ADHD facts

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

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  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9: 490-499.
  7. 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.
  8. Murphy K, Barkley RA. Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry 1996; 37: 393-401.
  9. 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.
  10. 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. 
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. Faraone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 2005; 57: 1313-1323.
  18. 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.
  19. Gizer IR, Ficks C, Waldman ID. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 2009; 126: 51-90.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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.
  28. 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.
  29. 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.
  30. 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.
  31. 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.
  32. 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.
  33. 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.
  34. 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.
  35. 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.
  36. 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.
  37. 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.
  38. 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.
  39. Shifrin JG, Proctor BE, Prevatt FF. Work performance differences between college students with and without ADHD. J Atten Disord 2010; 13: 489-496.
  40. 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.
  41. 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.
  42. 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.
  43. 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.
  44. 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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