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| {{Infobox disease | |||
| | Name = Attention-deficit/hyperactivity disorder | |||
| | Image= | |||
| | Caption= | |||
| | DiseasesDB = 6158 | |||
| | ICD10 = {{ICD10|F|90||f|90}} | |||
| | ICD9 = {{ICD9|314.00}}, {{ICD9|314.01}} | |||
| | OMIM = 143465 | |||
| | MedlinePlus = 001551 | |||
| | eMedicineSubj = med | |||
| | eMedicineTopic = 3103 | |||
| | eMedicine_mult = {{eMedicine2|ped|177}} | |||
| | MeshID = D001289 | |||
| }} | |||
| * | |||
| '''Attention-deficit/hyperactivity disorder'''<ref>American Psychiatric Association. (2000). ''Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision''. Washington DC.</ref> ('''ADHD''' or '''AD/HD''' or '''ADD''') is a ]<ref name="autogenerated1"> National Institute of Neurological Disorders and Stroke (NINDS/NIH) February 9, 2007. Retrieved on 2007-08-13.</ref> ].<ref>{{Cite journal|author=Zwi M, Ramchandani P, Joughin C |title=Evidence and belief in ADHD |journal=BMJ |volume=321 |issue=7267 |pages=975–6 |year=2000 |month=October |pmid=11039942 |pmc=1118810 |doi=10.1136/bmj.321.7267.975}}</ref> It is primarily characterized by "the co-existence of attentional problems and ], with each behavior occurring infrequently alone" and symptoms starting before seven years of age.<ref>{{Cite journal|author=Biederman J |title=Attention-deficit/hyperactivity disorder: a life-span perspective |journal=The Journal of Clinical Psychiatry |volume=59 Suppl 7 |issue= |pages=4–16 |year=1998 |pmid=9680048}}</ref> | |||
| ADHD is the most commonly studied and diagnosed ] in children, affecting about 3% to 5% of children globally<ref>{{Cite web|url=http://www.nimh.nih.gov/health/publications/adhd/complete-publication.shtml |archiveurl=http://web.archive.org/web/20071018052052/http://www.nimh.nih.gov/health/publications/adhd/complete-publication.shtml |archivedate=2007-10-18 |title=NIMH • ADHD • Complete Publication |accessdate=}}</ref><ref>{{Cite journal|author=Nair J, Ehimare U, Beitman BD, Nair SS, Lavin A |title=Clinical review: evidence-based diagnosis and treatment of ADHD in children |journal=Mo Med |volume=103 |issue=6 |pages=617–21 |year=2006 |pmid=17256270 |doi= |url=}}</ref> and diagnosed in about 2% to 16% of school aged children.<ref>{{Cite journal|author=Rader R, McCauley L, Callen EC |title=Current strategies in the diagnosis and treatment of childhood attention-deficit/hyperactivity disorder |journal=Am Fam Physician |volume=79 |issue=8 |pages=657–65 |year=2009 |month=April |pmid=19405409 |doi= |url=}}</ref> It is a ] disorder <ref>{{Cite journal|author=Van Cleave J, Leslie LK |title=Approaching ADHD as a chronic condition: implications for long-term adherence |journal=Journal of Psychosocial Nursing and Mental Health Services |volume=46 |issue=8 |pages=28–37 |year=2008 |month=August |pmid=18777966}}</ref> with 30% to 50% of those individuals diagnosed in childhood continuing to have symptoms into adulthood.<ref name="Balint2008" /><ref name="content.nejm.org">{{Cite journal|author=Elia J, Ambrosini PJ, Rapoport JL |title=Treatment of attention-deficit-hyperactivity disorder |journal=The New England Journal of Medicine |volume=340 |issue=10 |pages=780–8 |year=1999 |month=March |pmid=10072414 |doi=10.1056/NEJM199903113401007}}</ref> Adolescents and adults with ADHD tend to develop ] to compensate for some or all of their impairments.<ref name="psychiatrymmc.com">{{Cite journal|last=Gentile |first=Julie |authorlink= |coauthors= |year= 2004|month= |title=Adult ADHD: Diagnosis, Differential Diagnosis and Medication Management |journal=Psychiatry |volume=3 |issue=8 |pages=24–30 |id= |url=http://www.psychiatrymmc.com/displayArticle.cfm?articleID=article218 |format=}} {{Dead link|date=July 2010}}</ref> 4.7% of American adults are estimated to live with ADHD.<ref name="BarkleyAdultADHD">{{Cite web| last = Barkley | first = Russell A. | authorlink = | coauthors = | title = ADHD in Adults: History, Diagnosis, and Impairments | work = | publisher = ContinuingEdCourses.net | year = 2007 | url = http://www.continuingedcourses.net/active/courses/course034.php | format = | doi = | accessdate = July 27, 2009}}</ref> | |||
| ADHD is diagnosed two to four times as frequently in boys as in girls,<ref>{{Cite journal|author=Dulcan M |title=Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=36 |issue=10 Suppl |pages=85S–121S |year=1997 |month=October |pmid=9334567 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0890-8567&volume=36&issue=10&spage=85S |doi=10.1097/00004583-199710001-00007}}</ref><ref name="Singh I 2008 957–64">{{Cite journal|author=Singh I |title=Beyond polemics: science and ethics of ADHD |journal=Nature Reviews. Neuroscience |volume=9 |issue=12 |pages=957–64 |year=2008 |month=December |pmid=19020513 |doi=10.1038/nrn2514}}</ref> though studies suggest this discrepancy may be due to subjective bias of referring teachers.<ref>Sciutto, M.J., Nolfi, C.J., & Bluhm, C. (2004). Effects of Child Gender and Symptom Type on Referrals for ADHD by Elementary School Teachers. ''Journal of Emotional and Behavioral Disorders, 12''(4), 247-253.</ref> ] usually involves some combination of medications, behavior modifications, lifestyle changes, and counseling. Its symptoms can be difficult to differentiate from other disorders, increasing the likelihood that the diagnosis of ADHD will be missed.<ref name=Ramsay/> Additionally, most clinicians have not received formal training in the assessment and treatment of ADHD, particularly in adult patients.<ref name=Ramsay/> | |||
| ADHD and its diagnosis and treatment have been ] since the 1970s.<ref name="Parrillo 2008 63">{{Cite book|title=Encyclopedia of Social Problems |last=Parrillo |first=Vincent |year=2008 |publisher=SAGE |location= |isbn=9781412941655 |page=63 |url=http://books.google.com/?id=mRGr_B4Y1CEC&pg=PA63&dq=percent+who+consider+ADHD+controversial |accessdate=2009-05-02 }}</ref> The controversies have involved clinicians, teachers, policymakers, parents and the media. Topics include the actuality of the disorder, its causes, and the use of stimulant medications in its treatment.<ref name=US1999>{{Cite web|url=http://www.ahrq.gov/clinic/epcsums/adhdsum.htm |title=Treatment of Attention-Deficit/Hyperactivity Disorder |accessdate=2008-10-02 |work= |publisher=US department of health and human services |month=December | year=1999 }}</ref><ref name=autogenerated3>{{Cite journal|author=Mayes R, Bagwell C, Erkulwater J |title=ADHD and the rise in stimulant use among children |journal=Harv Rev Psychiatry |volume=16 |issue=3 |pages=151–66 |year=2008 |pmid=18569037 |doi=10.1080/10673220802167782|url=}}</ref><ref name="Cohen, Donald J.; Cicchetti, Dante 2006">{{Cite book|author=Cohen, Donald J.; Cicchetti, Dante |title=Developmental psychopathology |publisher=John Wiley & Sons|location=Chichester |year=2006 |pages= |isbn=0-471-23737-X |oclc= |doi= |accessdate=}}</ref> Most healthcare providers accept that ADHD is a genuine disorder with debate in the scientific community centering mainly around how it is diagnosed and treated.<ref name="Sim MG, Hulse G, Khong E 2004 615–8">{{Cite journal|author=Sim MG, Hulse G, Khong E |title=When the child with ADHD grows up |journal=Aust Fam Physician |volume=33 |issue=8 |pages=615–8 |year=2004 |month=August |pmid=15373378 |doi= |url=http://www.racgp.org.au/afp/200408/20040803sim.pdf|format=PDF}}</ref><ref name="Online">Silver, Larry B. ''Attention-deficit/hyperactivity disorder.'' American Psychiatric Publishing, Inc.; 3 edition (September 2003) ISBN 1-58562-131-5; July 20, 2009</ref><ref name="Schonwald A, Lechner E 2006 189–95">{{Cite journal|author=Schonwald A, Lechner E |title=Attention deficit/hyperactivity disorder: complexities and controversies |journal=Curr. Opin. Pediatr. |volume=18 |issue=2 |pages=189–95 |year=2006|month=April |pmid=16601502 |doi=10.1097/01.mop.0000193302.70882.70 |url=}}</ref> The ] concluded in 1998 that the diagnostic criteria for ADHD are based on extensive research and, if applied appropriately, lead to the diagnosis with high ].<ref>{{Cite journal|author=Goldman LS, Genel M, Bezman RJ, Slanetz PJ |title=Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association |journal=JAMA |volume=279 |issue=14 |pages=1100–7 |year=1998 |month=April |pmid=9546570 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=9546570}}</ref> | |||
| {{TOC limit|limit=3}} | |||
| ==Classification== | |||
| ADHD may be seen as one or more continuous traits found normally throughout the general population.<ref name = NICE2008>{{Cite web|url=http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf |format=PDF|title= | |||
| CG72 Attention deficit hyperactivity disorder (ADHD): full guideline|accessdate=2008-10-08 |work= |publisher=NHS |date=24 September 2008 }}</ref> | |||
| ADHD is a ] in which certain traits such as ] lag in development. Using ] of the prefrontal cortex, this developmental lag has been estimated to range from 3 to 5 years.<ref>{{Cite web|url=http://www.sciencedaily.com/releases/2007/11/071112172200.htm |title=Brain Matures A Few Years Late In ADHD, But Follows Normal Pattern |publisher=Sciencedaily.com |date=2007-11-13 |accessdate=2009-05-25}}</ref> These delays are considered to cause impairment. A diagnosis of ADHD does not, however, imply a neurological disease.<ref name=NICE2008/>{{Clarify|date=November 2009}} | |||
| ADHD is classified as a ] along with ], ] and ].<ref name=autogenerated10>{{Cite book|author=Wiener, Jerry M., Editor |title=Textbook Of Child & Adolescent Psychiatry |publisher=American Psychiatric Association |location=Washington, DC |year=2003 |pages= |isbn=1-58562-057-2 | url=http://books.google.com/?id=EIgGKcp0SpkC&dq=weiner+2003+%22textbook+of+child+%26+adolescent+psychiatry%22&printsec=frontcover |oclc= |doi= |accessdate=}}</ref> | |||
| ===Subtypes=== | |||
| ADHD has three subtypes:<ref>DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.</ref> | |||
| *Predominantly hyperactive-impulsive | |||
| **Most symptoms (six or more) are in the hyperactivity-impulsivity categories. | |||
| **Fewer than six symptoms of inattention are present, although inattention may still be present to some degree. | |||
| *] | |||
| **The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree. | |||
| **Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice symptoms of ADHD. | |||
| *Combined hyperactive-impulsive and inattentive | |||
| **Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present. | |||
| **Most children with ADHD have the combined type. | |||
| ===Childhood ADHD=== | |||
| Attention-deficit hyperactivity disorder or ADHD is a common childhood condition that can be treated. ADHD may affect certain areas of the brain that allow problem solving, planning ahead, understanding others’ actions, and impulse control.<ref name=AACAP>American Academy of Child Adolescent Psychiatry. "ADHD - A Guide for Families." June 27, 2009. http://www.aacap.org/cs/adhd_a_guide_for_families/what_is_adhd</ref> | |||
| The American Academy of Child Adolescent Psychiatry (AACAP) considers it necessary that the following be present before attaching the label of ADHD to a child: | |||
| *The behaviors must appear before age 7. | |||
| *They must continue for at least six months. | |||
| *The symptoms must also create a real handicap in at least two of the following areas of the child’s life: | |||
| **in the classroom, | |||
| **on the playground, | |||
| **at home, | |||
| **in the community, or | |||
| **in social settings.<ref name=AACAP/> | |||
| If a child seems too active on the playground but not elsewhere, the problem might not be ADHD. It might also not be ADHD if the behaviors occur in the classroom but nowhere else. A child who shows some symptoms would not be diagnosed with ADHD if his or her schoolwork or friendships are not impaired by the behaviors.<ref name=AACAP/> | |||
| Even if a child’s behavior seems like ADHD, it might not actually be ADHD; careful attention to the process of ] is mandatory. Many other conditions and situations can trigger behavior that resembles ADHD. For example, a child might show ADHD symptoms when experiencing: | |||
| *A death or divorce in the family, a parent’s job loss, or other sudden change | |||
| *Undetected seizures | |||
| *An ear infection that causes temporary hearing problems | |||
| *Problems with schoolwork caused by a learning disability | |||
| *Anxiety or depression<ref name=AACAP/> | |||
| *Insufficient or poor quality sleep | |||
| *Child abuse | |||
| ===Adult ADHD=== | |||
| {{Main|Adult attention-deficit disorder}} | |||
| Researchers found that 60% of the children diagnosed with ADHD continue having symptoms well into adulthood.<ref name="webmd.com">http://www.webmd.com/add-adhd/guide/adhd-adults</ref><ref name="uspharmacist.com">{{Cite journal|url=http://web.archive.org/web/20080205232924/http://www.uspharmacist.com/index.asp?page=ce/10135/default.htm |title=Recognizing and Treating ADHD in Adolescents and Adults |publisher=uspharmacist.com |author=Tom, Catherine M. |date=2005-01-15 |accessdate=2009-05-25}}</ref> Many adults, however, remain untreated.<ref name="webmd.com"/> Untreated adults with ADHD often have chaotic lifestyles, may appear to be disorganized and may rely on non-prescribed drugs and alcohol to get by.<ref name="Art.218" /> They often have such associated psychiatric ] as ], ], ], ], or a ].<ref name="Art.218">{{Cite journal|url=http://www.psychiatrymmc.com/displayArticle.cfm?articleID=article218 |title=Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management |publisher=Psychiatrymmc.com |date= |accessdate=2009-05-25 |volume=3 |issue=8 |last=Gentile |first=Julie}} {{Dead link|date=September 2010|bot=H3llBot}}</ref> A diagnosis of ADHD may offer adults insight into their behaviors and allow patients to become more aware and seek help with coping and treatment strategies.<ref name="uspharmacist.com"/> There is controversy amongst some experts on whether ADHD persists into adulthood. Recognized as occurring in adults in 1978, it is currently not addressed separately from ADHD in childhood. Obstacles that clinicians face when assessing adults who may have ADHD include developmentally inappropriate diagnostic criteria, age-related changes, comorbidities and the possibility that high intelligence or situational factors can mask ADHD. | |||
