Attention deficit hyperactivity disorder

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Attention deficit hyperactivity disorder
ICD-10 ICD10 F84.0-F84.1
ICD-9 314.00

, 314.01

OMIM 143465
MedlinePlus 001551

Attention deficit hyperactivity disorder (ADHD) is a "behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. Although most individuals have symptoms of both inattention and hyperactivity-impulsivity, one or the other pattern may be predominant. The disorder is more frequent in males than females. Onset is in childhood. Symptoms often attenuate during late adolescence although a minority experience the full complement of symptoms into mid-adulthood."[1][2]

ADHD occurs in adults also.[3]

ADHD is associated with conduct disorder and school problems.[4]


There are three types:[5]

  • Predominantly attention deficit disorder (ADD) (10%–15%)
  • Predominantly hyperactive and impulsive (5%)
  • Combined (80%)


About 10% of American children may have ADD. [6]


Twin studies suggest 76% of ADHD is inherited.[7] Abnormalities of biogenic amine receptors may contribute to ADHD.[7] ADHD is 3 times as common among adolescents of domestic adoption than nonadopted children.[8]

A genome wide scan suggests abnormalities on chromosome 16.[9]

ADHD may result from reduced inhibitory dopamine transmission in the midbrain. This may be due to an increase in dopamine plasma membrane transport protein density which may remove dopamine from the synapse too quickly,[10][11] similar to a prior study on susceptibility to cocaine abuse.[12]

Magnetic resonance imaging has investigated the development of the brains of children with ADHD.[13]

The relationship between childhood bipolar disorder and attention deficit hyperactivity disorder is uncertain.[14][15][16]

Studies of the differences in brain and cognitive development in early childhood between children of the digital age of television and video games and those before raise the possibility that the digital visual environment leads to ADD and ADHD by disrupting the normal transition from right-brain visual processing to a balanced right- and left-brain cognitive and emotional state.

This view has enlisted some support by neurosurgeons, such as Restak (2003),[17] who suggests that modern brain science, genetic mapping, and advances in imaging technology and psychopharmacology provide an unprecedented opportunity to show that the visual, high-volume, sound-byte environment in which today’s children live is even leading to a situation in which Attention Deficit Disorder and/or Attention Deficit Hyperactivity Disorder is on its way to becoming the norm.[18]


Clinical practice guidelines are available.[19][20]

The Multimodal Treatment Study of Children with ADHD randomized controlled trial concluded "for ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes."[21] The components of this trial included over 14 months:[22]

  • Medications: "Were seen monthly for one-half hour at each medication visit. During the treatment visits, the prescribing physician spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child’s ADHD-related difficulties. The physicians, in addition, sought input from the teachers on a monthly basis."
  • Behavior: "Families met up to 35 times with a behavior therapist, mostly in group sessions. These therapists also made repeated visits to schools to consult with children’s teachers and to supervise a special aide assigned to each child in the group. In addition, children attended a special 8-week summer treatment program where they worked on academic, social, and sports skills, and where intensive behavioral therapy was delivered to assist children in improving their behavior"


Several stimulant medications, such as methylphenidate[23] and amphetamines (a 3:1 mixture of d-amphetamine to l-amphetamine is Adderall and others), are a mix of dopamine uptake inhibitors and adrenergic uptake inhibitors. Stimulants work by blocking the dopamine plasma membrane transport protein.[2]

These medications are effective[24] and may also reduce the incidence of subsequent psychiatric disorders[25] and criminality.[26]

In uncontrolled case series, nadolol, an adrenergic beta-receptor blockader, combined with a stimulant may help.[27]

Alternatively, atomoxetine (Straterra) is an adrenergic uptake inhibitor that is selective norepinephrine reuptake inhibitor. It is less likely to contribute to substance abuse.

Drug toxicity

These drugs may increase cardiac complications.[28]

Behavior therapy


Various behavioral programs have been studied.[29] Health care providers, parents, and schools should collaborate in behavior therapy. In the United States of America, federal regulation provides for support to public schools for the education of children with disabilities such as attention deficit hyperactivity disorder (see below).[30][31]

Behavioral therapy for adolescents
American Academy of Family Physicians Attention Deficit Disorder Association National Resource Center (NRC) on AD/HD

link to more details

link to more details

link to more details

  1. Make a schedule.
  2. Make simple house rules.
  3. Make sure your directions are understood.
  4. Reward good behavior.
  5. Make sure your child is supervised all the time.
  6. Watch your child around his or her friends.
  7. Set a homework routine.
  8. Focus on effort, not grades.
  9. Talk with your child's teachers
  1. Facilitate appropriate independence seeking.
  2. Maintain adequate structure and supervision.
  3. Establish “the bottom line” rules for living in your home and enforce them consistently.
  4. Negotiate with your adolescent all the other issues which are not bottom lines.
  5. Use consequences wisely.
  6. Maintain good communication.
  7. Keep a disability perspective, and practice forgiveness
  8. Focus on the positive.
  1. Establishing house rules and structure
  2. Learning to praise appropriate behaviors (praising good behavior at least five times as often as bad behavior is criticized) and ignoring mild inappropriate behaviors (choosing your battles)
  3. Using appropriate commands
  4. Using "when-then?" contingencies (withdrawing rewards or privileges in response to inappropriate behavior)
  5. Planning ahead and working with children in public places
  6. Time out from positive reinforcement (using time outs as a consequence for inappropriate behavior)
  7. Daily charts and point/token systems with rewards and consequences
  8. School-home note system for rewarding behavior at school and tracking homework


Attention deficit hyperactivity disorder may be helped by cognitive behavioral therapy according to a randomized controlled trial. [32]

Amphetamines may help adults.[33]

United States: Individuals with Disabilities Education Act (IDEA)

In the United States of America, Title 34 Part 300 of the Code of Federal Regulation provides for support to public schools for the education of children with 'other health impairments' such as attention deficit hyperactivity disorder.[30][31]


There are significant adverse socioeconomic outcomes from ADHD.[34][35] Teenage males are more likely to have automobile accidents.[36]

Mortality may be increased.[37]

Military recruits who do not require medications to finish high school or to hold a job may have similar military performance as recruits without ADHD.[15]


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