Attention deficit hyperactivity disorder (ADHD) is a mental disorder of the neurodevelopmental type. It is characterized by difficulty paying attention, excessive activity, and behavior without regards to consequences which is not appropriate for a person's age. There are also often problems with regulation of emotions. The symptoms appear before a person is twelve years old, are present for more than six months, and cause problems in at least two settings (such as school, home, or recreational activities). In children, problems paying attention may result in poor school performance. Additionally there is an association with other mental disorders and substance misuse. Although it causes impairment, particularly in modern society, many people with ADHD can have sustained attention for tasks they find interesting or rewarding (known as hyperfocus).
Despite being the most commonly studied and diagnosed mental disorder in children and adolescents, the exact cause is unknown in the majority of cases. It affects about 5–7% of children when diagnosed via the DSM-IV criteria and 1–2% when diagnosed via the ICD-10 criteria. As of 2015 it is estimated to affect about 51.1 million people globally. Rates are similar between countries and depend mostly on how it is diagnosed. ADHD is diagnosed approximately two times more often in boys than in girls, although the disorder is often overlooked in girls because their symptoms differ from those of boys. About 30–50% of people diagnosed in childhood continue to have symptoms into adulthood and between 2–5% of adults have the condition. In adults inner restlessness rather than hyperactivity may occur. They often develop coping skills which make up for some or all of their impairments. The condition can be difficult to tell apart from other conditions, as well as to distinguish from high levels of activity that are still within the range of normative behaviors.
ADHD management recommendations vary by country and usually involve some combination of counseling, lifestyle changes, and medications. The British guideline only recommends medications as a first-line treatment in children who have severe symptoms and for medication to be considered in those with moderate symptoms who either refuse or fail to improve with counseling, though for adults medications are a first-line treatment. Canadian and American guidelines recommend that medications and behavioral therapy be used together as a first-line therapy, except in preschool-aged children. Stimulant medication therapy is not recommended as a first-line therapy in preschool-aged children in either guideline. Treatment with stimulants is effective for at least 14 months; however, their long term effectiveness is unclear and there are potentially serious side effects.
The medical literature has described symptoms similar to those of ADHD since the 18th century. ADHD, its diagnosis, and its treatment have been considered controversial since the 1970s. The controversies have involved clinicians, teachers, policymakers, parents, and the media. Topics include ADHD's causes and the use of stimulant medications in its treatment. Most healthcare providers accept ADHD as a genuine disorder in children and adults, and the debate in the scientific community mainly centers on how it is diagnosed and treated. The condition was officially known as attention-deficit disorder (ADD) from 1980 to 1987, while before this it was known as hyperkinetic reaction of childhood.
|Attention deficit hyperactivity disorder|
|Other names||Attention-deficit disorder, hyperkinetic disorder (ICD-10)|
|Children with ADHD may find it more difficult than others to focus on and complete tasks such as schoolwork.|
|Symptoms||Difficulty paying attention, excessive activity, difficulty controlling behavior|
|Usual onset||Before age 6–12|
|Causes||Both genetic and environmental factors|
|Diagnostic method||Based on symptoms after other possible causes ruled out|
|Differential diagnosis||Normally active young child, conduct disorder, oppositional defiant disorder, learning disorder, bipolar disorder|
|Treatment||Counseling, lifestyle changes, medications|
|Medication||Stimulants, atomoxetine, guanfacine, clonidine|
|Frequency||51.1 million (2015)|
Inattention, hyperactivity (restlessness in adults), disruptive behavior, and impulsivity are common in ADHD. Academic difficulties are frequent as are problems with relationships. The symptoms can be difficult to define, as it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms must be present for six months or more to a degree that is much greater than others of the same age and they must cause significant problems functioning in at least two settings (e.g., social, school/work, or home). The criteria must have been met prior to age twelve in order to receive a diagnosis of ADHD. This requires more than 5 symptoms of inattention or hyperactivity/impulsivity for those under 17 and more than 4 for those over 16 years old.
A person with ADHD hyperactive-impulsive type has most or all of the following symptoms, excluding situations where these symptoms are better explained by another psychiatric or medical condition:
Girls with ADHD tend to display fewer hyperactivity and impulsivity symptoms but more symptoms pertaining to inattention and distractability. Symptoms of hyperactivity tend to go away with age and turn into "inner restlessness" in teens and adults with ADHD.
People with ADHD of all ages are more likely to have problems with social skills, such as social interaction and forming and maintaining friendships. This is true for all subtypes. About half of children and adolescents with ADHD experience social rejection by their peers compared to 10–15% of non-ADHD children and adolescents. People with attention deficits are prone to having difficulty processing verbal and nonverbal language which can negatively affect social interaction. They also may drift off during conversations, miss social cues, and have trouble learning social skills.
Difficulties managing anger are more common in children with ADHD as are poor handwriting and delays in speech, language and motor development. Although it causes significant difficulty, many children with ADHD have an attention span equal to or better than that of other children for tasks and subjects they find interesting.