| ==Signs and symptoms== | |||
| Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. The symptoms of ADHD are especially difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin.<ref name="Ramsay"/> To be diagnosed with ADHD, symptoms must be observed in two different settings for six months or more and to a degree that is greater than other children of the same age.<ref name="ReferenceA">https://health.google.com/health/ref/Attention+deficit+hyperactivity+disorder+(ADHD)</ref> | |||
| The symptom categories of ADHD in children yield three potential classifications of ADHD—predominantly inattentive type, predominantly hyperactive-impulsive type, or combined type if criteria for both subtypes are met:<ref name="Ramsay"/>{{rp|p.4}} | |||
| Predominantly inattentive type symptoms may include:<ref name="NIMH1">"Attention Deficit Hyperactivity Disorder (ADHD)." Health & Outreach. Publications. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml July 15, 2009</ref> | |||
| * Be easily distracted, miss details, forget things, and frequently switch from one activity to another | |||
| * Have difficulty maintaining focus on one task | |||
| * Become bored with a task after only a few minutes, unless doing something enjoyable | |||
| * Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities | |||
| * Not seem to listen when spoken to | |||
| * Daydream, become easily confused, and move slowly | |||
| * Have difficulty processing information as quickly and accurately as others | |||
| * Struggle to follow instructions. | |||
| Predominantly hyperactive-impulsive type symptoms may include:<ref name="NIMH1"/> | |||
| * Fidget and squirm in their seats | |||
| * Talk nonstop | |||
| * Dash around, touching or playing with anything and everything in sight | |||
| * Have trouble sitting still during dinner, school, and story time | |||
| * Be constantly in motion | |||
| * Have difficulty doing quiet tasks or activities. | |||
| and also these manifestations primarily of impulsivity:<ref name="NIMH1"/> | |||
| * Be very impatient | |||
| * Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences | |||
| * Have difficulty waiting for things they want or waiting their turns in games | |||
| Most people exhibit some of these behaviors, but not to the degree where such behaviors significantly interfere with a person's work, relationships, or studies. The core impairments are consistent even in different cultural contexts.<ref>{{Cite journal|title=ADHD-Type Behavior and Harmful Dysfunction in Childhood: A Cross-Cultural Model|journal=American Anthropologist|date=2000-12|first=Alexandra|last=Brewis|volume=102|issue=4|page=826|id= |doi= 10.1525/aa.2000.102.4.823|accessdate=2008-04-19|last2=Schmidt|first2=Karen L.|last3=Meyer|first3=Mary }}</ref> | |||
| Symptoms may persist into adulthood for up to half of children diagnosed with ADHD. Estimating this is difficult as there are no official diagnostic criteria for ADHD in adults.<ref name="Ramsay">Ramsay, J. Russell. ''Cognitive Behavioral Therapy for Adult ADHD.'' Routledge, 2007. ISBN 0-415-95501-7</ref> ADHD in adults remains a clinical diagnosis. The signs and symptoms may differ from those during childhood and adolescence due to the adaptive processes and avoidance mechanisms learned during the process of socialisation.<ref>http://www.herbalfreak.com/medical-condition/ailments/attention-deficit-hyperactivity-disorder/2009/12/</ref> | |||
| A 2009 study found that children with ADHD move around a lot because it helps them stay alert enough to complete challenging tasks.<ref name="Rapport"> | |||
| *{{Cite web|url=http://www.eurekalert.org/pub_releases/2009-03/uocf-ush030909.php |title=UCF study: Hyperactivity enables children with ADHD to stay alert |format= |work= |accessdate=}} | |||
| *{{Cite journal|author=Rapport MD, Bolden J, Kofler MJ, Sarver DE, Raiker JS, Alderson RM |title=Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits? |journal=J Abnorm Child Psychol |volume=37 |issue=4 |pages=521–34 |year=2009 |month=May |pmid=19083090 |doi=10.1007/s10802-008-9287-8 |url=}}</ref> | |||
| ===Comorbidities=== | |||
| ADHD may accompany other disorders such as anxiety or depression. Such combinations can greatly complicate diagnosis and treatment. Academic studies and research in private practice suggest that depression in ADHD appears to be increasingly prevalent in children as they get older, with a higher rate of increase in girls than in boys, and to vary in prevalence with the subtype of ADHD. Where a mood disorder complicates ADHD it would be prudent to treat the mood disorder first, but parents of children who have ADHD often wish to have the ADHD treated first, because the response to treatment is quicker.<ref name="Brunsvold">{{Cite journal|author=Brunsvold GL, Oepen G |title=Comorbid Depression in ADHD: Children and Adolescents |journal=Psychiatric Times |volume=25 |issue=10|year=2008 |url=http://www.psychiatrictimes.com/adhd/article/10168/1286863}}</ref> | |||
| Inattention and "hyperactive" behavior are not the only problems in children with ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it. Many co-existing conditions require other courses of treatment and should be diagnosed separately instead of being grouped in the ADHD diagnosis. Some of the associated conditions are: | |||
| * ] (35%) and ] (26%) which both are characterized by antisocial behaviors such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, or stealing,<ref name=UTP2008>{{Cite web|url=http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293#5 |author = Krull, K.R. |title=Evaluation and diagnosis of attention deficit hyperactivity disorder in children |format= Subscription required |accessdate=2008-09-12 |work= |publisher=Uptodate |date=December 5, 2007 }}</ref> inevitably linking these comorbid disorders with ] (ASPD); about half of those with hyperactivity and ODD or CD develop ASPD in adulthood.<ref>PMID 19428109</ref> | |||
| * ], which was according to a study on 120 female psychiatric patients diagnosed and treated for BPD associated with ADHD in 70% of those cases.<ref>{{Cite journal|author=Philipsen A |title=Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=256 Suppl 1 |issue= |pages=i42–6 |year=2006 |month=September |pmid=16977551 |doi=10.1007/s00406-006-1006-2}}</ref> | |||
| * Primary disorder of ], which is characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch and appear to be hyperactive in order to remain alert and active.<ref name="UTP2008" /> | |||
| * ]s. Boys diagnosed with the combined subtype have been shown likely to suffer from a mood disorder.<ref>Bauermeister, J., Shrout, P., Chávez, L., Rubio-Stipec, M., Ramírez, R., Padilla, L., et al. (2007, August). ADHD and gender: are risks and sequela of ADHD the same for boys and girls?. Journal of Child Psychology & Psychiatry, 48(8), 831-839. Retrieved February 17, 2009, doi:10.1111/j.1469-7610.2007.01750.x</ref> | |||
| * ]. As many as 25% of children with ADHD have bipolar disorder. Children with this combination may demonstrate more aggression and behavioral problems than those with ADHD alone.<ref name="UTP2008" /> | |||
| * ], which has been found to be common in girls diagnosed with the inattentive subtype of ADHD.<ref>Bauermeister, J., Shrout, P., Chávez, L., Rubio-Stipec, M., Ramírez, R., Padilla, L., et al. (2007, August). ADHD and gender: are risks and sequela of ADHD the same for boys and girls?. Journal of Child Psychology & Psychiatry, 48(8), 831-839.</ref> | |||
| * ]. OCD is believed to share a genetic component with ADHD and shares many of its characteristics.<ref name="UTP2008" /> | |||
| ==Cause== | |||
| A specific cause of ADHD is not known.<ref>{{Cite journal| last = Bailly | first = Lionel | date = | year = 2005 | month = | title = Stimulant medication for the treatment of attention-deficit hyperactivity disorder: evidence-b(i)ased practice? | journal = Psychiatric Bulletin | volume = 29 | issue = 8 | pages = 284–287 | publisher = The Royal College of Psychiatrists| doi = 10.1192/pb.29.8.284 | url = http://pb.rcpsych.org/cgi/content/full/29/8/284 | format = Full text | accessdate = | quote = }}</ref> There are, however, a number of factors that may contribute to, or exacerbate ADHD. They include genetics, diet and social and physical environments. | |||
| ===Genetics=== | |||
| ] scan: ADHD brains dopamine transporters]] | |||
| ] indicate that the disorder is highly heritable and that genetics are a factor in about 75% of all cases.<ref name=NICE2008/> Hyperactivity also seems to be primarily a genetic condition; however, other causes do have an effect.<ref>{{Cite web|url=http://www.continuingedcourses.net/active/courses/course003.php|title=Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity|last=Barkley|first=Russel A.|accessdate=2006-06-26}}</ref> | |||
| Researchers believe that a large majority of ADHD cases arise from a combination of various genes, many of which affect ] transporters. Candidate genes include ], ], ]s ]/],<ref>{{Cite journal| author=N.D. Volkow, G.J. Wang | title=Evaluating Dopamine Reward Pathway in ADHD | journal=JAMA | year=2009 | volume=302 | issue=10 | pages= 1084–1091 | doi=10.1001/jama.2009.1308 | pmid=19738093 | last1=Volkow | first1=ND | last2=Wang | first2=GJ | last3=Kollins | first3=SH | last4=Wigal | first4=TL | last5=Newcorn | first5=JH | last6=Telang | first6=F | last7=Fowler | first7=JS | last8=Zhu | first8=W | last9=Logan | first9=J}}</ref> ] ] A, ]-methyl transferase, serotonin transporter promoter (SLC6A4), ], ],<ref name="dopamine">Roman T, Rohde LA, Hutz MH. (2004). "Polymorphisms of the dopamine transporter gene: influence on response to methylphenidate in attention deficit-hyperactivity disorder." ''American Journal of Pharmacogenomics'' 4(2):83–92 PMID 15059031</ref> the 10-repeat allele of the DAT1 gene,<ref name="gene">Swanson JM, Flodman P, Kennedy J, et al. "Dopamine Genes and ADHD." ''Neurosci Biobehav Rev.'' 2000 Jan;24(1):21–5. PMID 10654656</ref> the 7-repeat allele of the DRD4 gene,<ref name="gene"/> and the dopamine beta hydroxylase gene (DBH TaqI).<ref>Smith KM, Daly M, Fischer M, et al. "Association of the dopamine beta hydroxylase gene with attention deficit hyperactivity disorder: genetic analysis of the Milwaukee longitudinal study." ''Am J Med Genet B Neuropsychiatr Genet.'' 2003 May 15;119(1):77–85. PMID 12707943</ref> | |||
| The broad selection of targets indicates that ADHD does not follow the traditional model of "a genetic disease" and should therefore be viewed as a complex interaction among genetic and environmental factors. Even though all these genes might play a role, to date no single gene has been shown to make a major contribution to ADHD.<ref name="autogenerated2">{{Cite journal| author=M. T. Acosta, M. Arcos-Burgos, M. Muenke | title=Attention deficit/hyperactivity disorder (ADHD): Complex phenotype, simple genotype? | journal=Genetics in Medicine | year=2004 | volume=6 | issue=1 | pages= 1–15 | doi = 10.1097/01.GIM.0000110413.07490.0B | pmid=14726804 | last1=Acosta | first1=MT | last2=Arcos-Burgos | first2=M | last3=Muenke | first3=M}}</ref> | |||
| ====Evolutionary theories==== | |||
| {{See also|Hunter vs. farmer theory}} | |||
| The hunter vs. farmer theory is a hypothesis proposed by author ] about the origins of ADHD. The theory proposes that hyperactivity may be an adaptive behavior in pre-modern humans<ref>{{Cite journal|author=Arcos-Burgos M, Acosta MT |title=Tuning major gene variants conditioning human behavior: the anachronism of ADHD |journal=Curr. Opin. Genet. Dev. |volume=17 |issue=3 |pages=234–8 |year=2007 |month=June |pmid=17467976 |doi=10.1016/j.gde.2007.04.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0959-437X(07)00076-7}}</ref> and that those with ADHD retain some of the older "hunter" characteristics associated with early pre-agricultural human society. According to this theory, individuals with ADHD may be more adept at searching and seeking and less adept at staying put and managing complex tasks over time.<ref>{{Cite book|author=Hartmann, Thom |title=The Edison gene: ADHD and the gift of the hunter child |publisher=Park Street Press |location=Rochester, Vt |year=2003 |pages= |isbn=0-89281-128-5 |oclc= |url=http://books.google.com/?id=L0l5EaHppyoC&dq=hunter+vs+farmer+The+Edison+Gene:+ADHD+and+the+Gift+of+the+Hunter+Child |accessdate=}}</ref> Further evidence showing hyperactivity may be evolutionarily beneficial was put forth in 2006 in a study which found it may carry specific benefits for certain forms of ancient society. In these societies, those with ADHD are hypothesized to have been more proficient in tasks involving risk or competition (i.e. hunting, mating rituals, etc.).<ref>{{Cite journal|author=Williams J, Taylor E |title=The evolution of hyperactivity, impulsivity and cognitive diversity |journal=J R Soc Interface |volume=3|issue=8 |pages=399–413 |year=2006 |month=June |pmid=16849269 |pmc=1578754 |doi=10.1098/rsif.2005.0102 |url=}}</ref> | |||
