Franke B, Faraone SV, Asherson P, et al. [41][37][179] Methylphenidate appears to improve symptoms as reported by teachers and parents. Prevalence. It is hard for these children to control their behavior and/or pay attention. In Zebrafish, knockout of this gene causes a loss of dopaminergic function in the ventral diencephalon and the fish display a hyperactive/impulsive phenotype. [82][83] However, some strengths have been identified. It is a neurodevelopmental disorder because it affects how the brain develops. [145] In 2014, Keith Conners, one of the early advocates for recognition of the disorder, spoke out against overdiagnosis in a The New York Times article. A person diagnosed with ADHD will likely be one of three subtypes: predominantly hyperactive-impulsive, predominantly inattentive, or combined hyperactive-impulsive and inattentive. [123] They also appear to use ADHD medications at nearly twice the rate as their peers. [99] Rare genetic variants show more relevant clinical significance as their penetrance (the chance of developing the disorder) tends to be much higher. [109] Exposure to tobacco smoke during pregnancy can cause problems with central nervous system development and can increase the risk of ADHD. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, or excessive activity and impulsivity, which are otherwise not appropriate for a person's age. at home and at school or work). [41] Most healthcare providers accept ADHD as a genuine disorder in children and adults, and the debate in the scientific community mainly centers on how it is diagnosed and treated. [198] Antipsychotics may also be used to treat aggression in ADHD. [91] Typically, a number of genes are involved, many of which directly affect dopamine neurotransmission. Adults with attention-deficit/hyperactivity disorder, or ADHD, have a strikingly high prevalence of attempted suicide, with women being at particular risk, … [93][94][95] Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. [128][130] The dopamine pathways and norepinephrine pathways which project to the prefrontal cortex and striatum are directly responsible for modulating executive function (cognitive control of behavior), motivation, reward perception, and motor function;[128][129][130] these pathways are known to play a central role in the pathophysiology of ADHD. [27] Children with ADHD have a higher risk of unintentional injuries. [201] This is particularly common in adolescents and adults as approved dosing is based on school-aged children, causing some practitioners to use weight-based or benefit-based off-label dosing instead. False. [1] Other terms have included "minimal brain damage" used in the 1930s. Addictive behavior such as substance abuse and gambling are common. [27] Other problems may include relationship and job difficulties, and an increased risk of criminal activities. [112] There is an association between long term but not short term use of acetaminophen during pregnancy and ADHD. ", "Prenatal Exposure to Acetaminophen and Risk of ADHD", "An Association Between Prenatal Acetaminophen Use and ADHD: The Benefits of Large Data Sets", "The diet factor in attention-deficit/hyperactivity disorder", "Restriction and elimination diets in ADHD treatment", "Relative age and ADHD symptoms, diagnosis and medication: a systematic review", "[110] Stimulants for ADHD in children: Revisited | Therapeutics Initiative", "Mental health of children and adolescents", "Facts, values, and attention-deficit hyperactivity disorder (ADHD): an update on the controversies", "New perspectives on catecholaminergic regulation of executive circuits: evidence for independent modulation of prefrontal functions by midbrain dopaminergic and noradrenergic neurons", "Large-scale brain systems in ADHD: beyond the prefrontal-striatal model", "Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies", "Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis", "Hemispheric brain asymmetry differences in youths with attention-deficit/hyperactivity disorder", "Cognitive enhancers for the treatment of ADHD", "Validating neuropsychological subtypes of ADHD: how do children with and without an executive function deficit differ? The DSM-V criteria do specifically deal with adults, unlike those in DSM-IV, which were criticized for not being appropriate for adults; those who presented differently may lead to the claim that they outgrew the diagnosis. The neurodevelopmental conceptualisation of attention-deficit hyperactivitydisorder(ADHD)isbasedonthefactthatthedisorder hasits onsetbefore puberty,hasasteadycourseratherthan aremit- ting and relapsing pattern, and affects males predominantly.1 However, clinical and population-based studies do not support all these assumptions. [163] Obstructive sleep apnea can also cause ADHD-type symptoms. But for some people, staying focused, listening to others, and controlling impulses is a daily struggle. [33] A 2014 review found that an elimination diet results in a small overall benefit in a minority of children, such as those with allergies. For other uses, see, Neurodevelopmental disorder marked by difficulty focusing, or excessive activity and impulsive behavior, CS1 maint: DOI inactive as of December 2020 (, Diet and attention deficit hyperactivity disorder, International Statistical Classification of Diseases and Related Health Problems, Adult attention deficit hyperactivity disorder, Attention deficit hyperactivity disorder management, National Institute for Health and Care Excellence (NICE), National Institute for Health and Care Excellence, Agency for Healthcare Research and Quality, Epidemiology of attention deficit hyperactive disorder, History of attention deficit hyperactivity disorder, Attention deficit hyperactivity disorder controversies, "ICD-11 – Mortality