Attention deficit hyperactivity disorder

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Attention deficit hyperactivity disorder

ICD-10  | ICD10 F84.0-F84.1
ICD-9  | 314.00

, 314.01

OMIM  | 143465
MedlinePlus  | 001551

Attention deficit hyperactivity disorder (ADHD) is a "behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. Although most individuals have symptoms of both inattention and hyperactivity-impulsivity, one or the other pattern may be predominant. The disorder is more frequent in males than females. Onset is in childhood. Symptoms often attenuate during late adolescence although a minority experience the full complement of symptoms into mid-adulthood."[1][2]

ADHD occurs in adults also.[3]

ADHD is associated with conduct disorder and school problems.[4]

## Contents

* 1 Classification
* 2 Epidemiology
* 3 Etiology/cause
* 4 Treatment
* 4.1 Medications
* 4.1.1 Drug toxicity
* 4.2 Behavior therapy
* 4.2.1 Children
* 4.2.2 Adults
* 4.3 United States: Individuals with Disabilities Education Act (IDEA)
* 5 Prognosis
* 6 References

## Classification[edit]

There are three types:[5]

* Predominantly attention deficit disorder (ADD) (10%–15%)
* Predominantly hyperactive and impulsive (5%)
* Combined (80%)

## Epidemiology[edit]

About 10% of American children may have ADD. [6]

## Etiology/cause[edit]

Twin studies suggest 76% of ADHD is inherited.[7] Abnormalities of biogenic amine receptors may contribute to ADHD.[7] ADHD is 3 times as common among adolescents of domestic adoption than nonadopted children.[8]

A genome wide scan suggests abnormalities on chromosome 16.[9]

ADHD may result from reduced inhibitory dopamine transmission in the midbrain. This may be due to an increase in dopamine plasma membrane transport protein density which may remove dopamine from the synapse too quickly,[10][11] similar to a prior study on susceptibility to cocaine abuse.[12]

Magnetic resonance imaging has investigated the development of the brains of children with ADHD.[13]

The relationship between childhood bipolar disorder and attention deficit hyperactivity disorder is uncertain.[14][15][16]

Studies of the differences in brain and cognitive development in early childhood between children of the digital age of television and video games and those before raise the possibility that the digital visual environment leads to ADD and ADHD by disrupting the normal transition from right-brain visual processing to a balanced right- and left-brain cognitive and emotional state.

> This view has enlisted some support by neurosurgeons, such as Restak (2003),[17] who suggests that modern brain science, genetic mapping, and advances in imaging technology and psychopharmacology provide an unprecedented opportunity to show that the visual, high-volume, sound-byte environment in which today’s children live is even leading to a situation in which Attention Deficit Disorder and/or Attention Deficit Hyperactivity Disorder is on its way to becoming the norm.[18]

## Treatment[edit]

Clinical practice guidelines are available.[19][20]

The Multimodal Treatment Study of Children with ADHD randomized controlled trial concluded "for ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes."[21] The components of this trial included over 14 months:[22]

* Medications: "Were seen monthly for one-half hour at each medication visit. During the treatment visits, the prescribing physician spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child’s ADHD-related difficulties. The physicians, in addition, sought input from the teachers on a monthly basis."
* Behavior: "Families met up to 35 times with a behavior therapist, mostly in group sessions. These therapists also made repeated visits to schools to consult with children’s teachers and to supervise a special aide assigned to each child in the group. In addition, children attended a special 8-week summer treatment program where they worked on academic, social, and sports skills, and where intensive behavioral therapy was delivered to assist children in improving their behavior"

### Medications[edit]

Several stimulant medications, such as methylphenidate[23] and amphetamines (a 3:1 mixture of d-amphetamine to l-amphetamine is Adderall and others), are a mix of dopamine uptake inhibitors and adrenergic uptake inhibitors. Stimulants work by blocking the dopamine plasma membrane transport protein.[2]

These medications are effective[24] and may also reduce the incidence of subsequent psychiatric disorders[25] and criminality.[26]

In uncontrolled case series, nadolol, an adrenergic beta-receptor blockader, combined with a stimulant may help.[27]

Alternatively, atomoxetine (Straterra) is an adrenergic uptake inhibitor that is selective norepinephrine reuptake inhibitor. It is less likely to contribute to substance abuse.

#### Drug toxicity[edit]

These drugs may increase cardiac complications.[28]

### Behavior therapy[edit]

#### Children[edit]

Various behavioral programs have been studied.[29] Health care providers, parents, and schools should collaborate in behavior therapy. In the United States of America, federal regulation provides for support to public schools for the education of children with disabilities such as attention deficit hyperactivity disorder (see below).[30][31]

Behavioral therapy for adolescents American Academy of Family Physicians | Attention Deficit Disorder Association | National Resource Center (NRC) on AD/HD

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1. Make a schedule.
2. Make simple house rules.
3. Make sure your directions are understood.
4. Reward good behavior.
5. Make sure your child is supervised all the time.
6. Watch your child around his or her friends.
7. Set a homework routine.
8. Focus on effort, not grades.
9. Talk with your child's teachers

1. Facilitate appropriate independence seeking.
2. Maintain adequate structure and supervision.
3. Establish “the bottom line” rules for living in your home and enforce them consistently.
4. Negotiate with your adolescent all the other issues which are not bottom lines.
5. Use consequences wisely.
6. Maintain good communication.
7. Keep a disability perspective, and practice forgiveness
8. Focus on the positive.

