Attention-deficit/hyperactivity disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric condition.  It affects children, adolescents, and adults worldwide.  Patterns of diminished attention and increased hyperactivity or impulsivity are characteristics of ADHD. Often there is significant impairment in academics, social, and interpersonal situations. ADHD is associated with other comorbid disorders such as learning disabilities, anxiety, mood, and disruptive behavior disorders.

Risk factors

• Genetics

• Family history

• Neurochemical factors

• Neurophysiological factors

• Developmental factors

• Psychological factors

ADHD affects up to 5 to 8% of school-age children; 60-85% of those diagnosed in childhood continue to be symptomatic during adulthood. Previously there were two subtypes of ADHD. Inattentive and Hyperactive/impulsive type. Currently, these subtypes by three specifiers:

1. Combined presentation

2. Predominantly inattentive presentation

3. Predominantly hyperactive/impulsive presentation

Clinical Manifestations:

ADHD is characterized mainly in adults by inattention, impulsiveness, restlessness, executive dysfunction, and emotional dysregulation. These symptoms together lead to marked deficits in normal daily functioning. The predominant features of ADHD in adults differ from typical ADHD features in children. Inattention symptoms are more prominent in adults, while signs of hyperactivity or impulsivity are less noticeable.

Hyperactivity symptoms

• Restlessness

• Verbosity

• Constant activity, fidgeting 

• A tendency to choose very active jobs

Impulsivity symptoms 

• Ending relationships abruptly and often

• Quitting jobs

• Overreacting to frustrations

• More driving violations

Inattention symptoms

• Procrastination

• Difficulty making decisions

• Poor time management 

• Difficulty in organizing activities, prioritizing tasks, following through, and completing tasks

• Forgetfulness

How is ADHD diagnosed?

ADHD is usually diagnosed during childhood or late adolescence. The individual presents a persistent inattention or hyperactivity-impulsivity pattern that interferes with normal function and development. It requires continuous impairing of inattentiveness or hyperactivity in at least two different settings. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) gives diagnosis criteria to children and adults with ADHD. The DSM-5 requires that at least six inattentive or hyperactive-impulsive symptoms be present before age 12 to diagnose ADHD. 

To diagnose ADHD in adults and adolescents 17 years or older only five signs are needed for diagnosis. Symptoms might be different at older ages. Fidgetiness and verbal impulsivity, respectively, and extreme restlessness or wearing others out with their activity are signs in adults diagnosed with ADHD.

ADHD can be diagnosed by trained professionals such as psychiatrists, pediatricians, and nurse practitioners.

Course and prognosis:

The course of ADHD can be variable; overactivity is often the first symptom to remit, while inattention and distractibility are the last. Remission usually occurs between ages 12-and 20 years of age. Unfortunately, most patients with ADHD undergo partial remission while being vulnerable to mood, antisocial, and drug abuse behaviors. Approximately 60% of all cases persist into adulthood, while learning difficulties continue through life. Monitoring the pharmacological treatment for patients with ADHD is an essential part of the drug response and patient compliance. The goal is to reduce symptoms of ADHD and improve quality of life.

Treatment:

Pharmacologic treatment is considered the first-line treatment for ADHD. Long-acting stimulants are FDA approved for the adult treatment of ADHD. Stimulants are contraindicated in children, adolescents, and adults with known cardiac abnormalities and risks. The FDA approves some non-stimulant medications for the treatment of ADHD. Some antidepressants can be used in children older than six years, with variable success in treating ADHD.

Psychopharmacologic therapy may be needed indefinitely or for life. 

Although ADHD is a psychological condition, it is not a disability. Individuals with ADHD can find help and solutions to overcome any difficulties they may face. Cognitive Behavioral Therapy (CBT) can also help. A trained specialist can guide you or your loved one in managing stress, eating right, getting enough rest, and getting the proper medication to help overcome the symptoms of ADHD. To find out more about treatment options for ADHD, talk to your doctor or healthcare professional.

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.

Sadock, B. J., & Sadock, V. A. (2015). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolter Kluwer/Lippincott Williams & Wilkins.

https://www.psychiatry.org/psychiatrists/practice/dsm

https://www.cdc.gov/ncbddd/adhd/diagnosis.html

https://www.uptodate.com/contents/approach-to-treating-attention-deficit-hyperactivity-disorder-in-adults?search=adhd%20treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2