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Attention deficit hyperactivity disorder

Background

Overview

Definition
Attention deficit and hyperactivity disorder is a common psychiatric disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity according to DSM-V.
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Pathophysiology
Attention deficit and hyperactivity disorder is caused by biological (genetics, brain structure and their influence on neuropsychology) and environmental (pregnancy or birth complications, exposure to environmental toxins, chaotic parenting, and diet) factors.
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Disease course
The interplay of environmental, genetic factors, and dysfunction in the frontal cortex, basal ganglia, corpus callosum, and cerebellum results in attention deficit and hyperactivity disorder, which results in clinical manifestations of inattention, hyperactivity, and impulsivity. ADHD is associated with poor motor coordination, impaired academic functioning, unintentional physical injury, sleep disturbances, and poor QoL.
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Prognosis and risk of recurrence
Attention deficit and hyperactivity disorder is not associated with an increased risk of natural-cause mortality.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of attention deficit hyperactivity disorder are prepared by our editorial team based on guidelines from the American Society of Addiction Medicine (ASAM/AAAP 2024), the World Health Organization (WHO 2023), the American Academy of Pediatrics (AAP 2019), the British Association for Psychopharmacology (BAP 2019,2018), the American Academy of Neurology (AAN 2016), and ...
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Screening and diagnosis

Indications for testing: as per AAP 2019 guidelines, evaluate for ADHD in any pediatric patient 4-18 years old presenting with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.
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  • Diagnostic criteria

Diagnostic investigations

Screening for comorbid conditions: as per AAP 2019 guidelines, assess for other conditions that might coexist with ADHD, including:
Situation
Guidance
Emotional or behavioral conditions
Anxiety, depression, oppositional defiant disorder, conduct disorders, substance use
Developmental conditions
Learning and language disorders, autism spectrum disorders
Physical conditions
Tics, sleep apnea
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  • Electroencephalography

Medical management

General principles: as per AAP 2019 guidelines, manage pediatric patients with ADHD similar to the care of pediatric patients with special healthcare needs, following the principles of the chronic care model and the medical home.
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  • Pharmacotherapy (indications)

  • Pharmacotherapy (dose titration)

  • Pharmacotherapy (methylphenidate)

Nonpharmacologic interventions

Physical activity: as per WHO 2023 guidelines, consider offering structured physical exercise to improve motor skills and functioning, including attention and executive functioning, and reduce anxiety and problem behaviors in pediatric and adolescent patients with ADHD.
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  • Behavioral therapy

  • Psychosocial interventions

Specific circumstances

Adult patients: as per AAFP 2012 guidelines, recognize that various rating scales are available and are appropriate diagnostic tools for adult patients with ADHD.
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  • Patients with sleep disorders

  • Patients with autism spectrum disorder

  • Patients with stimulant use disorder

Follow-up and surveillance

Indications for referral: as per AAP 2019 guidelines, refer patients with comorbid conditions to an appropriate subspecialist for treatment, or consider initiating treatment if trained or experienced in diagnosing such conditions. Refer patients with possible comorbid conditions to an appropriate subspecialist for diagnosis and treatment if not trained or experienced in diagnosing or treating such conditions.
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