Attention Deficit Hyperactivity Disorder 9703

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Attention deficit hyperactivity disorder (ADHD)ADD; ADHD; Childhood hyperkinesis

Last reviewed: February 22, 2010.

ADHD is a problem with inattentiveness, over-a tivity, impulsivity, or a ombination. For these problems to bedia!nosed as ADHD, they must be out o" the normal ran!e "or a hild#s a!e and development.

Causes, incidence, and risk factors

$ma!in! studies su!!est that the brains o" hildren with ADHD are di""erent "rom those o" other hildren. %hesehildren handle neurotransmitters &in ludin! dopamine, serotonin, and adrenaline' di""erently "rom their peers.

ADHD may run in "amilies, but it is not lear e(a tly what auses it. )hatever the ause may be, it seems to be setin motion early in li"e as the brain is developin!.

Depression, la * o" sleep, learnin! disabilities, ti disorders, and behavior problems may be on"used with, or appear with, ADHD. +very hild suspe ted o" havin! ADHD should have a are"ul evaluation to determine what is

ontributin! to the behaviors that are ausin! on ern.

ADHD is the most ommonly dia!nosed behavioral disorder o" hildhood. $t a""e ts about - o" s hool a!edhildren. ADHD is dia!nosed mu h more o"ten in boys than in !irls.

/ost hildren with ADHD also have at least one other developmental or behavioral problem. %hey may also haveanother psy hiatri problem, su h as depression or bipolar disorder .Symptoms

%he symptoms o" ADHD are divided into inattentiveness, and hypera tivity and impulsivity.

ome hildren with ADHD primarily have the inattentive type, some the hypera tive-impulsive type, and some theombined type. %hose with the inattentive type are less disruptive and are more li*ely to miss bein! dia!nosed with

ADHD.

$nattention symptoms:

1. Fails to !ive lose attention to details or ma*es areless mista*es in s hoolwor*

2. Has di""i ulty sustainin! attention in tas*s or play

. Does not seem to listen when spo*en to dire tly

. Does not "ollow throu!h on instru tions and "ails to "inish s hoolwor*, hores, or duties in thewor*pla e

. Has di""i ulty or!ani in! tas*s and a tivities

3. Avoids or disli*es tas*s that re4uire sustained mental e""ort &su h as s hoolwor*'

5. 6"ten loses toys, assi!nments, pen ils, boo*s, or tools needed "or tas*s or a tivities

7. $s easily distra ted

8. $s o"ten "or!et"ul in daily a tivities
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Hypera tivity symptoms:

1. Fid!ets with hands or "eet or s4uirms in seat

2. Leaves seat when remainin! seated is e(pe ted

. 9uns about or limbs in inappropriate situations

. Has di""i ulty playin! 4uietly

. $s o"ten on the !o, a ts as i" driven by a motor, tal*s e( essively

$mpulsivity symptoms:

1. ;lurts out answers be"ore 4uestions have been ompleted

2. Has di""i ulty awaitin! turn

. $nterrupts or intrudes on others &butts into onversations or !ames'

Signs and tests

%oo o"ten, di""i ult hildren are in orre tly labeled with ADHD. 6n the other hand, many hildren who do haveADHD remain undia!nosed. $n either ase, related learnin! disabilities or mood problems are o"ten missed. %heAmeri an A ademy o"


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)hen treatment has not met the tar!et !oals, re-evaluate the ori!inal dia!nosis, the possible presen e o"

other onditions, and how well the treatment plan has been implemented.

Follow-up re!ularly with the do tor to he * on !oals, results, and any side e""e ts o" medi ations.

Durin! these he *-ups, in"ormation should be !athered "rom parents, tea hers, and the hild.

/+D$=A%$6?

=hildren who re eive both behavioral treatment and medi ation o"ten do the best. %here are now several di""erentlasses o" ADHD medi ations that may be used alone or in ombination.


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ADHD an be a "rustratin! problem. Alternative remedies have be ome popular, in ludin! herbs, supplements, andhiropra ti manipulation. However, there is little or no solid eviden e "or many remedies mar*eted to parents.

