Attention Deficit Hyperactivity Disorder (ADHD)

Key Points ⚡

ADHD is a neurodevelopmental disorder characterized by hyperactivity, impulsivity, and inattention.
Symptoms must be present before age 7 and occur in multiple settings.
Etiology involves a combination of genetic and environmental factors.
Risk factors: prematurity, low birth weight, low paternal education, prenatal smoking, maternal depression.
Clinical features: short attention span, rapid loss of interest, constant movement, impulsivity, poor organizational skills, acting without thinking.
Diagnosis is clinical, using DSM-5 criteria and supported by rating scales (e.g., Conners’ rating scale, DIVA for adults).
Primary care: watchful waiting up to 10 weeks with behavioral management and lifestyle modifications.
Secondary care: ADHD-focused parent training; pharmacological treatment if severe (e.g., methylphenidate).
Complications: persistence into adulthood (~60%), low educational/employment attainment, poor self-esteem, substance abuse, sleep disturbance, increased risk of criminality and road traffic accidents.

ADHD is defined by high activity levels and inability to concentrate.
Prevalence worldwide ~5%, male:female ratio ~3:1, often underdiagnosed in girls.
Symptoms must be consistent across multiple environments (home, school).

Cause unknown but linked to genetic predisposition and environmental factors.
Complex interplay between inherited and prenatal/postnatal influences.

Specialist clinical diagnosis using DSM-5 criteria:
Children ≤16 years: ≥6 symptoms of inattention and/or hyperactivity-impulsivity.
Adults ≥17 years: ≥5 symptoms.
Symptoms present for ≥6 months in ≥2 settings.
Tools: Strengths and Difficulties Questionnaire, Conners’ rating scale, DIVA questionnaire for adults.
Important to exclude situational/environmental causes.

Inattention Symptoms	Hyperactivity/Impulsivity Symptoms
Careless mistakes	Fidgeting, difficulty staying seated
Difficulty sustaining attention	Running/climbing in inappropriate settings
Often distracted	Inability to play quietly
Often forgetful	Talking excessively
Losing things	Interrupting or intruding on others
Avoids tasks needing sustained effort	Blurting out answers

Watchful waiting up to 10 weeks.
Promote healthy diet, regular exercise.
Behavioral management: reward charts, positive redirection, task breakdown (1-2-3-reward).
Referral to CAMHS or specialist if symptoms persist or severe.

ADHD-focused parent training programs.
Pharmacotherapy (if needed): methylphenidate (CNS stimulant) with monitoring of growth, heart rate, blood pressure every 6 months.