Attention Deficit Hyperactivity Disorder
Disease Details
Family Health Simplified
- Description
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development.
- Type
- Attention-Deficit/Hyperactivity Disorder (ADHD) is classified as a neurodevelopmental disorder. The type of genetic transmission for ADHD is complex and polygenic, meaning that multiple genes are likely involved, and the inheritance pattern does not follow simple Mendelian genetics. Genetic factors contribute significantly to the risk of developing ADHD, often in combination with environmental influences.
- Signs And Symptoms
- Inattention, hyperactivity (restlessness in adults), disruptive behaviour, and impulsivity are common in ADHD. Academic difficulties are frequent, as are problems with relationships. The signs and symptoms can be difficult to define, as it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin.According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and its text revision (DSM-5-TR), symptoms must be present for six months or more to a degree that is much greater than others of the same age. This requires at least six symptoms of either inattention or hyperactivity/impulsivity for those under 17 and at least five symptoms for those 17 years or older. The symptoms must be present in at least two settings (e.g., social, school, work, or home), and must directly interfere with or reduce quality of functioning. Additionally, several symptoms must have been present before age twelve. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and its text revision (DSM-5-TR), the required age of onset of symptoms is currently 12 years.
- Prognosis
- ADHD persists into adulthood in about 30–50% of cases. Those affected are likely to develop coping mechanisms as they mature, thus compensating to some extent for their previous symptoms. Children with ADHD have a higher risk of unintentional injuries. Effects of medication on functional impairment and quality of life (e.g. reduced risk of accidents) have been found across multiple domains. Rates of smoking among those with ADHD are higher than in the general population at about 40%.It affects about 5–7% of children when diagnosed via the DSM-IV criteria, and 1–2% when diagnosed via the ICD-10 criteria. Rates are similar between countries and differences in rates depend mostly on how it is diagnosed. ADHD is diagnosed approximately twice as often in boys as in girls, and 1.6 times more often in men than in women, although the disorder is overlooked in girls or diagnosed in later life because their symptoms sometimes differ from diagnostic criteria. About 30–50% of people diagnosed in childhood continue to have ADHD in adulthood, with 2.58% of adults estimated to have ADHD which began in childhood. In adults, hyperactivity is usually replaced by inner restlessness, and adults often develop coping skills to compensate for their impairments. The condition can be difficult to tell apart from other conditions, as well as from high levels of activity within the range of normal behaviour. ADHD has a negative impact on patient health-related quality of life that may be further exacerbated by, or may increase the risk of, other psychiatric conditions such as anxiety and depression.Individuals with ADHD are significantly overrepresented in prison populations. Although there is no generally accepted estimate of ADHD prevalence among inmates, a 2015 meta-analysis estimated a prevalence of 25.5%, and a larger 2018 meta-analysis estimated the frequency to be 26.2%. ADHD is more common among longer-term inmates; a 2010 study at Norrtälje Prison, a high-security prison in Sweden, found an estimated ADHD prevalence of 40%.
- Onset
- Attention-Deficit/Hyperactivity Disorder (ADHD) typically has an onset in childhood, with symptoms often appearing as early as preschool years and usually before the age of 12.
- Prevalence
- The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) varies by age and population. In the United States, it is estimated that approximately 5-10% of children and 2-5% of adults have ADHD. The disorder tends to be diagnosed more frequently in males than in females.