In children, ADHD occurs with other disorders about two-thirds of the time. Some commonly associated conditions include:
Overall, studies have shown that people with ADHD tend to have lower scores on intelligence quotient (IQ) tests. The significance of this is controversial due to the differences between people with ADHD and the difficulty determining the influence of symptoms, such as distractibility, on lower scores rather than intellectual capacity. In studies of ADHD, higher IQs may be over represented because many studies exclude individuals who have lower IQs despite those with ADHD scoring on average nine points lower on standardized intelligence measures.
Studies of adults suggest that differences in intelligence are not meaningful and may be explained by associated health problems.
Most ADHD cases are of unknown causes. It is believed to involve interactions between genetics, the environment, and social factors. Certain cases are related to previous infection of or trauma to the brain.
Twin studies indicate that the disorder is often inherited from one's parents with genetics determining about 75% of cases. Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the disorder. Genetic factors are also believed to be involved in determining whether ADHD persists into adulthood.
Typically, a number of genes are involved, many of which directly affect dopamine neurotransmission. Those involved with dopamine include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. A common variant of a gene called Latrophilin 3 is estimated to be responsible for about 9% of cases and when this variant is present, people are particularly responsive to stimulant medication. The 7 repeat variant of dopamine receptor D4 (DRD4–7R) causes increased inhibitory effects induced by dopamine and is associated with ADHD. The DRD4 receptor is a G protein-coupled receptor that inhibits adenylyl cyclase. The DRD4–7R mutation results in a wide range of behavioral phenotypes, including ADHD symptoms reflecting split attention.
Evolution may have played a role in the high rates of ADHD, particularly hyperactive and impulsive traits in males. Some have hypothesized that some women may be more attracted to males who are risk takers, increasing the frequency of genes that predispose to hyperactivity and impulsivity in the gene pool. Others have claimed that these traits may be an adaptation that help males face stressful or dangerous environments with, for example, increased impulsivity and exploratory behavior. In certain situations, ADHD traits may have been beneficial to society as a whole even while being harmful to the individual. The high rates and heterogeneity of ADHD may have increased reproductive fitness and benefited society by adding diversity to the gene pool despite being detrimental to the individual. In certain environments, some ADHD traits may have offered personal advantages to individuals, such as quicker response to predators or superior hunting skills.
In addition to genetics, some environmental factors might play a role in causing ADHD. Alcohol intake during pregnancy can cause fetal alcohol spectrum disorders which can include ADHD or symptoms like it. Children exposed to certain toxic substances, such as lead or polychlorinated biphenyls, may develop problems which resemble ADHD. Exposure to the organophosphate insecticides chlorpyrifos and dialkyl phosphate is associated with an increased risk; however, the evidence is not conclusive. Exposure to tobacco smoke during pregnancy can cause problems with central nervous system development and can increase the risk of ADHD.
Extreme premature birth, very low birth weight, and extreme neglect, abuse, or social deprivation also increase the risk as do certain infections during pregnancy, at birth, and in early childhood. These infections include, among others, various viruses (measles, varicella zoster encephalitis, rubella, enterovirus 71). There is an association between long term but not short term use of acetaminophen during pregnancy and ADHD. At least 30% of children with a traumatic brain injury later develop ADHD and about 5% of cases are due to brain damage.
Some studies suggest that in a small number of children, artificial food dyes or preservatives may be associated with an increased prevalence of ADHD or ADHD-like symptoms, but the evidence is weak and may only apply to children with food sensitivities. The United Kingdom and the European Union have put in place regulatory measures based on these concerns. In a minority of children, intolerances or allergies to certain foods may worsen ADHD symptoms.
Research does not support popular beliefs that ADHD is caused by eating too much refined sugar, watching too much television, parenting, poverty or family chaos; however, they might worsen ADHD symptoms in certain people.
The youngest children in a class have been found to be more likely to be diagnosed as having ADHD, possibly due to their being developmentally behind their older classmates. This effect has been seen across a number of countries. They also appear to use ADHD medications at nearly twice the rate as their peers.
In some cases, the diagnosis of ADHD may reflect a dysfunctional family or a poor educational system, rather than problems with the individuals themselves. In other cases, it may be explained by increasing academic expectations, with a diagnosis being a method for parents in some countries to get extra financial and educational support for their child. Typical behaviors of ADHD occur more commonly in children who have experienced violence and emotional abuse.
The social construct theory of ADHD suggests that because the boundaries between "normal" and "abnormal" behavior are socially constructed, (i.e. jointly created and validated by all members of society, and in particular by physicians, parents, teachers, and others) it then follows that subjective valuations and judgements determine which diagnostic criteria are used and, thus, the number of people affected. This could lead to the situation where the DSM-IV arrives at levels of ADHD three to four times higher than those obtained with the ICD-10. Thomas Szasz, a supporter of this theory, has argued that ADHD was " ... invented and then given a name".
Current models of ADHD suggest that it is associated with functional impairments in some of the brain's neurotransmitter systems, particularly those involving dopamine and norepinephrine. The dopamine and norepinephrine pathways that originate in the ventral tegmental area and locus coeruleus project to diverse regions of the brain and govern a variety of cognitive processes. The dopamine pathways and norepinephrine pathways which project to the prefrontal cortex and striatum are directly responsible for modulating executive function (cognitive control of behavior), motivation, reward perception, and motor function; these pathways are known to play a central role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed.
