|What is ADHD?||Attention-deficit hyperactivity disorder (ADHD) or hyperkinetic disorder (HKD), is a chronic neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity beyond the range of developmental norms, which may impact on personal, academic, familial and societal functioning.1,2|
|Prevalence||The prevalence rates in children, adolescents and adults can vary depending on a number of factors such as: age,3-7 gender,6,8,9 presentation of ADHD10,11 and comorbidities.9,12-15 Mean worldwide prevalence of ADHD is estimated at between 5.29%3 and 7.1% in children and adolescents,6 and at 3.4% (range 1.2–7.3%) in adults.16 Reported prevalence rates may also be affected by population characteristics; methodological, environmental and cultural differences; and variability in identification and diagnostic guideline tools employed in studies.1,2,6|
|Aetiology||Although the aetiology of ADHD is complex, there is evidence that multiple genetic,17-23 neurobiological,24-27 and environmental risk factors,28,29 which present differently in individuals, are associated with the pathology and development of this heterogeneous disorder.|
|Impact||The chronic nature of ADHD means that this disorder can have a significant impact at home,30-32 at school,33-35 and in the workplace,36-39 including an impact on relationships30,35 with family, friends, teachers and colleagues. ADHD is also associated with substantial financial burden for individuals, families and societal healthcare services.40|
|Assessment||Assessment of ADHD typically involves the comprehensive evaluation of information gathered from a number of sources, including parents/carers, family members, teachers, partners and colleagues.41-44
|Classification||Two medical classification systems commonly used for the diagnosis of ADHD are the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5TM)1 and the International Classification of Mental and Behavioural Disorders 10th revision (ICD-10).2|
|Patient-centred approach||ADHD is a diverse disorder, and can present differently in patients of different ages.1,41 Therefore, a patient-centred management approach is advisable, with consideration of each individual’s symptom profile and needs relative to their age.43|
|Management||To optimise outcomes and enable clinicians to best meet patients’ needs, management of ADHD should involve multidisciplinary teams of healthcare professionals, and the use of a tailored multimodal treatment plan, including goal setting, choice of appropriate therapy, ongoing assessment and regular follow-up.41-44|
|Non-pharmacological therapy||Non-pharmacological therapy for patients with ADHD may include behavioural therapy and psychoeducation and more holistic approaches, such as lifestyle and diet interventions, although there is limited evidence to support these.41-44|
|Pharmacological therapy||When non-pharmacological treatments failed to control ADHD symptoms, pharmacological therapy for ADHD is considered necessary. The decision about which medication to use depends on a range of factors, including: individual needs; the presence of comorbidities; side effects of medication; potential for drug diversion; and the personal preference of patients and their families.41-44|
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
- World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Available at: www.who.int/entity/classifications/icd/en/bluebook.pdf. Last updated 1993; 1: 1-263. Last accessed March 2015.
- Polanczyk G, de Lima MS, Horta BL, et al. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007; 164: 942-948.
- Faraone SV, Spencer TJ, Montano CB, et al. Attention-deficit/hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care. Arch Intern Med 2004; 164: 1221-1226.
- Lara C, Fayyad J, de Graaf R, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 2009; 65: 46-54.
- Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9: 490-499.
- Schlack R, Holling H, Kurth BM, et al. The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50: 827-835.
- Murphy K, Barkley RA. Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry 1996; 37: 393-401.
- Nøvik TS, Hervas A, Ralston SJ, et al. Influence of gender on attention-deficit/hyperactivity disorder in Europe--ADORE. Eur Child Adolesc Psychiatry 2006; 15 Suppl 1: I15-I24.
- Faraone SV, Biederman J, Weber W, et al. Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred sample. J Am Acad Child Adolesc Psychiatry 1998; 37: 185-193.
- Wilens TE, Biederman J, Faraone SV, et al. Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. J Clin Psychiatry 2009; 70: 1557-1562.
- Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006; 163: 716-723.
- Jensen PS, Hinshaw SP, Kraemer HC, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry 2001; 40: 147-158.
- Yoshimasu K, Barbaresi WJ, Colligan RC, et al. Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: a population-based birth cohort study. J Child Psychol Psychiatry 2012; 53: 1036-1043.