!pectations (prognosis)

ADHD is a lon!-term, hroni ondition. $" it is not treated appropriately, ADHD may lead to:

Dru! and al ohol abuse

Failure in s hool


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)$C$


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into adulthood . 7I 8I Adoles ents and adults with ADHD tend to develop opin! me hanisms to ompensate "or some

or all o" their impairments . 10I $t is estimated that .5 per ent o" Ameri an adults live with ADHD. 11I

ADHD is dia!nosed two to "our times more "re4uently in boys than in !irls, 12I 1 I thou!h studies su!!est this

dis repan y may be partially due to sub e tive bias o" re"errin! tea hers. 1 I ADHD mana!ement usually involves

some ombination o" medi ations, behavior modi"i ations, li"estyle han!es, and ounselin!. $ts symptoms an be

di""i ult to di""erentiate "rom other disorders, in reasin! the li*elihood that the dia!nosis o" ADHD will be missed.1 I Additionally, most lini ians have not re eived "ormal trainin! in the assessment and treatment o" ADHD,

parti ularly in adult patients. 1 I

ADHD and its dia!nosis and treatment have been onsidered ontroversial sin e the 1850s . 13I%he ontroversies have

involved lini ians, tea hers, poli yma*ers, parents and the media. %opi s in lude the a tuality o" the disorder, its

auses, and the use o" stimulant medi ations in its treatment . 15I 17I 18I /ost health are providers a ept that ADHD is

a !enuine disorder with debate in the s ienti"i ommunity enterin! mainly around how it is dia!nosed and treated.20I 21I 22I %he Ameri an /edi al Asso iation on luded in 1887 that the dia!nosti riteria "or ADHD are based on

e(tensive resear h and, i" applied appropriately, lead to the dia!nosis with hi!h reliability . 2 I

Contents

hide I

1 =lassi"i ation

2 i!ns and symptoms

o 2.1 =omorbid disorders

=ause

o .1 eneti s

o .2 +volutionary theories

o . +nvironmental

o . o ial


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o .2 $=D-10

o . 6ther !uidelines

o . Di""erential

3 /ana!ement

o 3.1


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Have di""i ulty "o usin! attention on or!ani in! and ompletin! a tas* or learnin! somethin! new or

trouble ompletin! or turnin! in homewor* assi!nments, o"ten losin! thin!s &e.!., pen ils, toys, assi!nments'

needed to omplete tas*s or a tivities

?ot seem to listen when spo*en to

Daydream, be ome easily on"used, and move slowly

Have di""i ulty pro essin! in"ormation as 4ui *ly and a urately as others

tru!!le to "ollow instru tions.


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A 2008 study "ound that hildren with ADHD move around a lot be ause it helps them stay alert enou!h to omplete

hallen!in! tas*s. 2I

Comor-id disorders

ADHD may a ompany other disorders su h as an(iety or depression. u h ombinations an !reatly ompli atedia!nosis and treatment. A ademi studies and resear h in private pra ti e su!!est that depression in ADHD appears

to be in reasin!ly prevalent in hildren as they !et older, with a hi!her rate o" in rease in !irls than in boys, and to

vary in prevalen e with the subtype o" ADHD. )here a mood disorder ompli ates ADHD it would be prudent to

treat the mood disorder "irst, but parents o" hildren who have ADHD o"ten wish to have the ADHD treated "irst,

be ause the response to treatment is 4ui *er. I

$nattention and hypera tive behavior are not the only problems in hildren with ADHD. ADHD e(ists alone in

only about 1> o" the hildren dia!nosed with it. /any o-e(istin! onditions re4uire other ourses o" treatment and

should be dia!nosed separately instead o" bein! !rouped in the ADHD dia!nosis. ome o" the asso iated onditions

are:

6ppositional de"iant disorder & ' and ondu t disorder &23 ' whi h both are hara teri ed by antiso ial

behaviors su h as stubbornness, a!!ression, "re4uent temper tantrums, de eit"ulness, lyin!, or stealin!,I inevitably lin*in! these omorbid disorders with antiso ial personality disorder &A


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Cause

%he spe i"i auses o" ADHD are not *nown. 8I %here are, however, a number o" "a tors that may ontribute to, or

e(a erbate ADHD. %hey in lude !eneti s, diet and the so ial and physi al environments.