In children with ADHD, there is a general reduction of volume in certain brain structures, with a proportionally greater decrease in the volume in the left-sided prefrontal cortex. The posterior parietal cortex also shows thinning in ADHD individuals compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits have also been found to differ between people with and without ADHD.
The subcortical volumes of the accumbens, amygdala, caudate, hippocampus, and putamen appears smaller in individuals with ADHD compared with controls. Inter-hemispheric asymmetries in white matter tracts have also been noted in ADHD youths, suggesting that disruptions in temporal integration may be related to the behavioral characteristics of ADHD.
Previously it was thought that the elevated number of dopamine transporters in people with ADHD was part of the pathophysiology but it appears that the elevated numbers are due to adaptation to exposure to stimulants. Current models involve the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. ADHD psychostimulants possess treatment efficacy because they increase neurotransmitter activity in these systems. There may additionally be abnormalities in serotoninergic, glutamatergic, or cholinergic pathways.
The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., attentional control, inhibitory control, and working memory). Executive functions are a set of cognitive processes that are required to successfully select and monitor behaviors that facilitate the attainment of one's chosen goals. The executive function impairments that occur in ADHD individuals result in problems with staying organized, time keeping, excessive procrastination, maintaining concentration, paying attention, ignoring distractions, regulating emotions, and remembering details. People with ADHD appear to have unimpaired long-term memory, and deficits in long-term recall appear to be attributed to impairments in working memory. The criteria for an executive function deficit are met in 30–50% of children and adolescents with ADHD. One study found that 80% of individuals with ADHD were impaired in at least one executive function task, compared to 50% for individuals without ADHD. Due to the rates of brain maturation and the increasing demands for executive control as a person gets older, ADHD impairments may not fully manifest themselves until adolescence or even early adulthood.
ADHD has also been associated with motivational deficits in children. Children with ADHD often find it difficult to focus on long-term over short-term rewards, and exhibit impulsive behavior for short-term rewards.
ADHD is diagnosed by an assessment of a child's behavioral and mental development, including ruling out the effects of drugs, medications and other medical or psychiatric problems as explanations for the symptoms. It often takes into account feedback from parents and teachers with most diagnoses begun after a teacher raises concerns. It may be viewed as the extreme end of one or more continuous human traits found in all people. Whether someone responds to medications does not confirm or rule out the diagnosis. As imaging studies of the brain do not give consistent results between individuals, they are only used for research purposes and not diagnosis.
In North America, DSM-5 criteria are used for diagnosis, while European countries usually use the ICD-10. With the DSM-IV criteria a diagnosis of ADHD is 3–4 times more likely than with the ICD-10 criteria. It is classified as neurodevelopmental psychiatric disorder. Additionally, it is classified as a disruptive behavior disorder along with oppositional defiant disorder, conduct disorder, and antisocial personality disorder. A diagnosis does not imply a neurological disorder.
Associated conditions that should be screened for include anxiety, depression, oppositional defiant disorder, conduct disorder, and learning and language disorders. Other conditions that should be considered are other neurodevelopmental disorders, tics, and sleep apnea.
Diagnosis of ADHD using quantitative electroencephalography (QEEG) is an ongoing area of investigation, although the value of QEEG in ADHD is currently unclear. In the United States, the Food and Drug Administration has approved the use of QEEG to evaluate ADHD. The approved test uses the ratio of EEG theta to beta activity to guide diagnosis; however, at least five studies have failed to replicate the finding.
As with many other psychiatric disorders, formal diagnosis should be made by a qualified professional based on a set number of criteria. In the United States, these criteria are defined by the American Psychiatric Association in the DSM. Based on the DSM criteria, there are three sub-types of ADHD:
This subdivision is based on presence of at least six out of nine long-term (lasting at least six months) symptoms of inattention, hyperactivity–impulsivity, or both. To be considered, the symptoms must have appeared by the age of six to twelve and occur in more than one environment (e.g. at home and at school or work). The symptoms must be inappropriate for a child of that age and there must be clear evidence that they are causing social, school or work related problems.
In the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) by the World Health Organization, the symptoms of "hyperkinetic disorder" are analogous to ADHD in the DSM-5. When a conduct disorder (as defined by ICD-10) is present, the condition is referred to as hyperkinetic conduct disorder. Otherwise, the disorder is classified as disturbance of activity and attention, other hyperkinetic disorders or hyperkinetic disorders, unspecified. The latter is sometimes referred to as hyperkinetic syndrome.
Adults with ADHD are diagnosed under the same criteria, including that their signs must have been present by the age of six to twelve. Questioning parents or guardians as to how the person behaved and developed as a child may form part of the assessment; a family history of ADHD also adds weight to a diagnosis. While the core symptoms of ADHD are similar in children and adults they often present differently in adults than in children, for example excessive physical activity seen in children may present as feelings of restlessness and constant mental activity in adults.