and Morbidity Statistics", "Inattentiveness in attention-deficit/hyperactivity disorder", "Response Inhibition, Response Execution, and Emotion Regulation among Children with Attention-Deficit/Hyperactivity Disorder", "Pharmacotherapy of emotional dysregulation in adults with ADHD: A systematic review and meta-analysis", "Attention Deficit Hyperactivity Disorder", "Updated European Consensus Statement on diagnosis and treatment of adult ADHD", "Attention Deficit Hyperactivity Disorder (Easy-to-Read)", "Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder", "Prenatal nicotine exposure and child behavioural problems", "The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review", Institute for Health Metrics and Evaluation, "Global Burden of Disease Study 2019: Attention-deficit/hyperactivity disorder—Level 3 cause", "Ch. [105] Omega-3 and omega-6 fatty acid supplementation was found by a 2018 review to not improve ADHD outcomes. [100], Evolution may have played a role in the high rates of ADHD, particularly hyperactive and impulsive traits in males. [232][233], Until the 1990s, many studies "implicated the prefrontal-striatal network as being smaller in children with ADHD". [35], Associated conditions that should be screened for include anxiety, depression, ODD, conduct disorder, and learning and language disorders. "[219] In 1987 this was changed to ADHD in the DSM-III-R and the DSM-IV in 1994 split the diagnosis into three subtypes, ADHD inattentive type, ADHD hyperactive-impulsive type and ADHD combined type. [165] These measurements could potentially serve as diagnostic biomarkers for ADHD, but more research is needed to establish their diagnostic utility. [202][203][204], Regular physical exercise, particularly aerobic exercise, is an effective add-on treatment for ADHD in children and adults, particularly when combined with stimulant medication, although the best intensity and type of aerobic exercise for improving symptoms are not currently known. [78] The significance of this is controversial due to the differences between people with ADHD and the difficulty determining the influence of symptoms, such as distractibility, on lower scores rather than intellectual capacity. People with ADHD may find it more difficult than others to focus on and complete tasks such as schoolwork. ", "MerckMedicus Modules: ADHD –Pathophysiology", "ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents", "FDA permits marketing of first brain wave test to help assess children and teens for ADHD", "Diagnostic Criteria in Attention Deficit Hyperactivity Disorder - Changes in DSM 5", "Diagnosis of attention deficit hyperactivity disorder: much ado about something", "Challenges in identifying and managing attention-deficit/hyperactivity disorder in adults in the primary care setting: a review of the literature", "Annual Research Review: Does late‐onset attention‐deficit/hyperactivity disorder exist? [47], The youngest children in a class have been found to be more likely to be diagnosed as having ADHD, possibly due to their being developmentally behind their older classmates. [35] Neurofeedback has been used,[173] but it is unclear whether it is useful. These medicines have a stimulating effect in most people. [98] The genes glucose-fructose oxidoreductase domain-containing 1 (GFOD1) and cadherin 13 (CHD13) show strong genetic associations with ADHD. [205] It is believed that these short-term effects of exercise are mediated by an increased abundance of synaptic dopamine and norepinephrine in the brain. [185], The long-term effects of ADHD medication have yet to be fully determined,[186][187] although stimulants are generally beneficial and safe for up to 2 years. [215], ADHD is estimated to affect about 6–7% of people aged 18 and under when diagnosed via the DSM-IV criteria. 1,3. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. [182][183][184] A 2018 review found the greatest short-term benefit with methylphenidate in children and amphetamines in adults. They include methylphenidate, dextroamphetamine, lisdexamfetamine dimesylate, and a drug that combines dextroamphetamine and amphetamine. ", "Evaluating Prescription Drugs Used to Treat: Attention Deficit Hyperactivity Disorder (ADHD) Comparing Effectiveness, Safety, and Price", "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", "Rare cancers may masquerade as ADHD in children, NIH researchers suggest", "Interventions by pharmacists in out-patient pharmaceutical care", "A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment", "Cognitive-behavioural Interventions for Attention Deficit Hyperactivity Disorder (ADHD) in Adults", "Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder", "Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials", "Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder", "Attention deficit hyperactivity disorder (ADHD)", "The importance of friendship for youth with attention-deficit/hyperactivity disorder", "Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults", "Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)", "Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis", "Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects", "Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies", "Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects", "Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis", "The challenges to demonstrating long-term effects of psychostimulant treatment for attention-deficit/hyperactivity disorder", "Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades", "Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder", "Using stimulants for attention-deficit/hyperactivity disorder: clinical approaches and challenges", "Individualizing Treatment for Adult ADHD: An Evidence-Based