.enetics

D , 1I dopamine beta-hydro(ylase monoamine o(idase A, ate holamine -methyl trans"erase, serotonin

transporter promoter & L=3A ', H%2A re eptor , H%1; re eptor , 2I the 10-repeat allele o" the DA%1 !ene, I the 5-

repeat allele o" the D9D !ene, I and the dopamine beta hydro(ylase !ene &D;H %a4$'. I A ommon variant o" a

!ene alled L


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put "orth in 2003 in a study whi h "ound it may arry spe i"i bene"its "or ertain "orms o" an ient so iety. $n these

so ieties, those with ADHD are hypothesi ed to have been more pro"i ient in tas*s involvin! ris* or ompetition

&i.e. huntin!, matin! rituals, et .'. 8I A !eneti variant asso iated with ADHD & D9D 7bp ?%9 59 allele', has

been "ound to be at hi!her "re4uen y in more nomadi populations and those with more o" a history o" mi!ration.0I =onsistent with this, another !roup o" resear hers observed that the health status o" nomadi Ariaal men was

hi!her i" they had the ADHD asso iated !eneti variant &59 alleles'. However in re ently sedentary &non-

nomadi ' Ariaal those with 59 alleles seemed to have sli!htly worse health. 1I

nvironmental

%win studies to date have su!!ested that appro(imately 8 to 20 per ent o" the varian e in hypera tive-impulsive-

inattentive behavior or ADHD symptoms an be attributed to nonshared environmental &non!eneti ' "a tors . 2I I I

I +nvironmental "a tors impli ated in lude al ohol and toba o smo*e e(posure durin! pre!nan y and

environmental e(posure to lead in very early li"e . 3I %he relation o" smo*in! to ADHD ould be due to ni otine

ausin! hypo(ia &la * o" o(y!en' to the "etus in utero . 5I $t ould also be that women with ADHD are more li*ely to

smo*e 7I and there"ore, due to the stron! !eneti omponent o" ADHD, are more li*ely to have hildren with

ADHD . 8I =ompli ations durin! pre!nan y and birth in ludin! premature birth mi!ht also play a role . 30I ADHD

patients have been observed to have hi!her than avera!e rates o" head in uriesE 31I however, urrent eviden e does

not indi ate that head in uries are the ause o" ADHD in the patients observed. 32I$n"e tions durin! pre!nan y, at

birth, and in early hildhood are lin*ed to an in reased ris* o" developin! ADHD. %hese in lude various viruses

&measles, vari ella, rubella, enterovirus 51' and strepto o al ba terial in"e tion. 3 I 3 I

A 2005 study lin*ed the or!anophosphate inse ti ide hlorpyri"os , whi h is used on some "ruits and ve!etables, with

delays in learnin! rates, redu ed physi al oordination, and behavioral problems in hildren, espe ially ADHD. 3 I

A 2010 study "ound that pesti ide e(posure is stron!ly asso iated with an in reased ris* o" ADHD in hildren.

9esear hers analy ed the levels o" or!anophosphate residues in the urine o" more than 1,100 hildren a!ed 7 to 1

years old, and "ound that those with the hi!hest levels o" dial*yl phosphates, whi h are the brea*down produ ts o"

or!anophosphate pesti ides, also had the hi!hest in iden e o" ADHD. 6verall, they "ound a per ent in rease in

the odds o" developin! ADHD with every 10-"old in rease in urinary on entration o" the pesti ide residues. %he

e""e t was seen even at the low end o" e(posure: hildren who had any dete table, above-avera!e level o" pesti ide

metabolite in their urine were twi e as li*ely as those with undete table levels to re ord symptoms o" ADHD. 33I 35I

Diet

Main article: Diet and attention deficit hyperactivity disorder

A study 37I published in %he Lan et in 2005 "ound a lin* between hildrenNs in!estion o" many ommonly used

arti"i ial "ood olors, the preservative sodium ben oate and hypera tivity. $n response to these "indin!s, the ;ritish