It is estimated that between 2–5% of adults have ADHD. Around 25–50% of children with ADHD continue to experience ADHD symptoms into adulthood, while the rest experiences fewer or no symptoms. Currently, most adults remain untreated. Many adults with ADHD without diagnosis and treatment have a disorganized life and some use non-prescribed drugs or alcohol as a coping mechanism. Other problems may include relationship and job difficulties, and an increased risk of criminal activities. Associated mental health problems include: depression, anxiety disorder, and learning disabilities.
Some ADHD symptoms in adults differ from those seen in children. While children with ADHD may climb and run about excessively, adults may experience an inability to relax, or they talk excessively in social situations. Adults with ADHD may start relationships impulsively, display sensation-seeking behavior, and be short-tempered. Addictive behavior such as substance abuse and gambling are common. The DSM-V criteria do specifically deal with adults, unlike those in DSM-IV, which were criticized for not being appropriate for adults; those who presented differently may lead to the claim that they outgrew the diagnosis.
|ADHD symptoms which are related to other disorders|
|Depression||Anxiety disorder||Bipolar disorder|
Symptoms of ADHD, such as low mood and poor self-image, mood swings, and irritability, can be confused with dysthymia, cyclothymia or bipolar disorder as well as with borderline personality disorder. Some symptoms that are due to anxiety disorders, antisocial personality disorder, developmental disabilities or mental retardation or the effects of substance abuse such as intoxication and withdrawal can overlap with some ADHD. These disorders can also sometimes occur along with ADHD. Medical conditions which can cause ADHD type symptoms include: hyperthyroidism, seizure disorder, lead toxicity, hearing deficits, hepatic disease, sleep apnea, drug interactions, untreated celiac disease, and head injury.
Primary sleep disorders may affect attention and behavior and the symptoms of ADHD may affect sleep. It is thus recommended that children with ADHD be regularly assessed for sleep problems. Sleepiness in children may result in symptoms ranging from the classic ones of yawning and rubbing the eyes, to hyperactivity and inattentiveness. Obstructive sleep apnea can also cause ADHD type symptoms. Rare tumors called pheochromocytomas and paragangliomas may cause similar symptoms to ADHD.
Reviews of ADHD biomarkers have noted that platelet monoamine oxidase expression, urinary norepinephrine, urinary MHPG, and urinary phenethylamine levels consistently differ between ADHD individuals and healthy control. These measurements could potentially serve as diagnostic biomarkers for ADHD, but more research is needed to establish their diagnostic utility. Urinary and blood plasma phenethylamine concentrations are lower in ADHD individuals relative to controls and the two most commonly prescribed drugs for ADHD, amphetamine and methylphenidate, increase phenethylamine biosynthesis in treatment-responsive individuals with ADHD. Lower urinary phenethylamine concentrations are also associated with symptoms of inattentiveness in ADHD individuals. Electroencephalography (EEG) is not accurate enough to make the diagnosis.
The management of ADHD typically involves counseling or medications either alone or in combination. While treatment may improve long-term outcomes, it does not get rid of negative outcomes entirely. Medications used include stimulants, atomoxetine, alpha-2 adrenergic receptor agonists, and sometimes antidepressants. In those who have trouble focusing on long-term rewards, a large amount of positive reinforcement improves task performance. ADHD stimulants also improve persistence and task performance in children with ADHD.
There is good evidence for the use of behavioral therapies in ADHD and they are the recommended first line treatment in those who have mild symptoms or are preschool-aged. Psychological therapies used include: psychoeducational input, behavior therapy, cognitive behavioral therapy (CBT), interpersonal psychotherapy, family therapy, school-based interventions, social skills training, behavioral peer intervention, organization training, parent management training, and neurofeedback. Parent training may improve a number of behavioral problems including oppositional and noncompliant behaviors. It is unclear if neurofeedback is useful.
There is little high quality research on the effectiveness of family therapy for ADHD, but the evidence that exists shows that it is similar to community care and better than a placebo. ADHD-specific support groups can provide information and may help families cope with ADHD.
Training in social skills, behavioral modification and medication may have some limited beneficial effects. The most important factor in reducing later psychological problems, such as major depression, criminality, school failure, and substance use disorders is formation of friendships with people who are not involved in delinquent activities.
Regular physical exercise, particularly aerobic exercise, is an effective add-on treatment for ADHD in children and adults, particularly when combined with stimulant medication, although the best intensity and type of aerobic exercise for improving symptoms are not currently known. In particular, the long-term effects of regular aerobic exercise in ADHD individuals include better behavior and motor abilities, improved executive functions (including attention, inhibitory control, and planning, among other cognitive domains), faster information processing speed, and better memory. Parent-teacher ratings of behavioral and socio-emotional outcomes in response to regular aerobic exercise include: better overall function, reduced ADHD symptoms, better self-esteem, reduced levels of anxiety and depression, fewer somatic complaints, better academic and classroom behavior, and improved social behavior. Exercising while on stimulant medication augments the effect of stimulant medication on executive function. It is believed that these short-term effects of exercise are mediated by an increased abundance of synaptic dopamine and norepinephrine in the brain.
Stimulant medications are the pharmaceutical treatment of choice. They have at least some effect on symptoms, in the short term, in about 80% of people Methylphenidate appears to improve symptoms as reported by teachers and parents. Stimulants may also reduce the risk of unintentional injuries in children with ADHD.
