Attention-deficit hyperactivity disorder overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2], Haleigh Williams, B.S.
|
Attention-deficit hyperactivity disorder Microchapters |
|
Differentiating Attention-Deficit Hyperactivity Disorder from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Template:Attention-deficit hyperactivity disorder On the Web |
|
American Roentgen Ray Society Images of Attention-deficit hyperactivity disorder overview |
|
Attention-deficit hyperactivity disorder overview in the news |
|
Directions to Hospitals Treating Attention-deficit hyperactivity disorder |
|
Risk calculators and risk factors for Attention-deficit hyperactivity disorder 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.
- 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]
- 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.[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
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.[5]. 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.
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 forgetfulness, poor impulse control or impulsivity, and distractibility.[6][7], 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.
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.[8]
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.
Natural History, Complications and Prognosis
ADHD is currently considered to be a persistent and 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.[9] 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.
Diagnosis
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.
Treatment
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.
References
- ↑ National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."
- ↑ 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.
- ↑ Strohl, M. P. (2011). Bradley’s Benzedrine Studies on Children with Behavioral Disorders. The Yale Journal of Biology and Medicine, 84(1), 27–33.
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Barkley, Russel A. "Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity". Retrieved 2006-06-26.
- ↑ Diagnostic and Statistical Manual of [American Psychiatric Association, 2000.
- ↑ Psychiatric Association|the American Psychiatric Association, Fourth Edition, htm Attention-Deficit/Hyperactivity Disorder (ADHD).] Behavenet.com. Retrieved on December 11, 2006.
- ↑ Template:PDFlink. Centers for Disease Control (March, 2004). Retrieved on December 11, 2006.
- ↑ Attention-Deficit / Hyperactivity Disorder: ADHD in Adults. WebMd.com. Retrieved on December 11, 2006.