!overnment too* prompt a tion. A ordin! to the Food tandards A!en y , the "ood re!ulatory a!en y in the JC,
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tp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-65http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-66http://en.wikipedia.org/wiki/Diet_and_attention_deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-67http://en.wikipedia.org/wiki/Sodium_benzoatehttp://en.wikipedia.org/wiki/Food_Standards_Agency


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"ood manu"a turers are bein! en oura!ed to voluntarily phase out the use o" most arti"i ial "ood olors by the end o"

2008. citation needed I Followin! the F ANs a tions, the +uropean =ommission ruled that any "ood produ ts ontainin! the

O outhampton i(P &%he ontentious olourin!s are: sunset yellow F=F &+110', 4uinoline yellow &+10 ',

armoisine &+122', allura red &+128', tartra ine &+102' and pon eau 9 &+12 '' must display warnin! labels on

their pa *a!in! by 2010. citation needed I $n the J , little has been done clarification needed I to urb "ood manu"a turerNs use o"

spe i"i "ood olors, despite the new eviden e presented by the outhampton study. However, the e(istin! J Food

Dru! and =osmeti A t 38I had already re4uired that arti"i ial "ood olors be approved "or use, that they must be

!iven FDQ= numbers by the FDA, and the use o" these olors must be indi ated on the pa *a!e. 50I %his is why "ood

pa *a!in! in the J A may state somethin! li*e: =ontains FDQ= 9ed R 0.

Social

%he )orld Health 6r!ani ation states that the dia!nosis o" ADHD an represent "amily dys"un tion or inade4ua ies

in the edu ational system rather than individual psy hopatholo!y. 51I 6ther resear hers believe that relationships with

are!ivers have a pro"ound e""e t on attentional and sel"-re!ulatory abilities. A study o" "oster hildren "ound that a

hi!h number o" them had symptoms losely resemblin! ADHD. 52I 9esear hers have "ound behavior typi al o"

ADHD in hildren who have su""ered violen e and emotional abuse. 2 I5 I Furthermore ,=omple( or on entratin! on

s hoolwor* in some hildren, these hildren ould have "ailed to inte!rate others# so ial e(pe tations o" their

behavior "or a variety o" other reasons. 55I As !eneti resear h into ADHD pro eeds, it may be ome possible to

inte!rate this in"ormation with the neurobiolo!y in order to distin!uish disability "rom varieties o" normal or even

e( eptional "un tionin! in people alon! the same spe trum o" attention di""eren es. 57I
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Social construct theory of ADHD

Main article: Social construct theory of ADHD

o ial onstru tion theory states that it is so ieties that determine where the line between normal and abnormal

behavior is drawn. %hus so iety members in ludin! physi ians, parents, tea hers, and others are the ones whodetermine whi h dia!nosti riteria are applied and thus determine the number o" people a""e ted. 58I %his is

e(empli"ied in the "a t that the D / $ arrives at levels o" ADHD three to "our times hi!her than those obtained

with use o" the $=D 10. 1 I %homas as , an e(treme proponent o" this theory, has !one so "ar as to state that ADHD

was invented and not dis overed. 70I 71I

0o1 arousal theory

Main article: !o" arousal theory

A ordin! to the low arousal theory, people with ADHD need e( essive a tivity as sel"-stimulation be ause o" their

state o" abnormally low arousal . 72I 7 I %he theory states that those with ADHD annot sel"-moderate, and their

attention an only be !ained by means o" environmental stimuli , 72I whi h in turn results in disruption o" attentional

apa ity and an in rease in hypera tive behaviour . 7 I

)ithout enou!h stimulation omin! "rom the environment, an ADHD hild will reate it him or hersel" by wal*in!