There are a number of non-stimulant medications, such as atomoxetine, bupropion, guanfacine, and clonidine that may be used as alternatives, or added to stimulant therapy. There are no good studies comparing the various medications; however, they appear more or less equal with respect to side effects. Stimulants appear to improve academic performance while atomoxetine does not. Atomoxetine, due to its lack of addiction liability, may be preferred in those who are at risk of recreational or compulsive stimulant use. There is little evidence on the effects of medication on social behaviors. As of June 2015, the long-term effects of ADHD medication have yet to be fully determined. Magnetic resonance imaging studies suggest that long-term treatment with amphetamine or methylphenidate decreases abnormalities in brain structure and function found in subjects with ADHD. A 2018 review found the greatest short term benefit with methylphenidate in children and amphetamines in adults.
Guidelines on when to use medications vary by country. The United Kingdom's National Institute for Health and Care Excellence (NICE) recommending use for children only in severe cases, though for adults medication is a first-line treatment. However, most United States guidelines recommend medications in most age groups. Medications are not recommended for preschool children. Underdosing of stimulants can occur and result in a lack of response or later loss of effectiveness. This is particularly common in adolescents and adults as approved dosing is based on school-aged children, causing some practitioners to use weight based or benefit based off-label dosing instead. School-age boys are twice as likely as their female counterparts to take medication, while among adults, women are far more likely to take medication than men.
While stimulants and atomoxetine are usually safe, there are side-effects and contraindications to their use. There is low quality evidence of an association between methylphenidate and both serious and non-serious harmful side effects when taken by children and adolescents. Careful monitoring of children while taking this medication is recommended. A large overdose on ADHD stimulants is commonly associated with symptoms such as stimulant psychosis and mania. Although very rare, at therapeutic doses these events appear to occur in approximately 0.1% of individuals within the first several weeks after starting amphetamine therapy. Administration of an antipsychotic medication has been found to effectively resolve the symptoms of acute amphetamine psychosis. Regular monitoring has been recommended in those on long-term treatment. Stimulant therapy should be stopped periodically to assess continuing need for medication, decrease possible growth delay, and reduce tolerance. Long-term misuse of stimulant medications at doses above the therapeutic range for ADHD treatment is associated with addiction and dependence. Untreated ADHD, however, is also associated with elevated risk of substance use disorders and conduct disorders. The use of stimulants appears to either reduce this risk or have no effect on it. The safety of these medications in pregnancy is unclear.
Dietary modifications may be of benefit to a small proportion of children with ADHD. A 2013 meta-analysis found less than a third of children with ADHD see some improvement in symptoms with free fatty acid supplementation or decreased eating of artificial food coloring. These benefits may be limited to children with food sensitivities or those who are simultaneously being treated with ADHD medications. This review also found that evidence does not support removing other foods from the diet to treat ADHD. A 2014 review found that an elimination diet results in a small overall benefit. A 2016 review stated that the use of a gluten-free diet as standard ADHD treatment is not advised. A 2017 review showed that a few-foods elimination diet may help children too young to be medicated or not responding to medication, while free fatty acid supplementation or decreased eating of artificial food coloring as standard ADHD treatment is not advised. Chronic deficiencies of iron, magnesium and iodine may have a negative impact on ADHD symptoms. There is a small amount of evidence that lower tissue zinc levels may be associated with ADHD. In the absence of a demonstrated zinc deficiency (which is rare outside of developing countries), zinc supplementation is not recommended as treatment for ADHD. However, zinc supplementation may reduce the minimum effective dose of amphetamine when it is used with amphetamine for the treatment of ADHD. There is evidence of a modest benefit of omega 3 fatty acid supplementation, but it is not recommended in place of traditional medication.
ADHD persists into adulthood in about 30–50% of cases. Those affected are likely to develop coping mechanisms as they mature, thus compensating to some extent for their previous symptoms. Children with ADHD have a higher risk of unintentional injuries. Effects of medication on functional impairment and quality of life (e.g. reduced risk of accidents) have been found across multiple domains. But learning disorders and executive function deficits do not seem to respond to ADHD medications.
ADHD is estimated to affect about 6–7% of people aged 18 and under when diagnosed via the DSM-IV criteria. When diagnosed via the ICD-10 criteria rates in this age group are estimated at 1–2%. Children in North America appear to have a higher rate of ADHD than children in Africa and the Middle East; this is believed to be due to differing methods of diagnosis rather than a difference in underlying frequency. If the same diagnostic methods are used, the rates are more or less the same between countries. It is diagnosed approximately three times more often in boys than in girls. This difference between sexes may reflect either a difference in susceptibility or that females with ADHD are less likely to be diagnosed than males.
Rates of diagnosis and treatment have increased in both the United Kingdom and the United States since the 1970s. Prior to 1970, it was rare for children to be diagnosed with ADHD while in the 1970s rates were about 1%. This is believed to be primarily due to changes in how the condition is diagnosed and how readily people are willing to treat it with medications rather than a true change in how common the condition is. It is believed that changes to the diagnostic criteria in 2013 with the release of the DSM-5 will increase the percentage of people diagnosed with ADHD, especially among adults.