| ===Environmental=== | |||
| Twin studies to date have suggested that approximately 9% to 20% of the variance in hyperactive-impulsive-inattentive behavior or ADHD symptoms can be attributed to nonshared environmental (nongenetic) factors.<ref>Levy et al., 1997{{Verify source|date=November 2009}}</ref><ref>Nigg, 2006{{Verify source|date=November 2009}}</ref><ref>Sherman, Silberg et al., 1996{{Verify source|date=November 2009}}</ref><ref>{{Cite journal|author=Sherman DK, Iacono WG, McGue MK |title=Attention-deficit hyperactivity disorder dimensions: a twin study of inattention and impulsivity-hyperactivity |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=36 |issue=6 |pages=745–53 |year=1997 |month=June |pmid=9183128 |doi=10.1097/00004583-199706000-00010}}</ref> Environmental factors implicated include alcohol and tobacco smoke exposure during pregnancy and environmental exposure to ] in very early life.<ref name="pmid17185283">{{Cite journal|author=Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP |title=Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children |journal=Environ. Health Perspect. |volume=114 |issue=12 |pages=1904–9 |year=2006 |pmid=17185283 |doi=10.1289/ehp.10274 |pmc=1764142}}</ref> The relation of smoking to ADHD could be due to nicotine causing ] (lack of oxygen) to the ] ''in utero''.<ref>{{Cite news|url=http://news.bbc.co.uk/1/hi/health/4727197.stm|title=Bad behaviour 'linked to smoking' |date=31 July 2005|publisher=BBC|accessdate=2008-12-30}}</ref> It could also be that women with ADHD are more likely to smoke<ref>{{Cite web|url=http://www.sciencedaily.com/releases/2008/11/081121125602.htm|title=Ability To Quit Smoking May Depend On ADHD Symptoms, Researchers Find|date=24 November 2008|publisher=Science Daily |accessdate=2008-12-30}}</ref> and therefore, due to the strong genetic component of ADHD, are more likely to have children with ADHD.<ref>{{Cite web|url=http://www.sciencedaily.com/releases/2007/04/070410190421.htm|title=Prenatal Smoking Increases ADHD Risk In Some Children|date=11 April 2007|publisher=Science Daily|accessdate=2008-12-30}}</ref> Complications during pregnancy and birth—including ]—might also play a role.<ref>{{Cite news|url=http://news.bbc.co.uk/1/hi/health/5042308.stm|title=ADHD 'linked to premature birth' |date=4 June 2006|publisher=BBC|accessdate=2008-12-30}}</ref> | |||
| ADHD patients have been observed to have higher than average rates of head injuries;<ref>{{Cite journal|author=Keenan HT, Hall GC, Marshall SW |title=Early head injury and attention deficit hyperactivity disorder: retrospective cohort study; |journal=BMJ |volume=337 |issue= |pages=a1984 |year=2008 |pmid=18988644 |pmc=2590885 |doi= 10.1136/bmj.a1984|url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18988644}}</ref> however, current evidence does not indicate that head injuries are the cause of ADHD in the patients observed.<ref>{{Cite web|url=http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html |title=Mental Health: A report of the surgeon general |accessdate=2008-09-15 |work= |publisher= |year=1999 }}</ref> Infections during pregnancy, at birth, and in early childhood are linked to an increased risk of developing ADHD. These include various viruses (measles, varicella, rubella, enterovirus 71) and streptococcal bacterial infection.<ref>{{Cite journal|author=Millichap JG |title=Etiologic classification of attention-deficit/hyperactivity disorder |journal=Pediatrics |volume=121 |issue=2 |pages=e358–65 |year=2008 |month=February |pmid=18245408 |doi=10.1542/peds.2007-1332}}</ref><ref>. New York: Springer-Verlag, 2010</ref> | |||
| A 2007 study linked the ] insecticide ], which is used on some fruits and vegetables, with delays in learning rates, reduced physical coordination, and behavioral problems in children, especially ADHD.<ref> ''Beyond Pesticides.'' 5 January 2007.</ref> | |||
| A 2010 study found that pesticide exposure is strongly associated with an increased risk of ADHD in children. Researchers analyzed the levels of organophosphate residues in the urine of more than 1,100 children aged 8 to 15 years old, and found that those with the highest levels of dialkyl phosphates, which are the breakdown products of organophosphate pesticides, also had the highest incidence of ADHD. Overall, they found a 35% increase in the odds of developing ADHD with every 10-fold increase in urinary concentration of the pesticide residues. The effect was seen even at the low end of exposure: children who had any detectable, above-average level of pesticide metabolite in their urine were twice as likely as those with undetectable levels to record symptoms of ADHD.<ref>Klein, Sarah. ''].'' 17 May 2010.</ref><ref>{{cite news| url=http://articles.latimes.com/2010/may/16/science/la-sci-pesticides-20100517 | work=The Los Angeles Times | title=Study links pesticide to ADHD in children | first=Thomas H. | last=Maugh II | date=2010-05-16}}</ref> | |||
| ====Diet==== | |||
| <!--''Hide until discussion on the talk page have finished'': {{POV-section}}--> | |||
| {{Main|Diet and attention deficit hyperactivity disorder}} | |||
| A study<ref>{{Cite journal|author=McCann D, Barrett A, Cooper A |title=Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial |journal=Lancet |volume=370 |issue=9598 |pages=1560–7 |year=2007 |month=November |pmid=17825405 |doi=10.1016/S0140-6736(07)61306-3}}</ref> conducted by researchers at Southampton University in the United Kingdom and published in The Lancet on November 3, 2007 found a link between children’s ingestion of many commonly used artificial food colors, the preservative ] and hyperactivity. In response to these findings, the British government took prompt action. According to the ], the food regulatory agency in the UK, food manufacturers are being encouraged to voluntarily phase out the use of most artificial food colors by the end of 2009.{{Citation needed|date=July 2010}} Following the FSA’s actions, the European Commission ruled that any food products containing the “Southampton Six” (The contentious colourings are: sunset yellow FCF (E110), quinoline yellow (E104), carmoisine (E122), allura red (E129), tartrazine (E102) and ponceau 4R (E124)) must display warning labels on their packaging by 2010.{{Citation needed|date=July 2010}} In the US, little has been done{{Clarify|date=July 2010|as per IP concern the statement is sweeping - may be necessary to explain "in comparison to the UK and Europe"}} to curb food manufacturer’s use of specific food colors, despite the new evidence presented by the Southampton study. However, the existing US Food Drug and Cosmetic Act<ref></ref> had already required that artificial food colors be approved for use, that they must be given FD&C numbers by the FDA, and the use of these colors must be indicated on the package.<ref></ref> This is why food packaging in the USA may state something like: "Contains FD&C Red #40." | |||
| ===Social=== | |||
| The ] states that the diagnosis of ADHD can represent family dysfunction or inadequacies in the educational system rather than individual psychopathology.<ref>{{Cite web|url=http://www.euro.who.int/document/MNH/ebrief14.pdf |title=www.euro.who.int |format= |work= |accessdate=}}</ref> Other researchers believe that relationships with caregivers have a profound effect on attentional and self-regulatory abilities. A study of foster children found that a high number of them had symptoms closely resembling ADHD.<ref>{{PDFlink||661 KB}}</ref> Researchers have found behavior typical of ADHD in children who have suffered violence and emotional abuse.<ref name = NICE2008 /><ref>Adam James (2004) published on Psychminded.co.uk Psychminded Ltd</ref> Furthermore, ] can result in attention problems that can look like ADHD.<ref>{{Cite journal|author=Cuffe, S.P. |title=Comorbidity of attention Deficit Hyperactivity Disorder and Post-Traumatic Stress Disorder |journal=Journal of Child and Family Studies |volume=3 |issue=3 |pages=327–336 |year=1994 |month=September |doi=10.1007/BF02234689 |url=http://www.springerlink.com/content/l24j735448007435/ |last2=McCullough |first2=Elizabeth L. |last3=Pumariega |first3=Andres J.}}</ref> ADHD is also considered to be related to ].<ref name="healthatoz.com">{{Cite web|url=http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/sensory_integration_disorder.jsp|title=Sensory integration disorder|date=2006-08-14|publisher=healthatoz.com|accessdate=2008-12-30}}</ref> | |||
| A 2010 article by CNN suggests that there is an increased risk for internationally adopted children to develop mental health disorders, such as ADHD and ODD.<ref name="cnn.com">{{Cite web|url=http://www.cnn.com/2010/HEALTH/04/13/children.adoption.mental.health/index.html / |title=Adopted children at greater risk for mental health disorders |author=Park, Madison |date=14 April 2010 |work=CNN.com |accessdate=24 May 2010 }}</ref> The risk may be related to the length of time the children spent in an orphanage, especially if they were neglected or abused. Many of these families who adopted the affected children feel overwhelmed and frustrated, since managing their children may entail more responsibilities than originally anticipated. The adoption agencies may be aware of the child's behavioral history, but decide to withhold the information prior to the adoption. This in turn has resulted in some parents suing adoption agencies, the abuse of children, and even the relinquishment of the child. | |||
| ====Neurodiversity==== | |||
| {{Main|Neurodiversity}} | |||
| Proponents of the neurodiversity theory assert that atypical (neurodivergent) neurological development is a normal human difference that is to be tolerated and respected just like any other human difference. Social critics argue that while biological factors may play a large role in difficulties with sitting still in class and/or concentrating on schoolwork in some children, these children could have failed to integrate others' social expectations of their behavior for a variety of other reasons.<ref>{{Page needed|date=September 2010}}{{Year needed|date=September 2010}}</ref> It has been said that ADHD has a link with creativity.<ref>{{Cite web|url=http://www.healthcentral.com/adhd/c/1443/16796/adhd-creativity |title=ADHD and Creativity |publisher=Healthcentral.com |date=2007-11-23 |accessdate=2009-05-25 |last=Bailey |first=Eileen}}</ref> As genetic research into ADHD proceeds, it may become possible to integrate this information with the neurobiology in order to distinguish disability from varieties of normal or even exceptional functioning in people along the same spectrum of attention differences.<ref>{{Cite journal|author=Susan Smalley |title=Reframing ADHD in the Genomic Era |journal=Psychiatric Times |volume=25 |issue=7 |year=2008 |url=http://www.psychiatrictimes.com/adhd/article/10168/1163208}}</ref> | |||
| ====Social construct theory of ADHD==== | |||
| {{Main|Social construct theory of ADHD}} | |||
| Social construction theory states that it is societies that determine where the line between normal and abnormal behavior is drawn. Thus society members including physicians, parents, teachers, and others are the ones who determine which diagnostic criteria are applied and thus determine the number of people affected.<ref>{{Cite journal|author=Parens E, Johnston J |title=Facts, values, and Attention-Deficit Hyperactivity Disorder (ADHD): an update on the controversies |journal=Child Adolesc Psychiatry Ment Health |volume=3 |issue=1 |pages=1 |year=2009 |pmid=19152690|pmc=2637252 |doi=10.1186/1753-2000-3-1 |url=}}</ref> This is exemplified in the fact that the DSM IV arrives at levels of ADHD three to four times higher than those obtained with use of the ICD 10.<ref name="Singh I 2008 957–64"/> ], an extreme proponent of this theory, has gone so far as to state that ADHD was "invented and not discovered."<ref>{{Cite book|author=Chriss, James J.|title=Social control: an introduction |publisher=Polity |location=Cambridge, UK |year=2007 |page=230 |isbn=0-7456-3858-9 |oclc= |doi= |accessdate=}}</ref><ref>{{Cite book|author=Szasz, Thomas Stephen |title=Pharmacracy: medicine and politics in America |publisher=Praeger |location=New York |year=2001 |page=212 |isbn=0-275-97196-1 |oclc= |doi=|accessdate=}}</ref> | |||
| ====Low arousal theory==== | |||
| {{Main|Low arousal theory}} | |||
| According to the low arousal theory, people with ADHD need excessive activity as self-stimulation because of their state of abnormally low ].<ref name="horizons">{{Cite web|url=http://www.incrediblehorizons.com/Understanding%20Add.htm |title=Attention Deficit Hyperactivity Disorder is a neurologically based disorder |publisher=Incrediblehorizons.com |date= |accessdate=2009-05-25}}{{Year needed|date=September 2010}}</ref><ref>{{Cite web|url=http://www.sci.csuhayward.edu/~dsandberg/CHLDPATHLECTS/ChldPathLect05ADHD.htm |title=ADHD |publisher=Sci.csuhayward.edu |date= |accessdate=2009-05-25}}</ref> The theory states that those with ADHD cannot self-moderate, and their attention can only be gained by means of environmental ],<ref name="horizons"/> which in turn results in disruption of attentional capacity and an increase in hyperactive behaviour.<ref>{{Cite journal|author=Sikström S, Söderlund G |title=Stimulus-dependent dopamine release in attention-deficit/hyperactivity disorder |journal=Psychol Rev |volume=114 |issue=4 |pages=1047–75 |year=2007 |month=October |pmid=17907872 |doi=10.1037/0033-295X.114.4.1047 |url=http://content.apa.org/journals/rev/114/4/1047}}</ref> | |||