around, "id!etin! , tal*in!, et . %his theory also e(plains why stimulant medi ations have hi!h su ess rates and an

indu e a almin! e""e t at therapeuti dosa!es amon! hildren with ADHD. $t establishes a stron! lin* with

s ienti"i data that ADHD is onne ted to abnormalities with the neuro hemi al dopamine and a power"ul lin* with

low-stimulation


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%he pathophysiolo!y o" ADHD is un lear and there are a number o" ompetin! theories. 7 I9esear h on hildren

with ADHD has shown a !eneral redu tion o" brain volume, but with a proportionally !reater redu tion in the

volume o" the le"t-sided pre"rontal orte( . %hese "indin!s su!!est that the ore ADHD "eatures o" inattention,

hypera tivity, and impulsivity may re"le t "rontal lobe dys"un tion , but other brain re!ions parti ularly

the erebellum have also been impli ated. 73I ?euroima!in! studies in ADHD have not always !iven onsistent

results and as o" 2007 are only used "or resear h not dia!nosti purposes . 75I A 200 review o" published studies

involvin! neuroima!in!, neuropsy holo!i al !eneti s, and neuro hemistry "ound onver!in! lines o" eviden e to

su!!est that "our onne ted "rontostriatal re!ions play a role in the pathophysiolo!y o" ADHD: %he lateral pre"rontal

orte( , dorsal anterior in!ulate orte( , audate, and putamen . 77I

$n one study a delay in development o" ertain brain stru tures by an avera!e o" three years o urred in ADHD

elementary s hool a!ed patients. %he delay was most prominent in the "rontal orte( and temporal lobe , whi h are

believed to be responsible "or the ability to ontrol and "o us thin*in!. $n ontrast, the motor orte( in the ADHD

patients was seen to mature "aster than normal, su!!estin! that both slower development o" behavioral ontrol and

advan ed motor development mi!ht be re4uired "or the "id!etiness that hara teri es ADHD. 78I $t should be noted

that stimulant medi ation itsel" may a""e t !rowth "a tors o" the entral nervous system. 80I

%he same laboratory had previously "ound involvement o" the 5-repeat variant o" the dopamine D re eptor !ene,

whi h a ounts "or about 0 per ent o" the !eneti ris* "or ADHD, in unusual thinness o" the orte( o" the ri!ht side

o" the brainE however, in ontrast to other variants o" the !ene "ound in ADHD patients, the re!ion normali ed in

thi *ness durin! the teen years in these hildren, oin idin! with lini al improvement. 81I

Additionally,


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A 1880


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1. ADHD, =ombined %ype: i" both riteria 1A and 1; are met "or the past 3 months

2. ADHD impulsivity &ADHD, predominately hypera tive-impulsive type' or

inattention &ADHD predominately inattentive type' or both &ADHD ombined type'.

DS+$&2

$A. i( or more o" the "ollowin! si!ns o" inattention have been present "or at least 3 months to a point that isdisruptive and inappropriate "or developmental level:

#nattention:

1. 6"ten does not !ive lose attention to details or ma*es areless mista*es in s hoolwor*, wor*, or

other a tivities.

2. 6"ten has trouble *eepin! attention on tas*s or play a tivities.

. 6"ten does not seem to listen when spo*en to dire tly.

. 6"ten does not "ollow instru tions and "ails to "inish s hoolwor*, hores, or duties in the

wor*pla e &not due to oppositional behavior or "ailure to understand instru tions'.

. 6"ten has trouble or!ani in! a tivities.

3. 6"ten avoids, disli*es, or doesn#t want to do thin!s that ta*e a lot o" mental e""ort "or a lon! period

o" time &su h as s hoolwor* or homewor*'.

5. 6"ten loses thin!s needed "or tas*s and a tivities &su h as toys, s hool assi!nments, pen ils,

boo*s, or tools'.

7. $s o"ten easily distra ted.

8. 6"ten "or!et"ul in daily a tivities.
http://en.wikipedia.org/wiki/ADHD_predominantly_inattentivehttp://en.wikipedia.org/wiki/ADHD_predominantly_inattentivehttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-110http://en.wikipedia.org/wiki/ADHD_predominantly_inattentivehttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-110


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$;. i( or more o" the "ollowin! si!ns o" hypera tivity-impulsivity have been present "or at least 3 months to

an e(tent that is disruptive and inappropriate "or developmental level:

Hyperactivity:

1. 6"ten "id!ets with hands or "eet or s4uirms in seat.