Hyperactivity has long been part of the human condition. Sir Alexander Crichton describes "mental restlessness" in his book An inquiry into the nature and origin of mental derangement written in 1798. He made observations about children showing signs of being inattentive and having the “fidgets”. The first clear description of ADHD is credited to George Still in 1902 during a series of lectures he gave to the Royal College of Physicians of London. He noted both nature and nurture could be influencing this disorder.
The terminology used to describe the condition has changed over time and has included: in the DSM-I (1952) "minimal brain dysfunction," in the DSM-II (1968) "hyperkinetic reaction of childhood," and in the DSM-III (1980) "attention-deficit disorder (ADD) with or without hyperactivity." In 1987 this was changed to ADHD in the DSM-III-R and the DSM-IV in 1994 split the diagnosis into three subtypes, ADHD inattentive type, ADHD hyperactive-impulsive type and ADHD combined type. These terms were kept in the DSM-5 in 2013. Other terms have included "minimal brain damage" used in the 1930s.
In 1934, Benzedrine became the first amphetamine medication approved for use in the United States. Methylphenidate was introduced in the 1950s, and enantiopure dextroamphetamine in the 1970s. The use of stimulants to treat ADHD was first described in 1937. Charles Bradley gave the children with behavioral disorders benzedrine and found it improved academic performance and behavior.
Until the 1990s, many studies "implicated the prefrontal-striatal network as being smaller in children with ADHD". During this same period, a genetic component was identified and ADHD was acknowledged to be a persistent, long-term disorder which lasted from childhood into adulthood. ADHD was split into the current three subtypes beecause of a field trial completed by Lahey and colleagues.
ADHD, its diagnosis, and its treatment have been controversial since the 1970s. The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature. In 2014, Keith Conners, one of the early advocates for recognition of the disorder, spoke out against overdiagnosis in a The New York Times article. In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.
With widely differing rates of diagnosis across countries, states within countries, races, and ethnicities, some suspect factors other than the presence of the symptoms of ADHD are playing a role in diagnosis. Some sociologists consider ADHD to be an example of the medicalization of deviant behavior, that is, the turning of the previously non-medical issue of school performance into a medical one. Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms. Among healthcare providers the debate mainly centers on diagnosis and treatment in the much greater number of people with mild symptoms.
Reports indicate that ADHD affects 2.5%–5% of adults in the general population,5–8 compared with 5%–7% of children.9,10 ... However, fewer than 20% of adults with ADHD are currently diagnosed and/or treated by psychiatrists.7,15,16
likelihood that the adult with ADHD has developed coping mechanisms to compensate for his or her impairment
Why were the MTA medication treatments more effective than community treatments that also usually included medication? Answer: There were substantial differences in quality and intensity between the study-provided medication treatments and those provided in the community care group.
Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. ... Only one paper examining outcomes beyond 36 months met the review criteria. ... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22
Up till now, there is no conclusive evidence for a relationship between ADHD and CD. Therefore, it is not advised to perform routine screening of CD when assessing ADHD (and vice versa) or to implement GFD as a standard treatment in ADHD. Nevertheless, the possibility of untreated CD predisposing to ADHD-like behavior should be kept in mind. ... It is possible that in untreated patients with CD, neurologic symptoms such as chronic fatigue, inattention, pain, and headache could predispose patients to ADHD-like behavior (mainly symptoms of inattentive type), which may be alleviated after GFD treatment. (CD: celiac disease; GFD: gluten-free diet)
Although there is little direct evidence, changes in trace amines, in particular PE, have been identified as a possible factor for the onset of attention deficit/hyperactivity disorder (ADHD). … Further, amphetamines, which have clinical utility in ADHD, are good ligands at trace amine receptors. Of possible relevance in this aspect is modafanil, which has shown beneficial effects in ADHD patients and has been reported to enhance the activity of PE at TAAR1. Conversely, methylphenidate, …showed poor efficacy at the TAAR1 receptor. In this respect it is worth noting that the enhancement of functioning at TAAR1 seen with modafanil was not a result of a direct interaction with TAAR1.
Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities...
an elimination diet produces a small aggregate effect but may have greater benefit among some children. Very few studies enable proper evaluation of the likelihood of response in children with ADHD who are not already preselected based on prior diet response.
Mental diseases are invented and then given a name, for example attention deficit hyperactivity disorder (ADHD).
Early results with structural MRI show thinning of the cerebral cortex in ADHD subjects compared with age-matched controls in prefrontal cortex and posterior parietal cortex, areas involved in working memory and attention.
DA has multiple actions in the prefrontal cortex. It promotes the "cognitive control" of behavior: the selection and successful monitoring of behavior to facilitate attainment of chosen goals. Aspects of cognitive control in which DA plays a role include working memory, the ability to hold information "on line" in order to guide actions, suppression of prepotent behaviors that compete with goal-directed actions, and control of attention and thus the ability to overcome distractions. Cognitive control is impaired in several disorders, including attention deficit hyperactivity disorder. ... Noradrenergic projections from the LC thus interact with dopaminergic projections from the VTA to regulate cognitive control. ... it has not been shown that 5HT makes a therapeutic contribution to treatment of ADHD.