- Epidemiology
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ADHD is estimated to affect about 6–7% of people aged 18 and under when diagnosed via the DSM-IV criteria. When diagnosed via the ICD-10 criteria, rates in this age group are estimated around 1–2%. Children in North America appear to have a higher rate of ADHD than children in Africa and the Middle East; this is believed to be due to differing methods of diagnosis rather than a difference in underlying frequency. As of 2019, it was estimated to affect 84.7 million people globally. If the same diagnostic methods are used, the rates are similar between countries. ADHD is diagnosed approximately three times more often in boys than in girls. This may reflect either a true difference in underlying rate, or that women and girls with ADHD are less likely to be diagnosed. Studies from multiple countries have reported that children born closer to the start of the school year are more frequently diagnosed with and medicated for ADHD than their older classmates.Rates of diagnosis and treatment have increased in both the United Kingdom and the United States since the 1970s. Prior to 1970, it was rare for children to be diagnosed with ADHD, while in the 1970s rates were about 1%. This is believed to be primarily due to changes in how the condition is diagnosed and how readily people are willing to treat it with medications rather than a true change in how common the condition is. It was believed changes to the diagnostic criteria in 2013 with the release of the DSM-5 would increase the percentage of people diagnosed with ADHD, especially among adults.Due to disparities in the treatment and understanding of ADHD between caucasian and non-caucasian populations, many non-caucasian children go undiagnosed and unmedicated. It was found that within the US that there was often a disparity between caucasian and non-caucasian understandings of ADHD. This led to a difference in the classification of the symptoms of ADHD, and therefore, its misdiagnosis. It was also found that it was common in non-caucasian families and teachers to understand the symptoms of ADHD as behavioural issues, rather than mental illness.
Crosscultural differences in diagnosis of ADHD can also be attributed to the long-lasting effects of harmful, racially targeted medical practices. Medical pseudosciences, particularly those that targeted African American populations during the period of slavery in the US, lead to a distrust of medical practices within certain communities. The combination of ADHD symptoms often being regarded as misbehaviour rather than as a psychiatric condition, and the use of drugs to regulate ADHD, result in a hesitancy to trust a diagnosis of ADHD. Cases of misdiagnosis in ADHD can also occur due to stereotyping of non-caucasian individuals. Due to ADHD's subjectively determined symptoms, medical professionals may diagnose individuals based on stereotyped behaviour or misdiagnose due to differences in symptom presentation between caucasian and non-caucasian individuals. - Intractability
- Attention-Deficit/Hyperactivity Disorder (ADHD) is not considered intractable. While it is a chronic condition that may persist into adulthood, it can often be effectively managed with a combination of behavioral therapies, medications, and lifestyle changes. Treatments, such as stimulant and non-stimulant medications, can significantly alleviate symptoms for many individuals. Behavioral interventions and support strategies also play a crucial role in managing ADHD.
- Disease Severity
- Attention-Deficit/Hyperactivity Disorder (ADHD) can vary in severity. It is generally classified into three types: predominantly inattentive presentation, predominantly hyperactive-impulsive presentation, and combined presentation. The severity can range from mild to moderate to severe, depending on the extent to which symptoms impact daily functioning and quality of life. Severity is typically determined by the number of symptoms present and the degree to which they disrupt academic, social, and occupational activities.
- Healthcare Professionals
- Disease Ontology ID - DOID:1094
- Pathophysiology
- Current models of ADHD suggest that it is associated with functional impairments in some of the brain's neurotransmitter systems, particularly those involving dopamine and norepinephrine. The dopamine and norepinephrine pathways that originate in the ventral tegmental area and locus coeruleus project to diverse regions of the brain and govern a variety of cognitive processes. The dopamine pathways and norepinephrine pathways which project to the prefrontal cortex and striatum are directly responsible for modulating executive function (cognitive control of behaviour), motivation, reward perception, and motor function; these pathways are known to play a central role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed.
- Carrier Status
- Attention-deficit/hyperactivity disorder (ADHD) is not a condition associated with carrier status in the context of genetic inheritance. ADHD is a neurodevelopmental disorder influenced by a complex interplay of genetic, environmental, and neurological factors. Unlike single-gene disorders, ADHD does not follow a straightforward inheritance pattern and cannot be attributed to a specific carrier status.
- Mechanism
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Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. Its exact etiology is not fully understood, but it involves both genetic and environmental factors.