2. 6"ten !ets up "rom seat when remainin! in seat is e(pe ted.

. 6"ten runs about or limbs when and where it is not appropriate &adoles ents or adults may "eel

very restless'.

. 6"ten has trouble playin! or en oyin! leisure a tivities 4uietly.

. $s o"ten on the !o or o"ten a ts as i" driven by a motor .

3. 6"ten tal*s e( essively.

#mpulsiveness:

1. 6"ten blurts out answers be"ore 4uestions have been "inished.

2. 6"ten has trouble waitin! one#s turn.

. 6"ten interrupts or intrudes on others &e(ample: butts into onversations or !ames'.

$$. ome si!ns that ause impairment were present be"ore a!e 5 years.

$$$. ome impairment "rom the si!ns is present in two or more settin!s &su h as at s hool>wor* and

at home'.

$ . %here must be lear eviden e o" si!ni"i ant impairment in so ial, s hool, or wor* "un tionin!.

. %he si!ns do not happen only durin! the ourse o" a


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Hyper*ineti ondu t disorder . 6therwise the disorder is lassi"ied as Disturban e o" A tivity

and Attention , 6ther Hyper*ineti Disorders or Hyper*ineti Disorders, Jnspe i"ied . %he

latter is sometimes re"erred to as, Hyper*ineti yndrome . 11 I

*ther guidelines

%he Ameri an A ademy o"


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$" a hild seems too a tive on the play!round but not elsewhere, the problem mi!ht not be ADHD.

$t mi!ht also not be ADHD i" the behaviors o ur in the lassroom but nowhere else. A hild who

shows some symptoms would not be dia!nosed with ADHD i" his or her s hoolwor* or

"riendships are not impaired by the behaviors . 115I

Differential

%o ma*e the dia!nosis o" ADHD, a number o" other possible medi al and psy holo!i al

onditions must be e( luded.

+edical conditions

/edi al onditions that must be e( luded in lude: hypothyroidism , anemia , lead

poisonin! , hroni illness , hearin! or vision impairment ,substan e abuse , medi ation side e""e ts ,

sleep impairment and hild abuse , 117I and lutterin! &ta hyphemia' amon! others.

Sleep conditions

As with other psy holo!i al and neurolo!i al issues, the relationship between ADHD and sleep is

omple(. $n addition to lini al observations, there is substantial empiri al eviden e "rom a

neuroanatomi standpoint to su!!est that there is onsiderable overlap in the entral nervous

system enters that re!ulate sleep and those that re!ulate attention>arousal. 118I


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=ir adian rhythm disorders, su h as delayed sleep phase syndrome &D < '. A study in the

?etherlands ompared two !roups o" unmedi ated 3-12-year-olds, all o" them with

ri!orously dia!nosed ADHD . 75 o" them had problems !ettin! to sleep, had no sleep

problems. %he lar!er !roup had a si!ni"i antly later dim li!ht melatonin onset &DL/6' than

did the hildren with no sleep problems. 12 I

+anagement

Main article: Attention&deficit hyperactivity disorder mana'ement

/ethods o" treatment o"ten involve some ombination o" behavior modi"i ation, li"e-style

han!es, ounselin!, and medi ation. A 200 study "ound that medi al mana!ement and

behavioral treatment is the most e""e tive ADHD mana!ement strate!y, "ollowed by medi ation

alone, and then behavioral treatment . 12 I )hile medi ation has been shown to improve behavior

when ta*en over the short term, they have not been shown to alter lon! term out omes.123I /edi ations have at least some e""e t in about 70 o" people . 125I

"sychosocial

%he eviden e is stron! "or the e""e tiveness o" behavioral treatments in ADHD. 127I $t is

re ommended "irst line in those who have mild symptoms and in pres hool a!ed hildren.128I


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/ethylphenidate &9italin' 10 m! tablets

timulant medi ation are the medi al treatment o" hoi e . 1 I %here are a number o" non-stimulant

medi ations, su h as atomo(etine , that may be used as alternatives. 1 I %here are no !ood studies

o" omparative e""e tiveness between various medi ations, and there is a la * o" eviden e on their

e""e ts on a ademi per"orman e and so ial behaviors. 1 I )hile stimulants and atomo(etine are