Recent conceptualizations of ADHD have taken seriously the distributed nature of neuronal processing [10,11,35,36]. Most of the candidate networks have focused on prefrontal-striatal-cerebellar circuits, although other posterior regions are also being proposed .
EFs and prefrontal cortex are the first to suffer, and suffer disproportionately, if something is not right in your life. They suffer first, and most, if you are stressed (Arnsten 1998, Liston et al. 2009, Oaten & Cheng 2005), sad (Hirt et al. 2008, von Hecker & Meiser 2005), lonely (Baumeister et al. 2002, Cacioppo & Patrick 2008, Campbell et al. 2006, Tun et al. 2012), sleep deprived (Barnes et al. 2012, Huang et al. 2007), or not physically fit (Best 2010, Chaddock et al. 2011, Hillman et al. 2008). Any of these can cause you to appear to have a disorder of EFs, such as ADHD, when you do not.
Behavioral studies show altered processing of reinforcement and incentives in children with ADHD. These children respond more impulsively to rewards and choose small, immediate rewards over larger, delayed incentives. Interestingly, a high intensity of reinforcement is effective in improving task performance in children with ADHD. Pharmacotherapy may also improve task persistence in these children. ... Previous studies suggest that a clinical approach using interventions to improve motivational processes in patients with ADHD may improve outcomes as children with ADHD transition into adolescence and adulthood.
While diagnosis of ADHD is usually done by analysis of the symptoms (American Psychiatric Association, 2000), PEA was recently described as a biomarker for ADHD
Beneficial chronic effects of cardio exercise were found on various functions as well, including executive functions, attention and behavior.
We may conclude that all different types of exercise ... attenuate the characteristic symptoms of ADHD and improve social behaviour, motor skills, strength and neuropsychological parameters without any undesirable side effects. Available reports do not reveal which type, intensity, duration and frequency of exercise is most effective
The findings from these studies provide some support for the notion that exercise has the potential to act as a protective factor for ADHD.
In addition, a consensus has not been reached on the optimal diagnostic criteria for ADHD. Moreover, the benefits and long-term effects of medical and complementary therapies for this disorder continue to be debated. These gaps in knowledge hinder the ability of clinicians to effectively recognize and treat ADHD.
Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
As most treatment guidelines and prescribing information for stimulant medications relate to experience in school-aged children, prescribed doses for older patients are lacking. Emerging evidence for both methylphenidate and Adderall indicate that when weight-corrected daily doses, equipotent with those used in the treatment of younger patients, are used to treat adults with ADHD, these patients show a very robust clinical response consistent with that observed in pediatric studies. These data suggest that older patients may require a more aggressive approach in terms of dosing, based on the same target dosage ranges that have already been established – for methylphenidate, 1–1.5–2 mg/kg/day, and for D,L-amphetamine, 0.5–0.75–1 mg/kg/day....
In particular, adolescents and adults are vulnerable to underdosing, and are thus at potential risk of failing to receive adequate dosage levels. As with all therapeutic agents, the efficacy and safety of stimulant medications should always guide prescribing behavior: careful dosage titration of the selected stimulant product should help to ensure that each patient with ADHD receives an adequate dose, so that the clinical benefits of therapy can be fully attained.
A minority of individuals who use amphetamines develop full-blown psychosis requiring care at emergency departments or psychiatric hospitals. In such cases, symptoms of amphetamine psychosis commonly include paranoid and persecutory delusions as well as auditory and visual hallucinations in the presence of extreme agitation. More common (about 18%) is for frequent amphetamine users to report psychotic symptoms that are sub-clinical and that do not require high-intensity intervention ...
About 5–15% of the users who develop an amphetamine psychosis fail to recover completely (Hofmann 1983) ...
Findings from one trial indicate use of antipsychotic medications effectively resolves symptoms of acute amphetamine psychosis.
Treatment-emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. ... In a pooled analysis of multiple short-term, placebo controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.
supervised use of stimulants at therapeutic doses may decrease risk of experimentation with drugs to self-medicate symptoms. Second, untreated ADHD may lead to school failure, peer rejection, and subsequent association with deviant peer groups that encourage drug misuse. ... amphetamines and methylphenidate are used in low doses to treat attention deficit hyperactivity disorder and in higher doses to treat narcolepsy (Chapter 12). Despite their clinical uses, these drugs are strongly reinforcing, and their long-term use at high doses is linked with potential addiction
Zinc binds at ... extracellular sites of the DAT , serving as a DAT inhibitor. In this context, controlled double-blind studies in children are of interest, which showed positive effects of zinc [supplementation] on symptoms of ADHD [105,106]. It should be stated that at this time [supplementation] with zinc is not integrated in any ADHD treatment algorithm.