| Without enough stimulation coming from the environment, an ADHD child will create it him or herself by walking around, ], talking, etc. This theory also explains why stimulant medications have high success rates and can induce a calming effect at therapeutic dosages among children with ADHD. It establishes a strong link with scientific data that ADHD is connected to abnormalities with the neurochemical dopamine and a powerful link with low-stimulation PET scan results in ADHD subjects.<ref name="horizons"/> | |||
| ==Pathophysiology== | |||
| ] | |||
| The ] of ADHD is unclear and there are a number of competing theories.<ref>{{Cite web|url=http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293&selectedTitle=4~150&source=search_result |title=Evaluation and diagnosis of attention deficit hyperactivity disorder in children |accessdate=2008-09-15 |work= |publisher= |date=December 5, 2007}}</ref> Research on children with ADHD has shown a general reduction of brain volume, but with a proportionally greater reduction in the volume of the left-sided ]. These findings suggest that the core ADHD features of inattention, hyperactivity, and impulsivity may reflect ], but other brain regions particularly the ] have also been implicated.<ref>{{Cite journal | |||
| |last=Krain | |||
| |first=Amy | |||
| |authorlink= |year=2006 |month= |title=Brain development and ADHD | |||
| |journal=Clinical Psychology Review |volume=26 |issue=4 |pages=433–444 |id= |url= |accessdate=2008-07-04|doi=10.1016/j.cpr.2006.01.005 |quote= |pmid=16480802 |last1=Krain |first1=AL |last2=Castellanos |first2=FX }}</ref> Neuroimaging studies in ADHD have not always given consistent results and as of 2008 are only used for research not diagnostic purposes.<ref>{{Cite web|url=http://www.merckmedicus.com/pp/us/hcp/diseasemodules/adhd/pathophysiology.jsp |title=MerckMedicus Modules: ADHD - Pathophysiology |work= |accessdate=}}</ref> A 2005 review of published studies involving neuroimaging, neuropsychological genetics, and neurochemistry found converging lines of evidence to suggest that four connected frontostriatal regions play a role in the pathophysiology of ADHD: The ], ] ], ], and ].<ref>{{Cite journal | |||
| |author=Bush G, Valera EM, Seidman LJ | |||
| |title=Functional neuroimaging of attention-deficit/hyperactivity disorder: a review and suggested future directions | |||
| |journal=Biological Psychiatry |volume=57 |issue=11 |pages=1273–84 |year=2005 |month=June |pmid=15949999 |doi=10.1016/j.biopsych.2005.01.034}}</ref> | |||
| In one study a delay in development of certain brain structures by an average of three years occurred in ADHD elementary school aged patients. The delay was most prominent in the ] and ], which are believed to be responsible for the ability to control and focus thinking. In contrast, the ] in the ADHD patients was seen to mature faster than normal, suggesting that both slower development of behavioral control and advanced motor development might be required for the fidgetiness that characterizes ADHD.<ref> NIMH Press Release, November 12, 2007</ref> It should be noted that stimulant medication itself may affect growth factors of the central nervous system.<ref name="Joshi SV">{{Cite journal|author=Joshi SV |title=ADHD, growth deficits, and relationships to psychostimulant use |journal=Pediatrics in Review |volume=23 |issue=2 |pages=67–8; discussion 67–8 |year=2002 |month=February |pmid=11826259 |doi=10.1542/pir.23-2-67 |last2=Adam |first2=H. M.}}</ref> | |||
| The same laboratory had previously found involvement of the "7-repeat" variant of the ] gene, which accounts for about 30 percent of the genetic risk for ADHD, in unusual thinness of the cortex of the right side of the brain; however, in contrast to other variants of the gene found in ADHD patients, the region normalized in thickness during the teen years in these children, coinciding with clinical improvement.<ref> NIMH Press Release, August 6, 2007</ref> | |||
| Additionally, ] scans found people with ADHD to have reduced blood circulation (indicating low neural activity),<ref>Lou HC, Andresen J, Steinberg B, McLaughlin T, Friberg L. "The striatum in a putative cerebral network activated by verbal awareness in normals and in ADHD children." ''Eur J Neurol.'' 1998 Jan;5(1):67–74. PMID 10210814</ref> and a significantly higher concentration of dopamine transporters in the ] which is in charge of planning ahead.<ref>{{Cite journal | |||
| |author=Dougherty DD, Bonab AA, Spencer TJ, Rauch SL, Madras BK, Fischman AJ | |||
| |title=Dopamine transporter density in patients with attention deficit hyperactivity disorder | |||
| |journal=Lancet |volume=354 |issue=9196 |pages=2132–-33 |year=1999 |pmid=10609822 | doi = 10.1016/S0140-6736(99)04030-1}}</ref><ref>{{Cite journal | |||
| |author=Dresel SH, Kung MP, Plössl K, Meegalla SK, Kung HF | |||
| |title=Pharmacological effects of dopaminergic drugs on in vivo binding of TRODAT-1 to the central dopamine transporters in rats | |||
| |journal=European journal of nuclear medicine | |||
| |volume=25 |issue=1 |pages=31–9 |year=1998 |pmid=9396872}}</ref> A study by the U.S. Department of Energy’s ] in collaboration with ] in New York suggest that it is not the dopamine transporter levels that indicate ADHD, but the brain's ability to produce ]s like dopamine itself. The study was done by injecting 20 ADHD subjects and 25 control subjects with a radiotracer that attaches itself to dopamine transporters. The study found that it was not the transporter levels that indicated ADHD, but the dopamine itself. ADHD subjects showed lower levels of dopamine (hypodopaminergia) across the board. They speculated that since ADHD subjects had lower levels of dopamine to begin with, the number of transporters in the brain was not the telling factor. In support of this notion, plasma ], an index of dopamine levels, was found to be inversely related not only to childhood ADHD symptoms in adult psychiatric patients, but to "childhood learning problems" in healthy subjects as well.<ref name="pmid17113158">{{Cite journal|author=Coccaro EF, Hirsch SL, Stein MA |title=Plasma homovanillic acid correlates inversely with history of learning problems in healthy volunteer and personality disordered subjects |journal=Psychiatry research |volume=149 |issue=1–3 |pages=297–302 |year=2007 |pmid=17113158 |doi=10.1016/j.psychres.2006.05.009}}</ref> One interpretation of dopamine pathway tracers is that the biochemical "reward" mechanism works for those with ADHD only when the task performed is inherently motivating; low levels of dopamine raise the threshold at which someone can maintain focus on a task which is otherwise boring.<ref>http://www.npr.org/templates/story/story.php?storyId=112752252</ref> Neuroimaging studies also found that ]s level (e.g. dopamine and serotonin) in the ] goes down during depression.<ref>{{Cite web|url=http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=1066|title=The Role of Dopamine and Norepinephrine in Depression}}</ref><ref>{{Cite web|url=http://depression.about.com/cs/brainchem101/a/brainchemistry_2.htm|title=The Chemistry of Depression}}</ref> | |||
| A 1990 ] study by Alan J. Zametkin ''et al.'' found that global cerebral ] was 8% lower in medication-naive adults who had been hyperactive since childhood.<ref name="Zametkin">{{Cite journal|author=Zametkin AJ, Nordahl TE, Gross M |title=Cerebral glucose metabolism in adults with hyperactivity of childhood onset |journal=N. Engl. J. Med. |volume=323 |issue=20 |pages=1361–6 |year=1990 |month=November |pmid=2233902 |doi= 10.1056/NEJM199011153232001|url=}}</ref> Further studies found that chronic stimulant treatment had little effect on global glucose metabolism,<ref>{{Cite journal|author=Matochik JA, Liebenauer LL, King AC, Szymanski HV, Cohen RM, Zametkin AJ |title=Cerebral glucose metabolism in adults with attention deficit hyperactivity disorder after chronic stimulant treatment |journal=Am J Psychiatry |volume=151 |issue=5 |pages=658–64 |year=1994 |month=May |pmid=8166305 |doi= |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=8166305}}</ref> a 1993 study in girls failed to find a decreased global glucose metabolism, but found significant differences in glucose metabolism in 6 specific regions of the brains of ADHD girls as compared to control subjects. The study also found that differences in one specific region of the frontal lobe were statistically correlated with symptom severity.<ref>{{Cite journal|author=Zametkin AJ, Liebenauer LL, Fitzgerald GA |title=Brain metabolism in teenagers with attention-deficit hyperactivity disorder |journal=Arch. Gen. Psychiatry |volume=50 |issue=5 |pages=333–40 |year=1993 |month=May |pmid=8489322 |doi= |url=}}</ref> A further study in 1997 also failed to find global differences in glucose metabolism, but similarly found differences in glucose normalization in specific regions of the brain. The 1997 study also noted that their findings were somewhat different than those in the 1993 study, and concluded that sexual maturation may have played a role in this discrepancy.<ref>{{Cite journal|author=Ernst M, Cohen RM, Liebenauer LL, Jons PH, Zametkin AJ |title=Cerebral glucose metabolism in adolescent girls with attention-deficit/hyperactivity disorder |journal=J Am Acad Child Adolesc Psychiatry |volume=36 |issue=10 |pages=1399–406 |year=1997 |month=October |pmid=9334553 |doi= 10.1097/00004583-199710000-00022|url=}}</ref> The significance of the research by Zametkin has not been determined and neither his group nor any other has been able to replicate the 1990 results.<ref>{{Cite book|title=Add/Adhd Alternatives in the Classroom |last=Armstrong |first=Thomas |authorlink= |coauthors= |year=1999 |publisher=ASCD |location= |isbn=9780871203595 |pages=3–5 |url= http://books.google.com/?id=EzXt100I4A8C&pg=PA3&lpg=PA3&dq=National+Institute+of+Mental+Health+ADHD+PET+scan |accessdate= 2009-05-02 }}</ref><ref>{{Cite journal|author=Ernst M, Liebenauer LL, King AC, Fitzgerald GA, Cohen RM, Zametkin AJ |title=Reduced brain metabolism in hyperactive girls |journal=J Am Acad Child Adolesc Psychiatry |volume=33 |issue=6 |pages=858–68 |year=1994 |pmid=8083143 |doi=10.1097/00004583-199407000-00012}}</ref><ref>{{Cite journal|author=Díaz-Heijtz R, Mulas F, Forssberg H |title= |language=Spanish |journal=Revista De Neurologia |volume=42 Suppl 2 |issue= |pages=S19–23 |year=2006 |month=February |pmid=16555214 |url=http://www.revneurol.com/LinkOut/formMedLine.asp?Refer=2005798&Revista=RevNeurol}}</ref> | |||
| Critics, such as Jonathan Leo and David Cohen, who reject the characterization of ADHD as a disorder, contend that the controls for stimulant medication usage were inadequate in some lobar volumetric studies which makes it impossible to determine whether ADHD itself or ] medication used to treat ADHD is responsible for the decreased thickness observed<ref>{{Cite journal|title=Longitudinal Mapping of Cortical Thickness and Clinical Outcome in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder |journal=Arch Gen Psychiatry |volume=5 |issue=63 |pages=540–549 |year=2006|pmid=16651511 |doi=10.1001/archpsyc.63.5.540 |author1=Philip Shaw, MD |author2=Jason Lerch, PhD |author3=Deanna Greenstein, PhD |author4=Wendy Sharp, MSW |author5=Liv Clasen, PhD |author6=Alan Evans, PhD |author7=Jay Giedd, MD |author8=F. Xavier Castellanos, MD |author9=Judith Rapoport, MD}}</ref> in certain brain regions. While the main study in question used age-matched controls, it did not provide information on height and weight of the subjects. These variables it has been argued could account for the regional brain size differences rather than ADHD itself.<ref name=autogenerated5>{{Cite journal|author=David Cohen |title=An Update on ADHD Neuroimaging Research |journal=The Journal of Mind and Behavior |volume=25 |issue=2 |pages=161–166 |year=2004 |publisher=The Institute of Mind and Behavior, Inc |issn =0271–0137 |url=http://psychrights.org/research/Digest/NLPs/neruoimagingupdate.pdf |format=PDF |accessdate=2009-05-25}}</ref><ref>{{Cite journal|author=David Cohen |title=Broken brains or flawed studies? A critical review of ADHD neuroimaging studies |journal=The Journal of Mind and Behavior |volume=24 |issue= |pages=29–56 |year=2003 |url= |format=}}</ref> They believe many neuroimaging studies are oversimplified in both popular and scientific discourse and given undue weight despite deficiencies in experimental methodology.<ref name=autogenerated5 /> | |||
| ==Diagnosis== | |||
| ADHD is diagnosed via a psychiatric assessment; to rule out other potential causes or comorbidities, physical examination, radiological imaging, and laboratory tests may be used.<ref>{{Cite journal|author=Joughin C, Ramchandani P, Zwi M |title=Attention-deficit/hyperactivity disorder |journal=American Family Physician |volume=67 |issue=9 |pages=1969–70 |year=2003 |month=May |pmid=12751659}}</ref> | |||
| In North America, the ] criteria are often the basis for a diagnosis, while European countries usually use the ]. If the DSM-IV criteria are used, rather than the ICD-10, a diagnosis of ADHD is 3–4 times more likely.<ref name="Singh I 2008 957–64"/> Factors other than those within the DSM or ICD however have been found to affect the diagnosis in clinical practice. A child's social and school environment as well as academic pressures at school are likely to be of influence.<ref>{{Cite journal|author=Schneider H, Eisenberg D |title=Who receives a diagnosis of attention-deficit/ hyperactivity disorder in the United States elementary school population? |journal=Pediatrics |volume=117 |issue=4 |pages=e601–9 |year=2006 |month=April |pmid=16585277 |doi=10.1542/peds.2005-1308 }}</ref> | |||