!enerally sa"e, there are side e""e ts and ontraindi ations to their use. 1 I/edi ations are not

re ommended "or pres hool hildren, as their lon!-term e""e ts in su h youn! people are

un*nown. 2 I 1 I %here is very little data on the lon!-term adverse e""e ts or bene"its o" stimulants

"or ADHD. 1 3I uidelines on when to use medi ations vary internationally, with the JC#s ?ational

$nstitute o" =lini al +( ellen e , "or e(ample, only re ommendin! use in severe ases, while most

Jnited tates !uidelines re ommend medi ations in nearly all ases. 1 5I

"rognosis

=hildren dia!nosed with ADHD have si!ni"i ant di""i ulties in adoles en e, re!ardless o"

treatment . 1 7I $n the Jnited tates, 5 per ent o" those with ADHD do not !et a hi!h s hool

diploma even thou!h many o" them will re eive spe ial edu ation servi es. 1 8I A 188 brie"in!

itin! a 188 boo* review says the ombined out omes o" the e(pulsion and dropout rates indi ate

that almost hal" o" all ADHD students never "inish hi!h s hool. 1 0I Also in the J , less than

per ent o" individuals with ADHD !et a olle!e de!ree 1 1I ompared to 27 per ent o" the !eneral

population . 1 2I %hose with ADHD as hildren are at in reased ris* o" a number o" adverse li"e

out omes on e they be ome teena!ers. %hese in lude a !reater ris* o" auto rashes, in ury and

hi!her medi al e(penses, earlier se(ual a tivity, and teen pre!nan y . 1 I9ussell ;ar*ley states that

adult ADHD impairments a""e t edu ation, o upation, so ial relationships, se(ual a tivities,

datin! and marria!e, parentin! and o""sprin! psy holo!i al morbidity, rime and dru! abuse,

health and related li"estyles, "inan ial mana!ement, or drivin!. ADHD an be "ound to produ e

diverse and serious impairments . 1 I %he proportion o" hildren meetin! the dia!nosti riteria "or

ADHD drops by about 0 per ent over three years a"ter the dia!nosis. %his o urs re!ardless o"

the treatments used and also o urs in untreated hildren with ADHD. 117I 1 I 1 3I ADHD persists

into adulthood in about 0 to 0 per ent o" ases. 7I %hose a""e ted are li*ely to develop opin!

me hanisms as they mature, thus ompensatin! "or their previous ADHD. 10I

pidemiology
http://en.wikipedia.org/wiki/Methylphenidatehttp://en.wikipedia.org/wiki/Stimulanthttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Atomoxetinehttp://en.wikipedia.org/wiki/Atomoxetinehttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-133http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-133http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-NICE2008-23http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-134http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-hta.ac.uk-135http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-hta.ac.uk-135http://en.wikipedia.org/wiki/Guidelineshttp://en.wikipedia.org/wiki/Guidelineshttp://en.wikipedia.org/wiki/National_Institute_of_Clinical_Excellencehttp://en.wikipedia.org/wiki/National_Institute_of_Clinical_Excellencehttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-136http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-autogenerated6-137http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-autogenerated6-137http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-BarkleyContEd-138http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-BarkleyContEd-138http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-139http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-139http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-adhd_superman-140http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-us_census_2005-141http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-us_census_2005-141http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-continuingedcourses.net-142http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-continuingedcourses.net-142http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-143http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-143http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-pmid11563573-117http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Jensen_PS.2C_Arnold_LE.2C_Swanson_JM_2007_989.E2.80.931002-144http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-TI2008-145http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Balint2008-7http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-psychiatrymmc.com-9http://en.wikipedia.org/wiki/Methylphenidatehttp://en.wikipedia.org/wiki/Stimulanthttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Atomoxetinehttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-133http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-CNS09-132http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-NICE2008-23http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-134http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-hta.ac.uk-135http://en.wikipedia.org/wiki/Guidelineshttp://en.wikipedia.org/wiki/National_Institute_of_Clinical_Excellencehttp://en.wikipedia.org/wiki/National_Institute_of_Clinical_Excellencehttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-136http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-autogenerated6-137http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-BarkleyContEd-138http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-139http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-adhd_superman-140http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-us_census_2005-141http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-continuingedcourses.net-142http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-143http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-pmid11563573-117http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Jensen_PS.2C_Arnold_LE.2C_Swanson_JM_2007_989.E2.80.931002-144http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-TI2008-145http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Balint2008-7http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-psychiatrymmc.com-9


