich JW, Herboso MNJ, Cuttie LK, Marlyne AC (2023). "Recommendation for Long-term Management of Adult Attention-Deficit/Hyperactivity Disorder in Military Populations, Veterans, and Dependents: A Narrative Review". Mil Med. doi:10.1093/milmed/usad403. PMID 37878798 Check |pmid= value (help).
  13. ↑ Cross-Disorder Group of the Psychiatric Genomics Consortium. "Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs." Nat Genet. (2013). 45(9):984-94. doi: 10.1038/ng.2711. Epub 2013 Aug 11.
  14. ↑ 14.0 14.1 14.2 Gualtieri CT, Johnson LG (2005). "ADHD: Is Objective Diagnosis Possible?". Psychiatry (Edgmont). 2 (11): 44–53. PMC 2993524. PMID 21120096.
  15. ↑ Brain Matures a Few Years Late in ADHD, But Follows Normal Pattern NIMH Press Release, November 12, 2007

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