1. Establishing house rules and structure
2. Learning to praise appropriate behaviors (praising good behavior at least five times as often as bad behavior is criticized) and ignoring mild inappropriate behaviors (choosing your battles)
3. Using appropriate commands
4. Using "when-then?" contingencies (withdrawing rewards or privileges in response to inappropriate behavior)
5. Planning ahead and working with children in public places
6. Time out from positive reinforcement (using time outs as a consequence for inappropriate behavior)
7. Daily charts and point/token systems with rewards and consequences
8. School-home note system for rewarding behavior at school and tracking homework

#### Adults[edit]

Attention deficit hyperactivity disorder may be helped by cognitive behavioral therapy according to a randomized controlled trial. [32]

Amphetamines may help adults.[33]

### United States: Individuals with Disabilities Education Act (IDEA)[edit]

In the United States of America, Title 34 Part 300 of the Code of Federal Regulation provides for support to public schools for the education of children with 'other health impairments' such as attention deficit hyperactivity disorder.[30][31]

## Prognosis[edit]

There are significant adverse socioeconomic outcomes from ADHD.[34][35] Teenage males are more likely to have automobile accidents.[36]

Mortality may be increased.[37]

Military recruits who do not require medications to finish high school or to hold a job may have similar military performance as recruits without ADHD.[15]