**Mechanism:**
ADHD is associated with dysregulation in neurotransmitter systems, particularly those involving dopamine and norepinephrine. These neurotransmitters play crucial roles in attention, executive function, and impulse control.
**Molecular Mechanisms:**
1. **Dopamine Dysregulation:** ADHD has been linked to reduced dopamine activity in certain brain regions, particularly in the prefrontal cortex and the basal ganglia. Dopamine is critical for reward processing and motivation, and its deficiency can lead to symptoms of inattention and impulsivity.
2. **Norepinephrine Function:** Norepinephrine affects arousal and alertness. In ADHD, there is often an imbalance in norepinephrine levels, impacting attention and focus.
3. **Genetic Factors:** ADHD has a strong genetic component. Genes involved in dopamine transport (such as the DAT1 gene), receptors (like DRD4 and DRD5), and other related pathways have been implicated. Variants in these genes may affect the availability and function of dopamine.
4. **Neuroanatomical Changes:** Individuals with ADHD often exhibit structural differences in brain regions involved in impulse control and executive function, such as reduced volume in the prefrontal cortex, caudate nucleus, and cerebellum.
5. **Receptor and Transporter Function:** Alterations in the function of dopamine receptors (D1, D2 receptors) and the dopamine transporter (DAT) can influence synaptic dopamine levels and signaling, contributing to ADHD symptoms.
6. **Synaptic Plasticity:** Abnormalities in synaptic plasticity, the brain's ability to change and adapt in response to experience, have also been observed in ADHD, potentially affecting learning and behavior regulation.
Understanding these molecular mechanisms helps in developing pharmacological treatments for ADHD, such as stimulant medications (e.g., methylphenidate and amphetamines) that increase dopamine and norepinephrine levels in the brain, improving attention and reducing hyperactivity and impulsivity. - Treatment
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Attention-deficit/hyperactivity disorder (ADHD) can be managed with a combination of treatments. This often includes:
1. **Medications**: Stimulants (like methylphenidate or amphetamines) and non-stimulants (like atomoxetine or guanfacine) are commonly prescribed to help control symptoms.
2. **Behavioral Therapy**: This involves training and modifying behavior patterns to improve attention, organization, and impulse control. Techniques may include time management skills, organizational skills, and structured routines.
3. **Psychoeducation**: Educating the patient and their family about ADHD to better understand and cope with the condition.
4. **School Interventions**: Special education services and accommodations such as extended time for tests or a distraction-free environment to help with learning.
5. **Lifestyle Changes**: Regular physical exercise, a healthy diet, adequate sleep, and structured routines can help manage symptoms.
6. **Support Groups and Counseling**: These provide emotional support and strategies for dealing with social and academic challenges. - Compassionate Use Treatment
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Compassionate use treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) involves providing patients access to investigational therapies outside of clinical trials when no satisfactory alternatives are available. Off-label or experimental treatments for ADHD can include:
1. **Non-Stimulant Medications**: Some antidepressants like bupropion (Wellbutrin) or tricyclic antidepressants (e.g., nortriptyline) may be used off-label for treating ADHD symptoms.
2. **Modafinil**: Typically used for narcolepsy, modafinil has been studied for its potential benefits in treating ADHD symptoms.
3. **Clonidine and Guanfacine**: While approved for ADHD in children, these medications are sometimes used off-label in adults.
4. **Nutritional Supplements**: Omega-3 fatty acids and certain vitamins, though evidence is mixed, are sometimes used as adjunctive treatments.
5. **Neurofeedback**: This experimental therapy involves training individuals to improve brain function through real-time feedback.
It is important to consult with a healthcare provider before considering any off-label or experimental treatments. - Lifestyle Recommendations
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For Attention-Deficit/Hyperactivity Disorder (ADHD), some effective lifestyle recommendations include:
1. **Regular Exercise**: Engaging in physical activity can improve concentration, decrease anxiety, and stimulate brain regions involved in focus and mood.
2. **Balanced Diet**: A diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain energy levels and support brain function.