| Many of the symptoms of ADHD occur from time to time in everyone; in patients with ADHD, the frequency of these symptoms is greater and patients' lives are significantly impaired. Impairment must occur in multiple settings to be classified as ADHD.<ref name="ReferenceA"/> As with many other psychiatric and medical disorders, the formal diagnosis is made by a qualified professional in the field based on a set number of criteria. In the USA these criteria are laid down by the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders (]), 4th edition. Based on the DSM-IV criteria listed below, three types of ADHD are classified: | |||
| # ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months | |||
| # ] Type: if criterion 1A is met but criterion 1B is not met for the past six months | |||
| # ADHD, Predominantly Hyperactive-Impulsive Type: if criterion 1B is met but criterion 1A is not met for the past six months.<ref>http://www.adhd.org.au/</ref> | |||
| The previously used term ''ADD'' expired with the most recent revision of the DSM. Consequently, ADHD is the current nomenclature used to describe the disorder as one distinct disorder which can manifest itself as being a primary deficit resulting in hyperactivity/impulsivity (ADHD, predominately hyperactive-impulsive type) or inattention (ADHD predominately inattentive type) or both (ADHD combined type). | |||
| ===DSM-IV criteria=== | |||
| IA. Six or more of the following signs of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level: | |||
| :* ''Inattention:'' | |||
| :# Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. | |||
| :# Often has trouble keeping attention on tasks or play activities. | |||
| :# Often does not seem to listen when spoken to directly. | |||
| :# Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). | |||
| :# Often has trouble organizing activities. | |||
| :# Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). | |||
| :# Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools). | |||
| :# Is often easily distracted. | |||
| :# Often forgetful in daily activities. | |||
| IB. Six or more of the following signs of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: | |||
| :* ''Hyperactivity:'' | |||
| :# Often fidgets with hands or feet or squirms in seat. | |||
| :# Often gets up from seat when remaining in seat is expected. | |||
| :# Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). | |||
| :# Often has trouble playing or enjoying leisure activities quietly. | |||
| :# Is often "on the go" or often acts as if "driven by a motor". | |||
| :# Often talks excessively. | |||
| :* ''Impulsiveness:'' | |||
| :# Often blurts out answers before questions have been finished. | |||
| :# Often has trouble waiting one's turn. | |||
| :# Often interrupts or intrudes on others (example: butts into conversations or games). | |||
| II. Some signs that cause impairment were present before age 7 years. | |||
| III. Some impairment from the signs is present in two or more settings (such as at school/work and at home). | |||
| IV. There must be clear evidence of significant impairment in social, school, or work functioning. | |||
| V. The signs do not happen only during the course of a Pervasive Developmental Disorder, ], or other Psychotic Disorder. The signs are not better accounted for by another mental disorder (such as ], ], ], or a ]).<ref>http://www.psychnet-uk.com/dsm_iv/attention_deficit_disorder.htm</ref> | |||
| ===ICD-10=== | |||
| In the tenth edition of the '']'' (ICD-10) the signs of ADHD are given the name "]". When a ] (as defined by ICD-10<ref name=ICD10> ]. Retrieved on December 11, 2006.</ref>) is present, the condition is referred to as "Hyperkinetic conduct disorder". Otherwise the disorder is classified as "Disturbance of Activity and Attention", "Other Hyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is sometimes referred to as, "Hyperkinetic Syndrome".<ref name=ICD10/> | |||
| ===Other diagnostic guidelines=== | |||
| The ] ] for children with ADHD emphasizes that a reliable diagnosis is dependent upon the fulfillment of three criteria:<ref name=AAP2001>{{Cite journal|author=American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement |title=Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder |journal=Pediatrics |volume=108 |issue=4 |pages=1033–44 |year=2001 |month=October |pmid=11581465 |doi=10.1542/peds.108.4.1033 }}</ref> | |||
| * The use of explicit criteria for the diagnosis using the ]. | |||
| * The importance of obtaining information about the child’s signs in more than one setting. | |||
| * The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning. | |||
| All three criteria are determined using the patient's history given by the parents, teachers and/or the patient. | |||
| Adults often continue to be impaired by ADHD. Adults with ADHD are diagnosed under the same criteria, including the stipulation that their signs must have been present prior to the age of seven.<ref name="DSM">{{Cite web|url=http://www.psychiatryonline.com/content.aspx?aID=7721 |title=PsychiatryOnline |work= |accessdate=}}</ref> Adults face some of their greatest challenges in the areas of self-control and self-motivation, as well as ], usually having more signs of inattention and fewer of hyperactivity or impulsiveness than children do.<ref> {{subscription}}</ref> | |||
| ===Comorbid conditions=== | |||
| Common comorbid conditions include ] (ODD). About 20% to 25% of children with ODD meet criteria for a ].<ref>{{Cite journal|author=Pliszka SR |title=Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder |journal=Child and Adolescent Psychiatric Clinics of North America |volume=9 |issue=3 |pages=525–40, vii |year=2000 |month=July |pmid=10944655}}</ref> Learning disorders are more common when there are inattention signs.<ref>{{Cite journal|title= Attention deficit hyperactivity disorder subtypes: Are there differences in academic problems?|journal=Dev neuropsychology|year=1995|author=Lamminmäky T ''|issue=11|pages=297–310}}</ref> | |||
| ] disorders or substance abuse can make the diagnosis and treatment of ADHD more difficult. Psychosocial therapy is useful in treating some comorbid conditions.<ref>{{Cite journal|author=Foster EM, Jensen PS, Schlander M, ''et al.'' |title=Treatment for ADHD: is more complex treatment cost-effective for more complex cases? |journal=Health Services Research |volume=42 |issue=1 Pt 1 |pages=165–82 |year=2007 |month=February |pmid=17355587 |pmc=1955245 |doi=10.1111/j.1475-6773.2006.00599.x}}</ref> ADHD is not, in boys, associated with increased substance misuse unless there is comorbid ]; but "research needs to examine the extent to which ADHD in adulthood increases the risk of substance use disorders."<ref>{{Cite journal|author=Lynskey MT, Hall W |title=Attention deficit hyperactivity disorder and substance use disorders: Is there a causal link? |journal=Addiction |volume=96 |issue=6 |pages=815–22 |year=2001 |month=June |pmid=11399213 |doi=10.1080/09652140020050988 |doi_brokendate=2010-08-28}}</ref> | |||
| ] may also coincide with ADHD, increasingly prevalent among girls and older children.<ref name="Brunsvold" /> | |||
| ] is a commonly found comorbid disorder in ADHD diagnosed individuals. Some forms of epilepsy can also cause ADHD like behaviour which can be misdiagnosed as ADHD.<ref>{{Cite journal|author=Tan M, Appleton R |title=Attention deficit and hyperactivity disorder, methylphenidate, and epilepsy |journal=Archives of Disease in Childhood |volume=90 |issue=1 |pages=57–9 |year=2005 |month=January |pmid=15613514 |pmc=1720074 |doi=10.1136/adc.2003.048504}}</ref><ref>{{Cite journal|author=Aldenkamp AP, Arzimanoglou A, Reijs R, Van Mil S |title=Optimizing therapy of seizures in children and adolescents with ADHD |journal=Neurology |volume=67 |issue=12 Suppl 4 |pages=S49–51 |year=2006 |month=December |pmid=17190923 |url=http://www.neurology.org/cgi/pmidlookup?view=long&pmid=17190923}}</ref> | |||
| ===Differential diagnoses=== | |||
| To make the diagnosis of ADHD, a number of other possible medical and psychological conditions must be excluded. | |||
| '''Medical conditions''' | |||
| Medical conditions that must be excluded include: ], ], ], ], ] or ] impairment, ], ], sleep impairment and ],<ref name="pmid11563573">{{Cite journal|author=Smucker WD, Hedayat M |title=Evaluation and treatment of ADHD |journal=American Family Physician |volume=64 |issue=5 |pages=817–29 |year=2001 |month=September |pmid=11563573 |url=http://www.aafp.org/afp/20010901/817.html}}</ref> and ] (tachyphemia) among others. | |||
| '''Sleep conditions''' | |||
| As with other psychological and neurological issues, the relationship between ADHD and ] is complex. In addition to clinical observations, there is substantial empirical evidence from a neuroanatomic standpoint to suggest that there is considerable overlap in the central nervous system centers that regulate sleep and those that regulate attention/arousal.<ref name=Owens2005>{{Cite journal|author=Owens JA |title=The ADHD and sleep conundrum: a review |journal=Journal of Developmental and Behavioral Pediatrics |volume=26 |issue=4 |pages=312–22 |year=2005 |month=August |pmid=16100507 |doi=10.1097/00004703-200508000-00011}}</ref> Primary sleep disorders play a role in the clinical presentation of symptoms of inattention and behavioral dysregulation. There are multilevel and bidirectional relationships among sleep, neurobehavioral functioning and the clinical syndrome of ADHD.<ref name=Owens2008>{{Cite journal|author=Owens JA |title=Sleep disorders and attention-deficit/hyperactivity disorder |journal=Current Psychiatry Reports |volume=10 |issue=5 |pages=439–44 |year=2008 |month=October |pmid=18803919 |doi=10.1007/s11920-008-0070-x}}</ref> | |||
| Behavioral manifestations of sleepiness in children range from the classic ones (yawning, rubbing eyes), to externalizing behaviors (impulsivity, hyperactivity, aggressiveness), to mood lability and inattentiveness.<ref name=Owens2005 /><ref>{{Cite journal|author=Golan N, Shahar E, Ravid S, Pillar G |title=Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder |journal=Sleep |volume=27 |issue=2 |pages=261–6 |year=2004 |month=March |pmid=15124720}}</ref><ref>{{Cite book|last= Hirshkowitz |first= Max |coauthors= |editor= Yudofsky, Stuart C. and Robert E. Hales, editors |others= |title= Essentials of neuropsychiatry and clinical neurosciences |origdate= |origyear= |origmonth= |url= |format= Google Books preview includes entire chapter 10 |accessdate= 2009-12-06 |edition= 4 |series= |date= |year= 2004 |month= |publisher= American Psychiatric Publishing |location= Arlington, Virginia, USA |isbn= 978-1-58562-005-0 |oclc= |doi= |id= |pages=315–40 |chapter=Neuropsychiatric Aspects of Sleep and Sleep Disorders |chapterurl= http://books.google.no/books?id=XKhu7yb3QtsC&pg=PA315&lpg=PA315&dq=%22Max+Hirshkowitz%22&source=bl&ots=Rt5ZMiMbxt&sig=7upt8PudAdiA5f9kk5KGsrfaMQU&hl=no&ei=y-0bS7vFKtTP-QabhdTaDw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CBIQ6AEwAjgK#v=onepage&q=%22Max%20Hirshkowitz%22&f=false |quote= }}</ref> Many sleep disorders are important causes of symptoms which may overlap with the cardinal symptoms of ADHD; children with ADHD should be regularly and systematically assessed for sleep problems.<ref name=Owens2005 /><ref>{{Cite journal|author=Walters AS, Silvestri R, Zucconi M, Chandrashekariah R, Konofal E |title=Review of the possible relationship and hypothetical links between attention deficit hyperactivity disorder (ADHD) and the simple sleep related movement disorders, parasomnias, hypersomnias, and circadian rhythm disorders |journal=Journal of Clinical Sleep Medicine |volume=4 |issue=6 |pages=591–600 |year=2008 |month=December |pmid=19110891 |pmc=2603539}}</ref> | |||
| From a clinical standpoint, mechanisms that account for the phenomenon of excessive daytime sleepiness include: | |||
| * Chronic ], that is insufficient sleep for physiologic sleep needs, | |||
| * Fragmented or disrupted sleep, caused by, for example, ] (OSA) or ] (PLMD), | |||
| * Primary clinical disorders of excessive daytime sleepiness, such as ] and | |||
| * Circadian rhythm disorders, such as ] (DSPS). A study in the Netherlands compared two groups of unmedicated 6-12-year-olds, all of them with "rigorously diagnosed ADHD". 87 of them had problems getting to sleep, 33 had no sleep problems. The larger group had a significantly later ] (DLMO) than did the children with no sleep problems.<ref>{{Cite journal|author=Van der Heijden KB, Smits MG, Van Someren EJ, Gunning WB |title=Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder |journal=Chronobiology International |volume=22 |issue=3 |pages=559–70 |year=2005 |pmid=16076654 |doi=10.1081/CBI-200062410}}</ref> | |||
| ==Management== | |||
| {{Main|Attention-deficit hyperactivity disorder management}} | |||
| Methods of treatment often involve some combination of behavior modification, life-style changes, counseling, and medication. A 2005 study found that medical management and behavioral treatment is the most effective ADHD management strategy, followed by medication alone, and then behavioral treatment.<ref name = "Jensen">{{Cite journal|author=Jensen PS, Garcia JA, Glied S |title=Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD |journal=The American Journal of Psychiatry |volume=162 |issue=9 |pages=1628–36 |year=2005 |month=September |pmid=16135621 |doi=10.1176/appi.ajp.162.9.1628}}</ref> While medication has been shown to improve behavior when taken over the short term, they have not been shown to alter long term outcomes.<ref>{{Cite journal|author=Yamada A, Takeuchi H, Miki H, Touge T, Deguchi K |title= |language=Japanese |journal=Rinshō Shinkeigaku |volume=30 |issue=7 |pages=784–6 |year=1990 |month=July |pmid=2242635}}</ref> | |||
