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Attention deficit hyperactivity disorder

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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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 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 the American Academy of Family Physicians (AAFP 2012).
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Guidelines

1.Screening and diagnosis

Indications for testing: 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

2.Diagnostic investigations

Screening for comorbid conditions: 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

3.Medical management

General principles: 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)

4.Nonpharmacologic interventions

Physical activity: 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

5.Specific circumstances

Adult patients: 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

6.Follow-up and surveillance

Indications for referral: 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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