- Piñeiro-Dieguez B, Balanzá-Martínez V, García-García P, et al. Psychiatric Comorbidity at the Time of Diagnosis in Adults With ADHD: The CAT Study. J Atten Disord 2014; 1-10.
- Fayyad J, de Graaf R, Kessler R, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007; 190: 402-409.
- Faraone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 2005; 57: 1313-1323.
- Sprich S, Biederman J, Crawford MH, et al. Adoptive and biological families of children and adolescents with ADHD. J Am Acad Child Adolesc Psychiatry 2000; 39: 1432-1437.
- Gizer IR, Ficks C, Waldman ID. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 2009; 126: 51-90.
- Larsson H, Chang Z, D'Onofrio BM, et al. The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan. Psychol Med 2013; 1-7.
- Lesch KP, Timmesfeld N, Renner TJ, et al. Molecular genetics of adult ADHD: converging evidence from genome-wide association and extended pedigree linkage studies. J Neural Transm 2008; 115: 1573-1585.
- Levy F, Hay DA, McStephen M, et al. Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study. J Am Acad Child Adolesc Psychiatry 1997; 36: 737-744.
- Larsson H, Asherson P, Chang Z, et al. Genetic and environmental influences on adult attention deficit hyperactivity disorder symptoms: a large Swedish population-based study of twins. Psychol Med 2013; 43: 197-207.
- Nakao T, Radua J, Rubia K, et al. Gray matter volume abnormalities in ADHD: voxel-based meta-analysis exploring the effects of age and stimulant medication. Am J Psychiatry 2011; 168: 1154-1163.
- Quintana H, Snyder SM, Purnell W, et al. Comparison of a standard psychiatric evaluation to rating scales and EEG in the differential diagnosis of attention-deficit/hyperactivity disorder. Psychiatry Res 2007; 152: 211-222.
- Economidou D, Theobald DE, Robbins TW, et al. Norepinephrine and dopamine modulate impulsivity on the five-choice serial reaction time task through opponent actions in the shell and core sub-regions of the nucleus accumbens. Neuropsychopharmacology 2012; 37: 2057-2066.
- Cortese S, Kelly C, Chabernaud C, et al. Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. Am J Psychiatry 2012; 169: 1038-1055.
- Galera C, Cote SM, Bouvard MP, et al. Early risk factors for hyperactivity-impulsivity and inattention trajectories from age 17 months to 8 years. Arch Gen Psychiatry 2011; 68: 1267-1275.
- Heinonen K, Raikkonen K, Pesonen AK, et al. Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: a longitudinal study. BMC Pediatr 2010; 10: 91.
- Klassen AF, Miller A, Fine S. Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics 2004; 114: e541-e547.
- Cussen A, Sciberras E, Ukoumunne OC, et al. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171: 271-280.
- Davis CC, Claudius M, Palinkas LA, et al. Putting families in the center: family perspectives on decision making and ADHD and implications for ADHD care. J Atten Disord 2012; 16: 675-684.
- Kuriyan AB, Pelham WE Jr., Molina BS, et al. Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD. J Abnorm Child Psychol 2012; 27-41.
- Holmberg K, Bolte S. Do Symptoms of ADHD at Ages 7 and 10 Predict Academic Outcome at Age 16 in the General Population? J Atten Disord 2012; 1-11.
- Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: Results from the European Lifetime Impairment Survey. Eur Psychiatry 2013; 1-8.
- Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
- Brod M, Pohlman B, Lasser R, et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.
- de Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med 2008; 65: 835-842.
- Shifrin JG, Proctor BE, Prevatt FF. Work performance differences between college students with and without ADHD. J Atten Disord 2010; 13: 489-496.
- Le HH, Hodgkins P, Postma MJ, et al. Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. Eur Child Adolesc Psychiatry 2014; 23: 587-598.
- NICE (2008) Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE clinical guideline 72. Available at www.nice.org.uk/CG72 [NICE guideline]. Last accessed May 2015.
- Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.
- Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder – first upgrade. Eur Child Adolesc Psychiatry 2004; 13 Suppl 1: i7-i30.
- The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines (CAP-Guidelines) Third Edition. 2011. Available at: http://caddra.ca/practice-guidelines/download. Last accessed March 2015.
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