| ===Behavioral interventions=== | |||
| A 2009 review concluded that the evidence is strong for the effectiveness of behavioral treatments in ADHD.<ref>{{Cite journal|author=Fabiano GA, Pelham WE, Coles EK, Gnagy EM, Chronis-Tuscano A, O'Connor BC |title=A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder |journal=Clinical Psychology Review |volume=29 |issue=2 |pages=129–40 |year=2009 |month=March |pmid=19131150 |doi=10.1016/j.cpr.2008.11.001}}</ref> | |||
| Psychological therapies used to treat ADHD include ] input, ], ] (CBT), ] (IPT), ], school-based interventions, social skills training and parent management training.<ref name=NICE2008/> | |||
| Parent training and education have been found to have short term benefits.<ref>{{Cite journal|author=Pliszka S |title=Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=46 |issue=7 |pages=894–921 |year=2007 |month=July |pmid=17581453 |doi=10.1097/chi.0b013e318054e724 |author2=AACAP Work Group on Quality Issues}}</ref> Family therapy has shown to be of little use in the treatment of ADHD,<ref>{{Cite web|url=http://www.cochrane.org/reviews/en/ab005042.html|title=Family therapy for attention-deficit disorder or attention-deficit/hyperactivity disorder in children and adolescents |accessdate=2008-09-19 |work= |publisher=The Cochrane Collaboration |date=April 20, 2005 }}</ref> though it may be worth noting that parents of children with ADHD are more likely to divorce than parents of children without ADHD, particularly when their children are younger than eight years old.<ref>{{Cite journal|author=Wymbs BT, Pelham WE, Molina BS, Gnagy EM, Wilson TK, Greenhouse JB |title=Rate and predictors of divorce among parents of youths with ADHD |journal=Journal of Consulting and Clinical Psychology |volume=76 |issue=5 |pages=735–44 |year=2008 |month=October |pmid=18837591 |pmc=2631569 |doi=10.1037/a0012719}}</ref> | |||
| Several ] exist as informational sources and to help families cope with challenges associated with dealing with ADHD. | |||
| A 2009 study found that children with ADHD move around a lot because it helps them stay alert enough to complete challenging tasks. The researcher advises that when they are doing homework, one should let them fidget, stand or chew gum since it may help them cope. Unless their behavior is destructive, severely limiting their activity could be counterproductive.<ref name="Rapport"/> | |||
| ===Medications=== | |||
| {{Undue|date=September 2010}} | |||
| Management with medication was shown to be the most cost-effective, followed by behavioral treatment and combined treatment in a 14 month follow-up study.<ref name="Jensen"/> However, a follow-up study found that stimulant medication offered no benefits over behavioral therapy in children after their respective treatments allocations had been discontinued for two years.<ref name="Jensen PS, Arnold LE, Swanson JM 2007 989–1002">{{Cite journal|author=Jensen PS, Arnold LE, Swanson JM |title=3-year follow-up of the NIMH MTA study |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=46 |issue=8 |pages=989–1002 |year=2007 |month=August |pmid=17667478 |doi=10.1097/CHI.0b013e3180686d48}}</ref> ] medication or non-stimulant medication may be prescribed. A 2007 drug class review found that there are no good studies of comparative effectiveness between various drugs for ADHD and that there is a lack of quality evidence on their effects on overall academic performance and social behaviors.<ref>McDonagh MS, Peterson K, Dana T, Thakurta S. (2007). Drug Class Review on Pharmacologic Treatments for ADHD. .</ref> ADHD medications are not recommended for preschool children as their long term effects in such young people are unknown.<ref name = NICE2008 /><ref>{{Cite journal|author=Greenhill LL, Posner K, Vaughan BS, Kratochvil CJ |title=Attention deficit hyperactivity disorder in preschool children |journal=Child and Adolescent Psychiatric Clinics of North America |volume=17 |issue=2 |pages=347–66, ix |year=2008 |month=April |pmid=18295150 |doi=10.1016/j.chc.2007.11.004}}</ref> There is very little data on the long-term adverse effects or benefits of stimulants for ADHD.<ref name="hta.ac.uk"/> | |||
| ====Stimulant medication==== | |||
| ]) 10 mg tablets (])]] | |||
| ] are the most commonly prescribed medications for ADHD. The most common stimulant medications are the chain subsitituted amphetamine ] (], ], ]), ] (]), ] (]),<ref>Stephen V. Faraone, P. (2003, September 18). Retrieved from Medscape Today: </ref><ref>{{Cite journal|author=Sulzer D, Sonders MS, Poulsen NW, Galli A |title=Mechanisms of neurotransmitter release by amphetamines: a review |journal=Progress in Neurobiology |volume=75 |issue=6 |pages=406–33 |year=2005 |month=April |pmid=15955613 |doi=10.1016/j.pneurobio.2005.04.003}}</ref> ] (])<ref>{{Cite journal|author= |title=NTP-CERHR monograph on the potential human reproductive and developmental effects of amphetamines |journal=Ntp Cerhr Mon |volume= |issue=16 |pages=vii–III1 |year=2005 |month=July |pmid=16130031 |last1= National Toxicology |first1= Program}}</ref> and ] (]).<ref>{{Cite journal|author=Howland RH |title=Lisdexamfetamine: a prodrug stimulant for ADHD |journal=Journal of Psychosocial Nursing and Mental Health Services |volume=46 |issue=8 |pages=19–22 |year=2008 |month=August |pmid=18777964}}</ref> However, caution needs to be used when prescribing medications that increase levels of "feel-good" ]s like ], because they can be addictive (see article: ]).<ref name="addict_r" /><ref>{{Cite web|url=http://www.iscid.org/encyclopedia/Dopamine|title=Dopamine}}</ref> According to several studies, use of stimulants (e.g. methylphenidate) can lead to development of ] to therapeutic doses; tolerance also occurs among high dose abusers of methylphenidate.<ref>{{Cite web|url=http://psychservices.psychiatryonline.org/cgi/content/full/53/1/102|title=Treatment of ADHD When Tolerance to Methylphenidate Develops}}</ref><ref>{{Cite web|url=http://www.nature.com/clpt/journal/v66/n3/abs/clpt1999454a.html|title=Acute tolerance to methylphenidate in the treatment of attention deficit hyperactivity disorder in children}}</ref><ref>{{Cite web|url=http://www.teenoverthecounterdrugabuse.com/methylphenidate.html|title=Methylphenidate}}</ref> | |||
| Stimulants used to treat ADHD raise the extracellular concentrations of the ]s ] and ] which causes an increase in ]. The therapeutic benefits are due to ] effects at the ] and the ] and ] effects at the ].<ref name="Solanto1998">{{Cite journal|author=Solanto MV |title=Neuropsychopharmacological mechanisms of stimulant drug action in attention-deficit hyperactivity disorder: a review and integration |journal=Behavioural Brain Research |volume=94 |issue=1 |pages=127–52 |year=1998 |month=July |pmid=9708845 |doi=10.1016/S0166-4328(97)00175-7}}</ref> | |||
| A ] of clinical trials found that about 70% of children improve after being treated with stimulants in the short term but found that this conclusion may be biased due to the high number of low quality clinical trials in the literature. There have been no randomized placebo controlled ] investigating the long term effectiveness of ] (Ritalin) beyond 4 weeks. Thus the long term effectiveness of methylphenidate has not been scientifically demonstrated. Serious concerns of ] regarding the use of methylphenidate for ADHD has also been noted.<ref name="pmid11762571">{{Cite journal|author=Schachter HM, Pham B, King J, Langford S, Moher D |title=How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis |journal=CMAJ |volume=165 |issue=11 |pages=1475–88 |year=2001 |month=November |pmid=11762571 |pmc=81663 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=11762571}}</ref> | |||
| Higher rates of schizophrenia and bipolar disorder as well as increased severity of these disorders occur in individuals with a past history of stimulant use for ADHD in childhood.<ref>{{Cite journal|author=Ross RG |title=Psychotic and manic-like symptoms during stimulant treatment of attention deficit hyperactivity disorder |journal=The American Journal of Psychiatry |volume=163 |issue=7 |pages=1149–52 |year=2006 |month=July |pmid=16816217 |doi=10.1176/appi.ajp.163.7.1149}}</ref> | |||
| Emergency room visits by children ages 10–14 involving Ritalin intoxication have now reached the same level as those for cocaine which indicates escalating abuse of this highly addictive drug.<ref name="emrg">{{Cite web|url=http://www.drug-rehabs.org/drugs/ritalin.php|title=Ritalin Addiction}}</ref> US and Canada account for a startling 95 percent of worldwide Ritalin consumption.<ref name="emrg" /><ref>{{Cite web|url=http://www.laleva.cc/choice/ritalin.html|title=The truth about North America’s greatest drug problem: Ritalin}}</ref> In one study which looked at adult cocaine users, it was found that those individuals who used Ritalin between one and ten years of age had a percentage of cocaine abuse twice that of those who had been diagnosed with ADHD but had not utilized Ritalin.<ref name="addict_r">{{Cite web|url=http://www.addictionsearch.com/treatment_articles/article/ritalin-abuse-addiction-and-treatment_43.html|title=Ritalin Abuse, Addiction and Treatment}}</ref> | |||
| Both children with and without ADHD abuse stimulants, with ADHD individuals being at the highest risk of abusing or diverting their stimulant prescriptions. Between 16 and 29 percent of students who are prescribed stimulants report diverting their prescriptions. Between 5 and 9 percent of grade/primary and high school children and between 5 and 35 percent of college students have used nonprescribed stimulants. Most often their motivation is to concentrate, improve alertness, "get high," or to experiment.<ref name="Wilens TE, Adler LA, Adams J, et al. 2008 21–31">{{Cite journal|author=Wilens TE, Adler LA, Adams J |title=Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=47 |issue=1 |pages=21–31 |year=2008 |month=January |pmid=18174822 |doi=10.1097/chi.0b013e31815a56f1}}</ref> | |||
| Although one review indicates that long-term use of methylphenidate has potential for ] and ] due to its similar pharmacologically to ] and ].<ref>Lerner M, Wigal T. Long-term safety of stimulant medications used to treat children with ADHD. ''Pediatr Ann.'' 2008 Jan;37(1):37-45.</ref><ref>{{Cite journal|author=Zhu J, Reith ME |title=Role of the dopamine transporter in the action of psychostimulants, nicotine, and other drugs of abuse |journal=CNS & Neurological Disorders Drug Targets |volume=7 |issue=5 |pages=393–409 |year=2008 |month=November |pmid=19128199 |doi=10.2174/187152708786927877}}</ref> Some other doctors argue that use of stimulant therapy for ADHD does not increase the risk of subsequent substance abuse and may be protective against it when treatment is started in childhood.{{who|date=October 2010}} However, when stimulant therapy is started during adolescence or adulthood, there is an increased risk of subsequent substance abuse.<ref>{{Cite journal|author=Faraone SV, Wilens T |title=Does stimulant treatment lead to substance use disorders? |journal=J Clin Psychiatry |volume=64 Suppl 11 |issue= |pages=9–13 |year=2003 |pmid=14529324 |doi= |url=}}</ref><ref>{{Cite journal|author=Faraone SV, Wilens TE |title=Effect of stimulant medications for attention-deficit/hyperactivity disorder on later substance use and the potential for stimulant misuse, abuse, and diversion |journal=J Clin Psychiatry |volume=68 Suppl 11 |issue= |pages=15–22 |year=2007 |pmid=18307377 |doi= |url=}}</ref> | |||
| One study found that children with ADHD actually ''need'' to move more to maintain the required level of alertness while performing tasks that challenge their working memory. Performing math problems mentally and remembering multi-step directions are examples of tasks that require working memory, which involves remembering and manipulating information for a short time. These findings may also explain why stimulant medications improve the behavior of most children with ADHD. Those medications improve the physiological arousal of children with ADHD, increasing their alertness.<ref name=Rapport/> Previous studies have shown that stimulant medications temporarily improve working memory abilities. | |||
