ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development as characterized by symptoms of inattention and/or hyperactivity and impulsivity. Distinguishing features of ADHD are short attention span and high levels of distractibility for chronological age and developmental level. This condition is also referred to as ADD (Attention Deficit Disorder), which is old terminology.
A diagnosis of ADHD is given based on symptoms of “inattention” or based on symptoms of “hyperactivity and impulsivity.” In addition, “other specified ADHD disorder” or “unspecified ADHD disorder” may be given as a diagnosis when a patient does not meet the full criteria for ADHD but the symptoms still causes significant distress or impairment in social, occupational, or other important areas of functioning.
A diagnosis of ADHD based on inattentive symptoms requires that six or more of the following symptoms have persisted for at least 6 months, negatively impacting directly on social and occupational activities. For older adolescents and adults, at least five symptoms are required.
Hyperactivity and Impulsivity
A diagnosis of ADHD based on hyperactive-impulsive symptoms requires that six or more of the following symptoms have persisted for at least 6 months, negatively impacting directly on social and occupational activities. For older adolescents and adults, at least five symptoms are required.
A diagnosis of ADHD based on either inattentive or hyperactive-impulsive symptoms requires that several of the symptoms were present prior to age 12. Moreover, there is clear evidence that the symptoms interfere with social, academic, or occupational functioning. Also, the symptoms are not better explained by another mental health disorder, substance intoxication or withdrawal.
Evidence suggests that ADHD occurs in about 5 percent of youth including children and adolescents, and in up to 4 percent of adults. ADHD is at least twice as prevalent in boys than in girls. Symptoms of ADHD are often present by age 3, but the diagnosis is often not made until kindergarten or elementary school.
The course of ADHD varies. Symptoms have been shown to persist into adolescence in 60 to 85 percent of cases, and into adult life in about 60 percent of cases. The remaining 40 percent of cases may remit at puberty or early adulthood. In some cases, the hyperactivity may disappear, but the decreased attention span and impulse-control problems persist. Most individuals with the disorder undergo partial remission and are vulnerable to antisocial behavior, substance use disorders, and mood disorders. Learning problems often continue throughout life.
Most children with ADHD have some social difficulties. Socially dysfunctional children with ADHD have significantly higher rates of other psychiatric disorders, and have more problems with behavior in school as well as with family members and peers. Overall, the outcome of ADHD in childhood seems to be related to the degree of other mental health issues, including conduct disorder, social disability, and chaotic family factors.
Yes. A number of medical conditions or their treatments may cause symptoms similar to those of ADHD. Examples include:
Yes, data suggest that ADHD is largely genetic, with a heritability factor of approximately 7 percent. The rate of ADHD in parents and siblings of children with ADHD is 2 to 8 times greater than in the general population. First-degree biological relatives are at high risk for developing ADHD as well as other psychiatric disorders, including disruptive behavior disorders, anxiety disorders, and depressive disorders. Siblings of children with ADHD are also at higher risk for learning disorders and academic difficulties.
Yes. Higher rates of ADHD occur in children born prematurely and in children whose mothers have had maternal infections during pregnancy.
Pharmaceutical medications are considered the first line of treatment for ADHD. Central nervous system stimulants are the first choice since they have the greatest effect with generally mild side effects. Excellent safety records are documented for short- and sustained-release preparations of methylphenidate (Ritalin, Ritalin-SR, Concerta, Metadate CD, Metadate ER), dextroamphetamine (Dexedrine, Dexedrine Spansule, Vyvanse), and dextroamphetamine and amphetamine salt combinations (Adderall, Adderall XR).
Newer preparations of methylphenidate include Methylin, a chewable form; Daytrana, a methylphenidate path; and dexmethylphenidate, the D-enantiomer (Focalin), and its longer acting from Focalin XR. These newer preparations aim to maximize effects and minimize adverse effects. Vyvanse, approved by the FDA for children 6 years and older, is less likely to have risks of abuse or overdose.
Stimulants are contraindicated in children, adolescents, and adults with known cardiac risks and abnormalities.
Nonstimulant medications approved by the FDA for the treatment of ADHD include atomoxetine (Strattera), a norepinephrine uptake inhibitor that requires monitoring for potential increases in suicidal thoughts or behaviors. A-agonist including clonidine (Catapres) and guanfacine (Tenex) have also been found effective in treating ADHD. Antidepressants, such as bupropion (Wellbutrin, Wellbutrin SR) have been used with mixed success in the treatment of ADHD.
Psychotherapy and Counseling
Children with ADHD often benefit from behavior therapy, psychotherapy, social skills training, and parent skills training and counseling. These types of therapy may be provided by a psychiatrist, psychologist, social worker or other mental health professional. Some children with ADHD may also have other conditions such as an anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling for adult ADHD generally includes psychotherapy, education about the disorder and learning skills to help one be successful. Cognitive behavioral therapy teaches specific skills to manage one’s behavior and change negative thinking patterns into positive ones. It can also help an individual deal with life challenges, such as school, work or relationship problems, and address other mental health conditions, such as depression or substance misuse.
Marital counseling and family therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to provide support.