## References[edit]

1. ↑ Anonymous (2025), Attention deficit hyperactivity disorder (English). Medical Subject Headings. U.S. National Library of Medicine.
2. ↑ 2.0 2.1 Biederman J, Faraone SV (2005). "Attention-deficit hyperactivity disorder". Lancet 366 (9481): 237–48. DOI:10.1016/S0140-6736(05)66915-2. PMID 16023516. Research Blogging.
3. ↑ Okie S (2006). "ADHD in adults". N. Engl. J. Med. 354 (25): 2637–41. DOI:10.1056/NEJMp068113. PMID 16790695. Research Blogging.
4. ↑ Larson K, Russ SA, Kahn RS, Halfon N (2011). "Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007.". Pediatrics 127 (3): 462-70. DOI:10.1542/peds.2010-0165. PMID 21300675. Research Blogging.
5. ↑ Rappley MD (2005). "Clinical practice. Attention deficit-hyperactivity disorder". N. Engl. J. Med. 352 (2): 165–73. DOI:10.1056/NEJMcp032387. PMID 15647579. Research Blogging.
6. ↑ Wolraich ML, McKeown RE, Visser SN, Bard D, Cuffe S, Neas B et al. (2012). "The Prevalence of ADHD: Its Diagnosis and Treatment in Four School Districts Across Two States.". J Atten Disord. DOI:10.1177/1087054712453169. PMID 22956714. Research Blogging.
7. ↑ 7.0 7.1 Faraone SV, Perlis RH, Doyle AE, et al (2005). "Molecular genetics of attention-deficit/hyperactivity disorder". Biol. Psychiatry 57 (11): 1313–23. DOI:10.1016/j.biopsych.2004.11.024. PMID 15950004. Research Blogging.
8. ↑ Bramlett MD, Radel LF, Blumberg SJ (2007). "The health and well-being of adopted children.". Pediatrics 119 Suppl 1: S54-60. DOI:10.1542/peds.2006-2089I. PMID 17272586. Research Blogging.
9. ↑ Lancet 2010 DOI:doi:10.1016/S0140-6736(10)61109-9
10. ↑ Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F et al. (2009). "Evaluating dopamine reward pathway in ADHD: clinical implications.". JAMA 302 (10): 1084-91. DOI:10.1001/jama.2009.1308. PMID 19738093. PMC PMC2958516. Research Blogging.
11. ↑ Dougherty DD, Bonab AA, Spencer TJ, Rauch SL, Madras BK, Fischman AJ (1999 Dec 18-25). "Dopamine transporter density in patients with attention deficit hyperactivity disorder.". Lancet 354 (9196): 2132-3. DOI:10.1016/S0140-6736(99)04030-1. PMID 10609822. Research Blogging.
12. ↑ Dalley JW, Fryer TD, Brichard L, Robinson ES, Theobald DE, Lääne K et al. (2007). "Nucleus accumbens D2/3 receptors predict trait impulsivity and cocaine reinforcement.". Science 315 (5816): 1267-70. DOI:10.1126/science.1137073. PMID 17332411. PMC PMC1892797. Research Blogging.
13. ↑ Castellanos FX, Lee PP, Sharp W, et al (October 2002). "Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder". JAMA 288 (14): 1740–8. PMID 12365958. [e]
14. ↑ Kuehn BM (March 2007). "Scientists probe child bipolar disorder". JAMA : the journal of the American Medical Association 297 (11): 1181. DOI:10.1001/jama.297.11.1181. PMID 17374805. Research Blogging.
15. ↑ 15.0 15.1 Wingo AP, Ghaemi SN (November 2007). "A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder". J Clin Psychiatry 68 (11): 1776–84. PMID 18052572. [e]
16. ↑ Singh MK, DelBello MP, Kowatch RA, Strakowski SM (December 2006). "Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children". Bipolar Disord 8 (6): 710–20. DOI:10.1111/j.1399-5618.2006.00391.x. PMID 17156157. Research Blogging.
17. ↑ Restak RM. (2003) The New Brain: How the Modern Age is Rewiring Your Brain. Emmaus, PA: Rodale. ISBN 1579545017.
18. ↑ Kenny R. (2009) Evaluating cognitive tempo in the digital age. Education Tech Research Dev 57:45–60.
19. ↑ Child/adolescent attention deficit/hyperactivity disorder (ADHD) clinical practice guideline Kaiser Permanente Care Management Institute - Managed Care Organization. 2009 NGC: http://www.guideline.gov/content.aspx?id=33564
20. ↑ Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults National Collaborating Centre for Mental Health - National Government Agency [Non-U.S.]. 2008 NGC: http://www.guideline.gov/content.aspx?id=14325&
21. ↑ (December 1999) "A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD". Archives of general psychiatry 56 (12): 1073–86. PMID 10591283. [e]
22. ↑ Anonymous. Attention Deficit Hyperactivity Disorder. National Institutes of Health.
23. ↑ Peterson K, McDonagh MS, Fu R (2008). "Comparative benefits and harms of competing medications for adults with attention-deficit hyperactivity disorder: a systematic review and indirect comparison meta-analysis.". Psychopharmacology (Berl) 197 (1): 1-11. DOI:10.1007/s00213-007-0996-4. PMID 18026719. Research Blogging.
24. ↑ Pritchard D (2006). "Attention deficit hyperactivity disorder in children". Clin Evid (15): 331–44. PMID 16973014. [e]
25. ↑ Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV (2009). "Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study.". Pediatrics 124 (1): 71-8. DOI:10.1542/peds.2008-3347. PMID 19564285. Research Blogging. >
26. ↑ Lichtenstein P, Halldner L, Zetterqvist J, Sjölander A, Serlachius E, Fazel S et al. (2012). "Medication for attention deficit-hyperactivity disorder and criminality.". N Engl J Med 367 (21): 2006-14. DOI:10.1056/NEJMoa1203241. PMID 23171097. Research Blogging.
27. ↑ Ratey JJ, Greenberg MS, Lindem KJ (1991). "Combination of treatments for attention deficit hyperactivity disorder in adults.". J Nerv Ment Dis 179 (11): 699-701. PMID 1940895.
28. ↑ Nissen SE (2006). "ADHD drugs and cardiovascular risk". N. Engl. J. Med. 354 (14): 1445–8. DOI:10.1056/NEJMp068049. PMID 16549404. Research Blogging.
29. ↑ Barkley RA, Guevremont DC, Anastopoulos AD, Fletcher KE (June 1992). "A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder". Journal of consulting and clinical psychology 60 (3): 450–62. PMID 1619099. [e]
30. ↑ 30.0 30.1 Anonymous (Oct. 30, 2007). Title 34: Education: PART 300—Assistance To States for the Education of Children With Disabilities. Electronic Code of Federal Regulations.
31. ↑ 31.0 31.1 Anonymous. IDEA - Building The Legacy of IDEA 2004. U.S. Department of Education.
32. ↑ Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M et al. (2010). "Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial.". JAMA 304 (8): 875-80. DOI:10.1001/jama.2010.1192. PMID 20736471. Research Blogging.
33. ↑ Castells X, Ramos-Quiroga JA, Bosch R, Nogueira M, Casas M (2011). "Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults.". Cochrane Database Syst Rev 6: CD007813. DOI:10.1002/14651858.CD007813.pub2. PMID 21678370. Research Blogging.
34. ↑ Biederman J, Faraone SV (2006). "The effects of attention-deficit/hyperactivity disorder on employment and household income". MedGenMed 8 (3): 12. PMID 17406154. [e]
35. ↑ Mannuzza S, Klein RG, Bessler A, Malloy P, Hynes ME (1997). "Educational and occupational outcome of hyperactive boys grown up". J Am Acad Child Adolesc Psychiatry 36 (9): 1222–7. PMID 9291723. [e]
36. ↑ Redelmeier DA, Chan WK, Lu H, 2010 Road Trauma in Teenage Male Youth with Childhood Disruptive Behavior Disorders: A Population Based Analysis. PLoS Med 7(11): e1000369. DOI:10.1371/journal.pmed.1000369
37. ↑ "Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study". The Lancet. DOI:10.1016/S0140-6736(14)61684-6. Research Blogging.