Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by excessive amounts of inattention, carelessness, hyperactivity, and impulsivity that are pervasive, impairing, and otherwise age-inappropriate.[1][2][3][4][5][6]

Attention deficit hyperactivity disorder
People with ADHD may struggle more than others to focus on tasks such as schoolwork, but can maintain an unusually intense level of attention for tasks they find rewarding or interesting.
SpecialtyPsychiatry, pediatrics
SymptomsInattention, carelessness, hyperactivity (evolves into restlessness in adults), executive dysfunction, impulsivity
Usual onsetBefore age 6–12
CausesBoth genetic and environmental factors
Diagnostic methodBased on symptoms after other possible causes have been ruled out
Differential diagnosisNormally active young child, conduct disorder, autism spectrum disorder, oppositional defiant disorder, learning disorder, bipolar disorder, borderline personality disorder, fetal alcohol spectrum disorder
TreatmentPsychotherapy, lifestyle changes, medication
MedicationCNS stimulants (i.e. methylphenidate, mixed amphetamine salts), atomoxetine, guanfacine, clonidine
Frequency140 million (2020)
External video
"Women and girls with ADHD", 04.17.2020, with Stephen P. Hinshaw and others,Knowable Magazine

ADHD symptoms arise from executive dysfunction,[7][8][9][10] and emotional dysregulation is considered a core symptom.[11] In children, problems paying attention may result in poor school performance. ADHD is associated with other mental disorders and substance use disorders, which can cause additional impairment, especially in modern society. Although people with ADHD struggle to focus on tasks they are not particularly interested in completing, they are often able to maintain an unusually prolonged and intense level of attention for tasks they do find interesting or rewarding; this is known as hyperfocus.

The precise causes of ADHD are unknown in the majority of cases.[12][13] Genetic factors play an important role; ADHD tends to run in families and has a heritability rate of 74%.[14] Toxins and infections during pregnancy and brain damage may be environmental risks. It affects about 5–7% of children when diagnosed via the DSM-IV criteria and 1–2% when diagnosed via the ICD-10 criteria. As of 2020, it was estimated to affect more than 140 million people globally.[15] Rates are similar between countries and differences in rates depend mostly on how it is diagnosed.[16] ADHD is diagnosed approximately twice as often in boys than in girls,[2] and 1.6 times more often in men than in women,[2] although the disorder is overlooked in girls or diagnosed in later life because their symptoms sometimes differ from diagnostic criteria.[17][18][19][20] About 30–50% of people diagnosed in childhood continue to have ADHD in adulthood, with 2.5–3% of adults estimated to have the condition.[15][21][22] 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 behavior.

ADHD management recommendations vary and usually involve some combination of medications, counseling, and lifestyle changes.[23] The British guideline emphasizes environmental modifications and education for individuals and carers about ADHD as the first response. If symptoms persist, parent-training, medication, or psychotherapy (especially cognitive behavioral therapy) can be recommended based on age.[24] Canadian and American guidelines recommend medications and behavioral therapy together, except in preschool-aged children for whom the first-line treatment is behavioral therapy alone.[25][26][27] Stimulant medications are the most effective pharmaceutical treatment,[28] although there may be side effects[28][29][30][31] and any improvements will be reverted if medication is ceased.[5]

ADHD, its diagnosis and treatment have been considered controversial since the 1970s. These controversies have involved doctors, teachers, policymakers, parents, and the media. Topics have included causes of ADHD and the use of stimulant medications in its treatment. ADHD is now a well-validated clinical diagnosis in children and adults, and the debate in the scientific community centers on how it is diagnosed and treated.[32][33] ADHD was officially known as attention deficit disorder (ADD) from 1980-87. Symptoms similar to ADHD have been described in medical literature dating back to the 1700s.

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