3. **Sleep Hygiene**: Establishing a regular sleep schedule and ensuring adequate sleep is crucial for managing ADHD symptoms.
4. **Routine and Structure**: Implementing a consistent daily routine can help reduce distractions and improve task Management.
5. **Mindfulness and Relaxation Techniques**: Practices such as meditation, yoga, and deep-breathing exercises can enhance attention and emotional regulation.
6. **Limiting Screen Time**: Reducing exposure to screens, especially before bedtime, can help with focus and sleep quality.
7. **Organizational Tools**: Using planners, calendars, and reminders can aid in managing tasks and deadlines effectively.
8. **Behavioral Therapy**: Regular sessions with a therapist can provide strategies for coping with challenges and improving executive function skills.
9. **Social Support**: Connecting with support groups or networks for individuals with ADHD can provide encouragement and practical advice.
Implementing these lifestyle changes alongside medical treatment, if necessary, can significantly improve the management of ADHD symptoms. - Medication
- Medications commonly prescribed for Attention-Deficit/Hyperactivity Disorder (ADHD) include stimulants like methylphenidate (e.g., Ritalin, Concerta) and amphetamines (e.g., Adderall, Vyvanse). Non-stimulant options include atomoxetine (Strattera), guanfacine (Intuniv), and clonidine (Kapvay). Treatment plans vary based on individual needs and medical advice.
- Repurposable Drugs
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For Attention Deficit Hyperactivity Disorder (ADHD), drugs that have shown potential for repurposing include:
1. **Bupropion (Wellbutrin)**
2. **Modafinil (Provigil)**
3. **Guanfacine (Intuniv)**
4. **Clonidine (Kapvay)**
These medications were originally developed for other conditions but have been found to help with ADHD symptoms in certain patients. However, these should be considered only under the guidance of a healthcare professional. - Metabolites
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. In the context of physiological and biochemical research, several metabolites have been studied in relation to ADHD, including neurotransmitters like dopamine and norepinephrine. Abnormal levels of these neurotransmitters and their metabolites are often associated with ADHD symptoms. Advanced methods such as nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS) are used to study these metabolites at a nanoscale (nanometer) level, providing insights into the biochemical pathways involved in the disorder.
- Nutraceuticals
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Nutraceuticals are food-derived products that can provide health benefits, including prevention and treatment of disease. For Attention-Deficit/Hyperactivity Disorder (ADHD), some common nutraceuticals include:
1. **Omega-3 Fatty Acids**: Found in fish oil, these have been shown to improve symptoms such as inattention, hyperactivity, and impulsiveness in some individuals with ADHD.
2. **Iron and Zinc**: Deficiencies in these minerals have been associated with ADHD symptoms. Supplementation might help reduce these symptoms, particularly if a deficiency is present.
3. **Magnesium**: Low levels of magnesium have been linked to increased hyperactivity and inattention. Supplementation could potentially help improve these symptoms.
4. **Multivitamins**: General vitamin and mineral supplements may help address any underlying nutritional deficiencies that could exacerbate ADHD symptoms.
5. **L-Carnitine**: This amino acid has shown promise in some studies for improving symptoms in children with ADHD.
While some evidence suggests that these nutraceuticals can help manage ADHD symptoms, they should not replace conventional treatments like behavioral therapy and medication without professional guidance. Nutraceuticals may work best as part of a comprehensive treatment plan. - Peptides
- Attention-Deficit/Hyperactivity Disorder (ADHD) is primarily managed through behavioral therapies and medications such as stimulants and non-stimulants. Peptides and nanotechnology are emerging areas of research in ADHD but are not currently standard treatments. Researchers are exploring how peptides can influence brain function and behavior, potentially leading to new therapeutic options. Nanotechnology is being investigated for targeted drug delivery systems to improve the effectiveness of ADHD medications with fewer side effects. However, these areas require more research before they become viable treatments for ADHD.