Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental, chronic disorder involving a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development.
ADHD is classified under the Neurodevelopmental Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
The DSM-5 has an extensive, but not exhaustive, list of criteria for ADHD. For these detailed criteria, please see the DSM-5 itself.
The criteria-based diagnosis requires meeting of inattention and/or hyperactivity-impulsivity criteria, onset before age 12, occurrence in two or more settings, and resulting impairment in functioning.
Population studies suggest that ADHD occurs in most cultures in 5% of children and 4.4% of adults.
More frequent in males than females, with ratio of 2:1 in children and 1.6:1 in adults
Females may be more likely to present primarily with inattentive features.
Temperament (e.g., reduced behavioral inhibition and effortful control, increased negative emotionality and novelty-seeking)
Environmental (e.g., very low birth weight: < 1500g, in utero exposures)
Genetic: substantial heritability
ADHD is a multifaceted disorder which varies greatly in symptom type and severity.
ADHD is a clinical diagnosis based on developmental history, clinical interview regarding symptoms/impairment, and objective ratings of inattention and/or hyperactivity/impulsivity across multiple settings, with multiple informants (e.g., parents, teachers).
When assessing adults, collateral and developmental data is needed to document developmental onset.
There is no diagnostic laboratory test or imaging modality to diagnose ADHD.
However, etiology-specific tests, such as TSH or serum lead levels may be helpful when hyperthyroidism or lead poisoning are suspected by history or examination.
In the pediatric population, common ADHD screening measures include:
Broad-band measures of psychopathology
e.g., the Child Behavior Checklist, the Behavior Assessment Scale for Children
Narrow-band measures that are specific to ADHD and common comorbidities
Attention and impulsivity/hyperactivity are dimensional in nature.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Adler LA, Dirks B, Deas P, et al. Self-Reported quality of life in adults with attention-deficit/hyperactivity disorder and executive function impairment treated with lisdexamfetamine dimesylate: a randomized, double-blind, multicenter, placebo-controlled, parallel-group study. BMC Psychiatry. 2013;13(1):253. [PMID:24106804]
Amador-Campos JA, Gómez-Benito J, Ramos-Quiroga JA. The Conners' Adult ADHD Rating Scales--Short Self-Report and Observer Forms: Psychometric Properties of the Catalan Version. J Atten Disord. 2012. [PMID:22771453]
Becker SP, Langberg JM, Luebbe AM, et al. Sluggish Cognitive Tempo is Associated With Academic Functioning and Internalizing Symptoms in College Students With and Without Attention-Deficit/Hyperactivity Disorder. J Clin Psychol. 2013. [PMID:24114716]
Chronis-Tuscano A, Molina BS, Pelham WE, et al. Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2010;67(10):1044-51. [PMID:20921120]
Greenhill LL, Pliszka S, Dulcan MK, et al. Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry. 2002;41(2 Suppl):26S-49S. [PMID:11833633]
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(4):716-23. [PMID:16585449]
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(1):46-54. [PMID:19006789]
McGee RA, Clark SE, Symons DK. Does the Conners' Continuous Performance Test aid in ADHD diagnosis? J Abnorm Child Psychol. 2000;28(5):415-24. [PMID:11100916]
Riccio CA, Reynolds CR. Continuous performance tests are sensitive to ADHD in adults but lack specificity. A review and critique for differential diagnosis. Ann N Y Acad Sci. 2001;931:113-39. [PMID:11462737]
Ward MF, Wender PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry. 1993;150(6):885-90. [PMID:8494063]
Wilens TE, Spencer TJ, Biederman J. A review of the pharmacotherapy of adults with attention-deficit/hyperactivity disorder. J Atten Disord. 2002;5(4):189-202. [PMID:11967475]
Attention-Deficit / Hyperactivity Disorder is a sample topic from the Johns Hopkins Psychiatry Guide.
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