| Although "under medical supervision, stimulant medications are considered safe",<ref name="AAP2001"/><ref>{{Cite web|url=http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/medications.shtml |title=NIMH · ADHD · The Treatment of ADHD |work= |accessdate=}}</ref> the use of stimulant medications for the treatment of ADHD has ] because of undesirable side effects, uncertain long term effects<ref name="hta.ac.uk">{{Cite journal|author=King S, Griffin S, Hodges Z |title=A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents |journal=Health Technology Assessment |volume=10 |issue=23 |pages=iii–iv, xiii–146 |year=2006 |month=July |pmid=16796929 |url=http://www.hta.ac.uk/execsumm/summ1023.htm}}</ref><ref name="meta.wkhealth.com">{{Cite journal|author=Stern HP, Stern TP |title=When children with attention-deficit/hyperactivity disorder become adults |journal=South. Med. J. |volume=95 |issue=9 |pages=985–91 |year=2002 |month=September |pmid=12356139 |doi= |url= |accessdate=2009-05-02}}</ref><ref>{{Cite book|author=Murphy, Kevin R.; Barkley, Russell A. |title=Attention-Deficit Hyperactivity Disorder, Third Edition : A Clinical Workbook |publisher=The Guilford Press |location=New York |year=2005 |pages= |isbn=1-59385-227-4 |oclc= |url=http://books.google.com/?id=EkyTTvjNRZAC&pg=PA626&lpg=PA626&dq=long+term+safety+of+stimulants |accessdate=}}</ref><ref name=TI2008>{{Cite web|url=http://www.ti.ubc.ca/letter69 |title=What is the evidence for using CNS stimulants to treat ADHD in children? | Therapeutics Initiative |work= |accessdate=}}</ref><ref>{{Cite journal|author=Lerner M, Wigal T |title=Long-term safety of stimulant medications used to treat children with ADHD |journal=Pediatric annals |volume=37 |issue=1 |pages=37–45 |year=2008 |month=January |pmid=18240852 |doi= 10.3928/00904481-20080101-11|url=}}</ref> and social and ethical issues regarding their use and dispensation. The FDA has added black-box warnings to some ADHD medications,<ref>{{Cite web|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108849.htm |title=FDA News |accessdate=2009-08-14 |work= |publisher=FDA|date=February 21, 2007 }}</ref><ref>{{Cite web|url=http://www.formularyproductions.com/master/showpage.php?dir=blackbox&whichpage=9 |title=Drugs with Black Box Warnings - Comprehensive List |accessdate=2009-05-19 |work=FormWeb |publisher=Joyce Generali|date=05-04-2009}}</ref> while the ] and the ] feel that it is prudent to carefully assess children for heart conditions before treating them with stimulant medications.<ref>{{Cite journal|author= |title=American Academy of Pediatrics/American Heart Association clarification of statement on cardiovascular evaluation and monitoring of children and adolescents with heart disease receiving medications for ADHD: May 16, 2008 |journal=Journal of Developmental and Behavioral Pediatrics |volume=29 |issue=4 |pages=335 |year=2008 |month=August |pmid=18698199 |doi=10.1097/DBP.0b013e31318185dc14 |author1= American Academy of Pediatrics/American Heart Association}}</ref> | |||
| A novel stimulant drug that has been used to treat ADHD is ]. There have been double-blind randomized controlled trials that have demonstrated the efficacy and tolerability of modafinil,<ref>{{Cite journal|author=Biederman J, Swanson JM, Wigal SB, Boellner SW, Earl CQ, Lopez FA |title=A comparison of once-daily and divided doses of modafinil in children with attention-deficit/hyperactivity disorder: a randomized, double-blind, and placebo-controlled study |journal=The Journal of Clinical Psychiatry |volume=67 |issue=5 |pages=727–35 |year=2006 |month=May |pmid=16841622 |url=http://article.psychiatrist.com/?ContentType=START&ID=10002551 |doi=10.4088/JCP.v67n0506}}</ref><ref>{{Cite journal|author=Greenhill LL, Biederman J, Boellner SW |title=A randomized, double-blind, placebo-controlled study of modafinil film-coated tablets in children and adolescents with attention-deficit/hyperactivity disorder |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=45 |issue=5 |pages=503–11 |year=2006 |month=May |pmid=16601402 |doi=10.1097/01.chi.0000205709.63571.c9}}</ref> however there are risks of serious side effects such as skin reactions and modafinil is not recommended for use in children.<ref>{{Cite web|url=http://secure.healthlinks.net.au/content/csl/pi.cfm?product=cspmodav11207 |title=Modavigil Product Information |accessdate=2008-07-02 |work= |publisher= |date= }}</ref> | |||
| ====Antipsychotic medication==== | |||
| ]) 4 mg tablets (])]] | |||
| In an odd contrast with the ] use of stimulant medication as a treatment for children with ADHD, the use of ] drugs as an ] treatment has been rising.<ref></ref> Antipsychotics work by blocking ], whereas stimulants trigger its release. Atypical antipsychotics have been approved for use in children and teenagers with ] spectrum disorders and ] by the ] (FDA) since 1993.<ref>{{Cite web|url=http://www.psychiatrictimes.com/schizophrenia/content/article/10168/1147536|title=Atypical Antipsychotics for Treatment of Schizophrenia Spectrum Disorders}}</ref> | |||
| Non-ADHD children do not respond differently to ADHD children when prescribed antipsychotic drugs, which are also increasingly prescribed off-label for children with aggression or defiant behavior.<ref>, Dosing of Atypical Antipsychotics in Children and Adolescents</ref> Social pressure to control a child's difficult and disruptive behavior, both at home and at school, may inadvertently change focus from what is in the best interest of the child's wellbeing; to how to render the child more compliant and easier to manage. | |||
| Careful approach needs to be taken when blocking dopamine function, which is responsible for the psychological ]. Excessive blocking of this ] can cause ]. This may in turn cause ], or lead some teenagers to compensate for their dopamine deficiency with illicit drugs or alcohol. Atypical antipsychotics are preferred for this reason, because they are less likely to cause movement disorders, dysphoria, and increased drug cravings that have been associated with older ].<ref>, Guidelines for the use of atypical antipsychotics in adults</ref> ], ], ], ], ], ], ] (inability to experience pleasure), ], ], ] problems and the possibility of ], an irreversible movement disorder, are among the adverse events associated with antipsychotic drugs. | |||
| ====Other non-stimulant medications==== | |||
| ] (]) and ] (Intuniv) are the only non-stimulant drugs approved for the treatment of ADHD. ] which may be prescribed ] include α<sub>2A</sub> adrenergic receptor agonists such as ], certain ] such as ], ], ] or ].<ref>{{Cite journal|author=Stein MA |title=Innovations in attention-deficit/hyperactivity disorder pharmacotherapy: long-acting stimulant and nonstimulant treatments |journal=The American Journal of Managed Care |volume=10 |issue=4 Suppl |pages=S89–98 |year=2004 |month=July |pmid=15352535 |url=http://www.ajmc.com/pubMed.php?pii=2632}}</ref><ref>{{Cite journal|author=Christman AK, Fermo JD, Markowitz JS |title=Atomoxetine, a novel treatment for attention-deficit-hyperactivity disorder |journal=Pharmacotherapy |volume=24 |issue=8 |pages=1020–36 |year=2004 |month=August |pmid=15338851 |doi=10.1592/phco.24.11.1020.36146}}</ref><ref>{{Cite journal|author=Hazell P |title=Do adrenergically active drugs have a role in the first-line treatment of attention-deficit/hyperactivity disorder? |journal=Expert Opinion on Pharmacotherapy |volume=6 |issue=12 |pages=1989–98 |year=2005 |month=October |pmid=16197353 |doi=10.1517/14656566.6.12.1989}}</ref><ref>{{Cite web|url=http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm107912.htm |title=Atomoxetine (marketed as Strattera) Information |work= |accessdate=12 July 2009}}</ref> | |||
| ==Prognosis== | |||
| Children diagnosed with ADHD have significant difficulties in adolescence, regardless of treatment.<ref name=autogenerated6>{{Cite journal|author=Molina BS, Hinshaw SP, Swanson JM |title=The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=48 |issue=5 |pages=484–500 |year=2009 |month=May |pmid=19318991 |doi=10.1097/CHI.0b013e31819c23d0}}</ref> In the United States, 37% of those with ADHD do not get a high school diploma even though many of them will receive special education services.<ref name="BarkleyContEd">{{Cite web|url=http://www.continuingedcourses.net/active/courses/course003.php |title=Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity. |accessdate=2008-09-19 |work=Barkley, Russell |publisher= |date= }}</ref> A 1995 briefing citing a 1994 book review says the combined outcomes of the expulsion and dropout rates indicate that almost half of all ADHD students never finish high school.<ref>{{PDFlink|http://web.archive.org/web/20070621111922/http://www.eric.ed.gov/ERICDocs/data/ericdocs2/content_storage_01/0000000b/80/22/94/d6.pdf|562 KB}}</ref> Also in the US, less than 5% of individuals with ADHD get a college degree<ref name="adhd_superman">{{Cite book| last = Cimera| first = Robert| title = Making ADHD a gift: teaching Superman how to fly| publisher = Scarecrow Press, Inc.| year = 2002 | location = Lanham, Maryland| page = 116| url = http://www.rowmaneducation.com/Catalog/SingleBook.shtml?command=Search&db=^DB/CATALOG.db&eqSKUdata=0810843196| isbn = 0810843188| accessdate = 2009-05-02}}</ref> compared to 28% of the general population.<ref name="us_census_2005"> U.S. Census Bureau March 28, 2005. Retrieved on 2008-08-02.</ref> Those with ADHD as children are at increased risk of a number of adverse life outcomes once they become teenagers. These include a greater risk of auto crashes, injury and higher medical expenses, earlier sexual activity, and teen pregnancy.<ref name="continuingedcourses.net"></ref> Russell Barkley states that adult ADHD impairments affect "education, occupation, social relationships, sexual activities, dating and marriage, parenting and offspring psychological morbidity, crime and drug abuse, health and related lifestyles, financial management, or driving. ADHD can be found to produce diverse and serious impairments".<ref></ref> | |||
| The proportion of children meeting the diagnostic criteria for ADHD drops by about 50% over three years after the diagnosis. This occurs regardless of the treatments used and also occurs in untreated children with ADHD.<ref name="pmid11563573" /><ref name="Jensen PS, Arnold LE, Swanson JM 2007 989–1002"/><ref name=TI2008/> ADHD persists into adulthood in about 30-50% of cases.<ref name=Balint2008>{{Cite journal|author=Bálint S, Czobor P, Mészáros A, Simon V, Bitter I |title= |language=Hungarian |journal=Psychiatr Hung |volume=23|issue=5 |pages=324–35 |year=2008 |pmid=19129549 |doi= |url=}}</ref> Those affected are likely to develop coping mechanisms as they mature, thus compensating for their previous ADHD.<ref name="psychiatrymmc.com"/> | |||
| ==Epidemiology== | |||
| ] | |||
| ADHD's global ] is estimated at 3-5% in people under the age of 19. There is, however, both geographical and local variability among studies. Geographically, children in North America appear to have a higher rate of ADHD than children in Africa and the Middle East,<ref name="Polanczyk">{{Cite journal|author=Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA |title=The worldwide prevalence of ADHD: a systematic review and metaregression analysis |journal=The American Journal of Psychiatry |volume=164 |issue=6 |pages=942–8 |year=2007 |month=June |pmid=17541055 |doi=10.1176/appi.ajp.164.6.942}}</ref> well published studies have found rates of ADHD as low as 2% and as high as 14% among school aged children.<ref name="autogenerated4">{{Cite web|url=http://www.loni.ucla.edu/Research/Projects/ADHD.shtml#CurrentResearch |title=LONI: Laboratory of Neuro Imaging |accessdate=2008-09-19 |work= |publisher= |date= }}</ref> The rates of diagnosis and treatment of ADHD are also much higher on the East Coast of the USA than on the West Coast.<ref>{{Cite web|url=http://www.cdc.gov/ncbddd/ADHD/ |title=ADHD Home |work= |accessdate=}}</ref> The frequency of the diagnosis differs between male children (10%) and female children (4%) in the United States.<ref>{{Cite web|url=http://www.cdc.gov/nchs/data/series/sr_10/sr10_221.pdf |format=PDF|title=CDC.gov |work= |accessdate=}}</ref> This difference between genders may reflect either a difference in susceptibility or that females with ADHD are less likely to be diagnosed than males.<ref>{{Cite journal|author=Staller J, Faraone SV |title=Attention-deficit hyperactivity disorder in girls: epidemiology and management |journal=CNS Drugs |volume=20 |issue=2 |pages=107–23 |year=2006 |pmid=16478287 |doi=10.2165/00023210-200620020-00003}}</ref> | |||
| Rates of ADHD diagnosis and treatment have increased in both the UK and the USA since the 1970s. In the UK an estimated 0.5 per 1,000 children had ADHD in the 1970s, while 3 per 1,000 received ADHD medications in the late 1990s. In the USA in the 1970s 12 per 1,000 children had the diagnosis, while in the late 1990s 34 per 1,000 had the diagnosis and the numbers continue to increase.<ref name=NICE2008/> | |||
| Adults are likely not to be diagnosed or treated for ADHD. This may result in a substantial underestimation of prevalence in most populations. Awareness about Hyperactivity and ADHD or its signs and symptoms has been rudimentary until early 1990 across Europe. | |||
| In the UK in 2003 a prevalence of 3.6% is reported in male children and less than 1% is reported in female children.<ref>NICE 2008 Pg. 134</ref> | |||
| {{As of|2009}}, eight percent of all ] players have been diagnosed with ADHD, making the disorder ] among this population. The increase coincided with the League's 2006 ban on ]s (q.v. ]).<ref>{{Cite web|url=http://www.slate.com/id/2208429/|title=Doping Deficit Disorder. Need performance-enhancing drugs? Claim ADHD|first=William|last=Saletan|publisher=Slate|date=2009-01-12|accessdate=2009-05-02}}</ref> | |||
| ==History== | |||
| {{Main|History of attention-deficit hyperactivity disorder}} | |||
| Hyperactivity has long been part of the human condition. Sir ] describes "mental restlessness" in his book ''An Inquiry Into the Nature and Origin of Mental Derangement'' written in 1798.<ref>, Volume 6, Number 2, May 2001 , pp. 66–73(8)</ref><ref>p 271, An inquiry into the nature and origin of mental derangement: comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effects.</ref> The terminology used to describe the symptoms of ADHD has gone through many changes over history including: "minimal brain damage", "minimal brain dysfunction" (or disorder),<ref>Bland, J.,(2002) About Gender: Testosterone and Aggression - Childhood. | |||
