ATTENTION DEFICIT-HYPERACTIVITY DISORDER

I. Epidemiology

  1. Various studies have found prevalence of 5-10% in school-aged children but used self-reporting rather than direct testing to confirm the diagnosis.
  2. Some studies suggest frequent comorbidities including oppositional defiant disorder and conduct disorder
  3. Risk factors include possibly some genetic factors, perinatal stres, low birth weight, traumatic brain injury, and maternal smoking during pregnancy.

II. DSM-IV-TR diagnostic criteria (2000):

  1. EITHER (1) or (2) below
    1. Six or more of the following symptoms of inattention for > 6mos to a degree that is maladaptive and inconsistent with developmental level:
      1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
      2. Often has difficulty sustaining attention in tasks or play activities
      3. Often does not seem to listen when spoken to directly
      4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
      5. Often has difficulty organizing tasks and activities
      6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
      7. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
      8. Is often easily distracted by extraneous stimuli
      9. Is often forgetful in daily activities
    2. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
      1. Often fidgets with hands or feet or squirms in seat
      2. Often leaves seat in classroom or in other situations in which remaining seated is expected
      3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
      4. Often has difficulty playing or engaging in leisure activities quietly
      5. Often "on the go" or often acts as if "driven by a motor"
      6. Often talks excessively
      7. Often blurts out answers before questions have been completed
      8. Often has difficulty awaiting turn
      9. Often interrupts or intrudes on others (e.g., butts into conversations or games)
  2. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
  3. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
  4. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
  5. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

III. Helpful rating scales in assessing children with suspected ADHD (per AACAP guidelines 2008):

IV. Pharmacologic treatment:

Stimulants (e.g. methylphenidate and amphetamine)

Atomoxetine (Strattera)

Guanfacine (Intuniv)

Sources include: American Academy of Child and Adolescent Psychiatry guidelines: Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J. Am. Acad. Child Adolesc. Psychiatry, 2007;46(7).