Guideline", "New-Generation Long-Acting Stimulants for the Treatment of Attention-Deficit/Hyperactivity Disorder", "Sweat it out? [188] Although very rare, at therapeutic doses these events appear to occur in approximately 0.1% of individuals within the first several weeks after starting amphetamine therapy. [32][29][33] A 2013 meta-analysis found less than a third of children with ADHD see some improvement in symptoms with free fatty acid supplementation or decreased eating of artificial food coloring. [191] Stimulant therapy should be stopped periodically to assess continuing need for medication, decrease possible growth delay, and reduce tolerance. [86], Twin studies indicate that the disorder is often inherited from the person's parents, with genetics determining about 75% of cases in children and 35% to potentially 75% of cases in adults. [96] The 7 repeat variant of dopamine receptor D4 (DRD4–7R) causes increased inhibitory effects induced by dopamine and is associated with ADHD. [46][47] Academic difficulties are frequent as are problems with relationships. [125] In other cases, it may be explained by increasing academic expectations, with a diagnosis being a method for parents in some countries to get extra financial and educational support for their child. [156] To be considered, the symptoms must have appeared by the age of six to twelve and occur in more than one environment (e.g. This study tests whether individuals with ADHD have lower mindfulness scores than controls and, if true, whether personality contributes to these differences. [229], In 1934, Benzedrine became the first amphetamine medication approved for use in the United States. [84][85] This is due in part to a number of high-profile entrepreneurs with ADHD. [178], Stimulant medications are the pharmaceutical treatment of choice. [1][236], ADHD, its diagnosis, and its treatment have been controversial since the 1970s. [188] Regular monitoring has been recommended in those on long-term treatment. american sign language interpreting icon Learn about symptoms of ADHD, how ADHD is diagnosed, and treatment recommendations including behavior therapy, medication, and school support. [34][35][36][37][38], The medical literature has described symptoms similar to those of ADHD since the 18th century. [137][138][139], The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., attentional control, inhibitory control, and working memory). [116] Among healthcare providers the debate mainly centers on diagnosis and treatment in the much greater number of people with mild symptoms. ", "Heritability of attention-deficit hyperactivity disorder in adults", "Trace Amine-Associated Receptors as Emerging Therapeutic Targets: TABLE 1", "Toward a better understanding of ADHD: LPHN3 gene variants and the susceptibility to develop ADHD", "ADHD and the DRD4 exon III 7-repeat polymorphism: an international meta-analysis", "Genetics of ADHD: What Should the Clinician Know? For a diagnosis, the symptoms should appear before a person is twelve years old, be present for more than six months, and cause problems in at least two settings (such as school, home, or recreation… [209] There is a small amount of evidence that lower tissue zinc levels may be associated with ADHD. People with attention deficits are prone to having difficulty processing verbal and nonverbal language which can negatively affect social interaction. [38][197] There are no good studies comparing the various medications; however, they appear more or less equal with respect to side effects. Positions range from the view that ADHD is within the normal range of behavior[61][238] to the hypothesis that ADHD is a genetic condition. Attention-deficit/hyperactivity disorder (ADHD) is a behavioral disorder that typically begins in childhood and is characterized by a short attention span (inattention), an inability to be calm and stay still (hyperactivity), and poor impulse control (impulsivity). [181] One study from Denmark found an increased risk of death among those with ADHD due to the increased rate of accidents. [219] Prior to 1970, it was rare for children to be diagnosed with ADHD while in the 1970s rates were about 1%. Learn about CDC’s initiative to support children with ADHD. [20][21][22] About 30–50% of people diagnosed in childhood continue to have symptoms into adulthood and between 2–5% of adults have the condition. [26] Adults often develop coping skills which compensate for some or all of their impairments. [127], 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. [205], Dietary modifications are not recommended as of 2019 by the American Academy of Pediatrics, the National Institute for Health and Care Excellence, or the Agency for Healthcare Research and Quality due to insufficient evidence. [176] ADHD-specific support groups can provide information and may help families cope with ADHD. [230] Methylphenidate was introduced in the 1950s, and enantiopure dextroamphetamine in the 1970s. [38][179] They improve symptoms in 80% of people, although improvement is not sustained if medication is ceased. [102] Others have claimed that these traits may be an adaptation that help males face stressful or dangerous environments with, for example, increased impulsivity and exploratory behavior. ADHD is a behavioral disorder, making it difficult to quantify. [82] However, people with ADHD may struggle with convergent thinking, which is a process of creativity which requires sustained effort and consistent use of executive functions to weed out solutions which aren't creative from a single area of inquiry. [17] As of 2019, it was estimated to affect 84.7 million people globally. [35], The social construct theory of ADHD suggests that because the boundaries between "normal" and "abnormal" behavior are socially constructed, (i.e.