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History

Main article: History of attention&deficit hyperactivity disorder

Hypera tivity has lon! been part o" the human ondition. ir Ale(ander =ri hton des ribes

mental restlessness in his boo* An #n(uiry #nto the ature and )ri'in of Mental

Deran'ement written in 1587 . 1 I 1 I %he terminolo!y used to des ribe the symptoms o" ADHD

has !one throu!h many han!es over history in ludin!: minimal brain dama!e , minimal brain

dys"un tion &or disorder' , 1 3I learnin!>behavioral disabilities and hypera tivity . $n the D /-

$$ &1837' it was the Hyper*ineti 9ea tion o" =hildhood . $n the D /-$$$ ADD &Attention-

De"i it Disorder' with or without hypera tivity was introdu ed. $n 1875 this was han!ed to

ADHD in the D /-$$$-9 and subse4uent editions. 1 5I %he use o" stimulants to treat ADHD was

"irst des ribed in 18 5. 1 7I

Society and culture

See also: !ist of people dia'nosed "ith attention&deficit hyperactivity disorder

%he media have reported on many issues related to ADHD. $n 2001


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?eil ;ush &brother o" "ormer


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not entertained by most ;ritish lini ians. 151I 152I $n 2008, the ;ritish


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adults with ADHD o"ten have haoti li"estyles, may appear to be disor!ani ed and may rely on

non-pres ribed dru!s and al ohol to !et by. 172I %hey o"ten have su h asso iated

psy hiatri omorbidities as depression , an(iety disorder , bipolar disorder , substan e abuse , or

a learnin! disability . 172I A dia!nosis o" ADHD may o""er adults insi!ht into their behaviors and

allow patients to be ome more aware and see* help with opin! and treatment strate!ies. 171I %here

is ontroversy amon!st some e(perts on whether ADHD persists into adulthood. 9e o!ni ed as

o urrin! in adults in 1857, it is urrently not addressed separately "rom ADHD in hildhood.

6bsta les that lini ians "a e when assessin! adults who may have ADHD in lude

developmentally inappropriate dia!nosti riteria, a!e-related han!es, omorbidities and the

possibility that hi!h intelli!en e or situational "a tors an mas* ADHD.
http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Art.218-181http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Art.218-181http://en.wikipedia.org/wiki/Comorbidityhttp://en.wikipedia.org/wiki/Comorbidityhttp://en.wikipedia.org/wiki/Comorbidityhttp://en.wikipedia.org/wiki/Clinical_depressionhttp://en.wikipedia.org/wiki/Clinical_depressionhttp://en.wikipedia.org/wiki/Anxiety_disorderhttp://en.wikipedia.org/wiki/Anxiety_disorderhttp://en.wikipedia.org/wiki/Anxiety_disorderhttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Substance_abusehttp://en.wikipedia.org/wiki/Substance_abusehttp://en.wikipedia.org/wiki/Substance_abusehttp://en.wikipedia.org/wiki/Learning_disabilityhttp://en.wikipedia.org/wiki/Learning_disabilityhttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Art.218-181http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Art.218-181http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-uspharmacist.com-180http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-uspharmacist.com-180http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Art.218-181http://en.wikipedia.org/wiki/Comorbidityhttp://en.wikipedia.org/wiki/Clinical_depressionhttp://en.wikipedia.org/wiki/Anxiety_disorderhttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Substance_abusehttp://en.wikipedia.org/wiki/Learning_disabilityhttp://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-Art.218-181http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-uspharmacist.com-180

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