| http://www.gender.org.uk/about/06encrn/63gaggrs.htm</ref> "learning/behavioral disabilities" and "hyperactivity". In the DSM-II (1968) it was the "Hyperkinetic Reaction of Childhood". In the DSM-III "ADD (Attention-Deficit Disorder) with or without hyperactivity" was introduced. In 1987 this was changed to ADHD in the DSM-III-R and subsequent editions.<ref>{{Cite web|url=http://kadi.myweb.uga.edu/The_Development_of_the_DSM.html |title=Development of the DSM |publisher=Kadi.myweb.uga.edu |date= |accessdate=2009-05-25}}</ref> The use of stimulants to treat ADHD was first described in 1937.<ref>{{Cite journal|author=Patrick KS, Straughn AB, Perkins JS, González MA |title=Evolution of stimulants to treat ADHD: transdermal methylphenidate |journal=Human Psychopharmacology |volume=24 |issue=1 |pages=1–17 |year=2009 |month=January |pmid=19051222 |pmc=2629554 |doi=10.1002/hup.992}}</ref> | |||
| ==Society and culture== | |||
| {{See also|List of people diagnosed with attention-deficit hyperactivity disorder}} | |||
| The media have reported on many issues related to ADHD. In 2001 ]'s ] aired a one-hour program about the effects of the diagnosis and treatment of ADHD in minors, entitled "Medicating Kids."<ref>{{Cite web|url=http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/ |title=Defining and Diagnosing ADHD |publisher=PBS |date= |accessdate=2009-05-25}}</ref> The program included a selection of interviews with representatives of various points of view. In one segment, entitled Backlash, retired ] ] and ] whom PBS described as "outspoken critics who insist a fraud perpetrated by the psychiatric and pharmaceutical industries on families anxious to understand their children's behavior"<ref>{{Cite web|url=http://www.pbs.org/wgbh/pages/frontline/shows/medicating/backlash |title=Opponents and Backlash |publisher=PBS |date= |accessdate=2009-05-25}}</ref> were interviewed on the legitimacy of the disorder. ] and Xavier Castellanos, then head of ADHD research at the ] (NIMH), defended the viability of the disorder. In the interview with Castellanos, he stated that little is scientifically understood.<ref>{{cite interview|url= http://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/castellanos.html |title=Interviews: Xavier Castellanos, M.D. |program=PBS |date=2000-10-10 |accessdate=2009-05-25 |last=Castellanos |first=Xavier}}</ref> Lawrence Diller was interviewed on the business of ADHD along with a representative from ].{{Citation needed|date=January 2009}} | |||
| A number of notable individuals have given controversial opinions on ADHD. ] ]'s interview with ] was widely watched by the public. In this interview he spoke about ] and also referred to ] and ] as being "street drugs" rather than as ADHD medication.<ref>{{Cite web|url=http://www.msnbc.msn.com/id/8343367/page/2/|title='I'm passionate about life'|publisher=msnbc.msn.com|accessdate=2008-12-30}}</ref> In England ] ], a leading neuroscientist, spoke out publicly about the need for a wide-ranging inquiry in the House of Lords into the dramatic increase in the diagnosis of ADHD in the UK and possible causes<ref>{{Cite news|url=http://news.bbc.co.uk/1/low/health/7093944.stm |title=Health | Peer calls for ADHD care review |publisher=BBC News |date=2007-11-14 |accessdate=2009-05-25}}</ref> following a 2007 BBC Panorama programme which highlighted US research (The Multimodal Treatment Study of Children with ADHD by the University of Buffalo showing treatment results of 600) suggesting drugs are no better than other forms of therapy for ADHD in the long term.<ref>{{Cite web|url=http://www.brunel.ac.uk/about/hongrads/2000/greenfield |title=Baroness Susan Greenfield |publisher=Brunel.ac.uk |date= |accessdate=2009-05-25}}</ref> | |||
| ==Controversies== | |||
| {{Main|Attention-deficit hyperactivity disorder controversies}} | |||
| ADHD and its diagnosis and treatment have been considered controversial since the 1970s.<ref name="Parrillo 2008 63"/><ref name="autogenerated3" /><ref>{{Cite journal|author=Foreman DM |title=Attention deficit hyperactivity disorder: legal and ethical aspects |journal=Archives of Disease in Childhood |volume=91 |issue=2 |pages=192–4 |year=2006 |month=February |pmid=16428370 |pmc=2082674 |doi=10.1136/adc.2004.064576}}</ref> The controversies have involved clinicians, teachers, policymakers, parents and the media. Opinions regarding ADHD range from not believing it exists at all to believing there are genetic and physiological bases for the condition as well as disagreement about the use of stimulant medications in treatment.<ref name="US1999"/><ref name="autogenerated3"/><ref name="Cohen, Donald J.; Cicchetti, Dante 2006"/> Most healthcare providers accept that ADHD is a genuine disorder with debate in the scientific community centering mainly around how it is diagnosed and treated.<ref name="Sim MG, Hulse G, Khong E 2004 615–8"/><ref name="Online"/><ref name="Schonwald A, Lechner E 2006 189–95"/> | |||
| Others have included that it may stem from a misunderstanding of the diagnostic criteria and how they are utilized by clinicians,<ref name="Ramsay"/>{{rp|p.3}} teachers, policymakers, parents and the media.<ref name="US1999"/> Debates center around: whether ADHD is a disability or whether it is merely a neurological description, the cause of the disorder, the changing of the diagnostic criteria, and the rapid increase in diagnosis of ADHD and the use of stimulants to treat the disorder.<ref name="Austin">{{Cite web|url=http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=13852&cn=3 |title=Controversies Surrounding ADHD - (ADHD) Attention Deficit Hyperactivity Disorder Cause, Diagnosis, History |format= |work= |accessdate=}}</ref> Some do not believe it exists at all.<ref name="US1999"/> Long term possible side effects of stimulants and their usefulness are largely unknown because of a lack of long term studies.<ref>{{Cite journal|author=Ashton H, Gallagher P, Moore B |title=The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder |journal=J. Psychopharmacol. (Oxford) |volume=20 |issue=5 |pages=602–10 |year=2006 |month=September |pmid=16478756 |doi=10.1177/0269881106061710 |url=http://jop.sagepub.com/cgi/content/abstract/20/5/602}}</ref> Some research raises questions about the long term effectiveness and side effects of medications used to treat ADHD.<ref>{{Cite journal|author=Lakhan SE, Hagger-Johnson GE |title=The impact of prescribed psychotropics on youth |journal=Clin Pract Epidemol Ment Health |volume=3 |issue= |pages=21 |year=2007 |pmid=17949504 |pmc=2100041 |doi=10.1186/1745-0179-3-21 |url=http://www.cpementalhealth.com/content/3/1/21}}</ref> | |||
| In 1998, the US National Institutes of Health (NIH) released a consensus statement on the diagnosis and treatment of ADHD. The statement, while recognizing that stimulant treatment is controversial, supports the validity of the ADHD diagnosis and the efficacy of stimulant treatment. It found controversy only in the lack of sufficient data on long-term use of medications, and in the need for more research in many areas.<ref> | title=Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). NIH Consensus Statement 1998 Nov 16Ð18; 16(2): 1Ð37.</ref> | |||
| Stimulants legal status was recently reviewed by several international organizations: | |||
| *Internationally, methylphenidate is a Schedule II drug under the ].<ref>{{PDFlink||1.63 MB}} 23rd edition. August 2003. International Narcotics Board, Vienna International Centre. Retrieved 2 March 2006</ref> | |||
| *In the ], methylphenidate is classified as a ] ], the designation used for substances that have a recognized medical value but present a high likelihood for abuse because of their addictive potential. | |||
| *In the ], methylphenidate is a controlled 'Class B' substance, and possession without prescription is illegal, with a sentence up to 14 years and/or an unlimited fine.<ref>http://www.homeoffice.gov.uk/drugs/drugs-law/Class-a-b-c/</ref> | |||
| *In ], it is a 'class B2 controlled substance'. unlawful possession is punishable by 6 month prison sentence and distribution of it is punishable by a 14 year sentence. | |||
| The ] said in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: "The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians."<ref name="Reason R 1999 85–91">{{Cite journal|author=Reason R |title=ADHD: a psychological response to an evolving concept. (Report of a Working Party of the British Psychological Society) |journal=Journal of Learning Disabilities |volume=32 |issue=1 |pages=85–91 |year=1999 |pmid=15499890 |doi=10.1177/002221949903200108 |author2=Working Party of the British Psychological Society}}</ref><ref></ref> However, several years later, in 2009, the British Psychological Society, in collaboration with the Royal College of Psychiatrists, released a set of guidelines for the diagnosis and treatment of ADHD.<ref>, ] (NICE) | |||
| </ref> | |||
| With a "wide variation in diagnosis across states, races, and ethnicities"<ref name=elder>{{Cite journal|author=Elder TE |title=The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates. | journal=J Health Econ. 2010 Jun 17.|volume=29|issue=5|pages=641–56|year=2010 |pmid= 20638739|pmc=2933294|doi=10.1016/j.jhealeco.2010.06.003 }}</ref> some investigators suspect that factors other than neurological conditions play a role when the diagnosis of ADHD is made.<ref name=elder/><ref name=evans>{{Cite journal|author= Evans WN, Morrill MS, Parente ST |title= Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children. | journal=J Health Econ. 2010 Aug 4.|volume= 29|issue= 5|pages= 657–73|year= 2010 |pmid= 20739076|doi= 10.1016/j.jhealeco.2010.07.005 }}</ref> Two studies published in 2010 suggest that the diagnosis is more likely to be made in the younger children within a grade; the authors propose that such a misdiagnosis of ADHD within a grade may be due to different states of maturity and may lead to potentially inappropriate treatment.<ref name=elder/><ref name=evans/> | |||
| ==References== | |||
| {{Reflist|2}} | |||
| ===Bibliography=== | |||
| {{Refbegin}} | |||
| *{{Cite book|author=Dr Jennifer Erkulwater; Dr Rick Mayes; Dr Catherine Bagwell |title=Medicating Children: ADHD and Pediatric Mental Health|publisher=Harvard University Press|location=Cambridge |year=2009 |pages=5 |isbn=0-674-03163-6 |oclc= |doi= |accessdate=}} | |||
| {{Refend}} | |||
| ==Further reading== | |||
| <div class="references-small"> | |||
| *Barkley, Russell A. ''Take Charge of ADHD: The Complete Authoritative Guide for Parents'' (2005) New York: Guilford Publications. | |||
| *Conrad, Peter ''Identifying Hyperactive Children'' (Ashgate, 2006). | |||
| *Crawford, Teresa ''I'm Not Stupid! I'm ADHD!'' | |||
| *Faraone, Stephen V. (2005). ''The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder''. Eur Child Adolesc Psychiatry 14, 1-10. | |||
| *Faraone, Stephen, V.''Straight Talk about Your Child's Mental Health: What to Do When Something Seems Wrong'' (2003) New York:Guilford Press | |||
| *Green, Christopher, Kit Chee, ''Understanding ADD''; Doubleday 1994; ISBN 0-86824-587-9 | |||
| *Hanna, Mohab. (2006) ''Making the Connection: A Parent's Guide to Medication in ADHD'', Washington D.C.: Ladner-Drysdale. | |||
| *{{Cite book|author=Hartmann, Thom |title=The Edison gene: ADHD and the gift of the hunter child |publisher=Park Street Press |location=Rochester, Vt |year=2003 |pages= |isbn=0-89281-128-5 |oclc= |doi= |accessdate=}} | |||
| *Mate, Gabor. Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder. Vintage Canada (1999). ISBN-10: 0676972594 | |||
| *Matlen, Terry. (2005) "Survival Tips for Women with AD/HD". ISBN 1-886941-59-9 | |||
| *Mellor, Nigel | |||
| * New York: ISBN: | |||
| *Ninivaggi, F.J. "Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Rethinking Diagnosis and Treatment Implications for Complicated Cases", ''Connecticut Medicine''. September 1999; Vol. 63, No. 9, 515-521. PMID 10531701 | |||
| *{{Cite book|title=The Other Side of ADHD:Attention Deficit Hyperactivity Disorder Exposed and Explained |last=Southall |first=Angela |year=2007 |publisher=Radcliffe Publishing Ltd |location= |isbn=1846190681 |pages= |url=http://books.google.com/?id=AKXhThWgvyYC&pg=PA41&lpg=PA41&dq=barkley+drug+company+funding |accessdate=2009-05-02 }} | |||
| </div> | |||
| *Mohammed M. Alqahtani. The Comorbidity of ADHD in the General Population of Saudi Arabian School-Age Children. J Atten Disord. 2009 Oct 22.DOI:10.1177/1087054709347195. | |||
| * Mohammed M.J. Alqahtani. Attention-deficit hyperactive disorder in school-aged children in Saudi Arabia. Eur J Pediatr. 2010 Mar 27. DOI 10.1007/s00431-010-1190-y | |||
| '''Adult ADHD''' | |||
| <div class="references-small"> | |||
| *Kelly, Kate, Peggy Ramundo. (1993) ''You Mean I'm Not Lazy, Stupid or Crazy?! A Self-Help Book for Adults with Attention deficit Disorder''. ISBN 0-684-81531-1 | |||
| *Mate, Gabor. Scattered: How Attention Deficit Disorder Originates And What You Can Do About It. Plume (August 1, 2000). ISBN-10: 0452279631 | |||
| *Ratey, Nancy. (2008) ''The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks, and Talents''. ISBN 0-312-35533-5 | |||
| *Sarkis, Stephanie. (2006) ''10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction & Accomplish Your Goals''. ISBN 1-57224-434-8 | |||
| *Weiss, Lynn. (2005) ''Attention Deficit Disorder in Adults, 4th Edition: A Different Way of Thinking'' ISBN 1-58979-237-8 | |||
| </div> | |||
| ==External links== | |||
| {{Wiktionary|ADHD|ADHD-PI|ADHD-C|ADHD-PH/I}} | |||
| * | |||
| *{{Cite web|url=http://www.nice.org.uk/nicemedia/pdf/ADHDFullGuideline.pdf |format=PDF|title= | |||
| CG72 Attention deficit hyperactivity disorder (ADHD): full guideline|accessdate=2009-01-08 |work= |publisher=NHS |date=09 March 2009 }} | |||
| * | |||
| * | |||
| * | |||
| {{adhd|state=uncollapsed}} | |||
| {{Mental and behavioral disorders|selected=childhood}} | |||
| {{Emotional and behavioral disorders}} | |||
| {{DEFAULTSORT:Attention-Deficit Hyperactivity Disorder}} | |||
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Revision as of 16:08, 19 October 2010