ADDitude Magazine is the quarterly consumer publication about attention deficit hyperactivity disorder (ADD ADHD) created and distributed by New Hope Media in New York, NY. It contains feature and service articles about ADD, ADHD and learning disabilities like dyslexia. It addresses topics including: diagnosing ADHD in children and adults, attention-deficit hyperactivity disorder treatments including medication and/or alternative therapies, parenting children with ADHD, learning disabilities and school challenges, and living with adult ADD. ADDitude Magazine is described by child psychotherapist Keath Low as "The happy, healthy lifestyle magazine for people with ADD."The official web site for ADDitude magazine was launched in April 2007, and now contains free searchable archives, expert Q&As, ADHD bloggers, ADHD discussion forums, and a directory of ADHD service providers at http://directory.additudemag.com/.Adult attention deficit hyperactivity disorder
Adult attention deficit hyperactivity disorder is the psychiatric condition of attention deficit hyperactivity disorder (ADHD) in adults. About one-third to two-thirds of children with symptoms from early childhood continue to demonstrate ADHD symptoms throughout life.Three types of ADHD are identified in the DSM-5 as:
Predominantly Inattentive Type (ADHD-PI or ADHD-I)
Predominantly Hyperactive or Hyperactive-Impulsive Type (ADHD-PH or ADHD-HI)
Combined Type (ADHD-C)In later life, the hyperactive/impulsive subtype manifests less frequently. The hyperactivity symptoms tend to turn more into "inner restlessness", starting in adolescence and carrying on in adulthood.Adult ADHD is typically marked by inattention and hyperfocus, hyperactivity (often internalised as restlessness) emotional dysregulation, and excessive mind wandering. Specifically, adults with ADHD present with persistent difficulties in following directions, remembering information, concentrating, organizing tasks, completing work within specified time frames and appearing timely in appointments. These difficulties affect several different areas of an ADHD adult's life, causing emotional, social, vocational, marital, legal, financial and/or academic problems. As a result, low self-esteem is commonly developed. However, given the right guidance and coaching, these traits of ADHD could also lead to career success.Diagnosis follows one or several assessment which may include examination of personal history, observational evidence from family members or friends, academic reports, often going back to school years, as well as evaluation to diagnose additional possible conditions which often coexist with ADHD, called comorbidities or comorbid disorders.
The condition often runs in families, and while its exact causes are not fully known, genetic or environmental factors are understood to play a part. ADHD is a childhood-onset condition, usually requiring symptoms to have been present before age 12 for a diagnosis. Children under treatment will migrate to adult health services if necessary as they transit into adulthood, however diagnosis of adults involves full examination of their history.
Treatment of ADHD is usually based on a combination of medication, cognitive behavioral therapy, and coaching or skills training. Medium-to-high intensity physical exercise, improved sleep and improved and targeted nutrition are also known to have a positive effect. Within school and work, reasonable accommodations may be put in place to help the individual work more efficiently and productively.Attention deficit hyperactivity disorder controversies
Attention deficit hyperactivity disorder (ADHD) controversies include concerns about its existence, causes, perceived overdiagnosis, and methods of treatment, especially with the use of stimulant medications in children. These controversies have surrounded the subject since at least the 1970s.Attention deficit hyperactivity disorder management
Attention deficit hyperactivity disorder management options are evidence-based practices with established treatment efficacy for ADHD. The American Academy of Pediatrics recommends different treatment paradigms depending on the age of the person being treated. For those aged 4–5, the Academy recommends evidence-based parent- and/or teacher-administered behavior therapy, with the addition of methylphenidate only if there is continuing moderate-to-severe functional disturbances. For those aged 6–11, the use of medication in combination with behavior therapy is recommended, with the evidence for stimulant medications being stronger than that for other classes. For those aged 12–18, medication should be prescribed with the consent of the treated adolescent, preferably in combination with behavioral therapy. The evidence for the utility of behavioral interventions in this aged group was rated only "C" quality, however.There are a number of stimulant and non-stimulant medications indicated for the treatment of ADHD. The most commonly used stimulant medications include methylphenidate (Ritalin, Concerta), mixed amphetamine salts (Adderall, Mydayis), dextroamphetamine (Dexedrine), and lisdexamfetamine (Vyvanse). Non-stimulant medications with a specific indication for ADHD include atomoxetine (Strattera), guanfacine (Intuniv), and clonidine (Kapvay). Other medicines which may be prescribed off-label include bupropion (Wellbutrin), tricyclic antidepressants, SNRIs, or MAOIs. The presence of comorbid (co-occurring) disorders can make finding the right treatment and diagnosis much more complicated, costly, and time-consuming. So it is recommended to assess and simultaneously treat any comorbid disorders.A variety of psychotherapeutic and behavior modification approaches to managing ADHD including psychotherapy and working memory training may be used. Improving the surrounding home and school environment with parent management training and classroom management can improve the behavior of children with ADHD. Specialized ADHD coaches provide services and strategies to improve functioning, like time management or organizational suggestions. Self-control training programs have been shown to have limited effectiveness.
As of 2006 there was a shortage of data regarding ADHD drugs' potential adverse effects, with very few studies assessing the safety or efficacy of treatments beyond four months, and no randomized controlled trials assessing for periods of usage longer than two years.Attention deficit hyperactivity disorder predominantly inattentive
Attention deficit hyperactivity disorder predominantly inattentive (ADHD-PI or ADHD-I), is one of the three presentations of attention deficit hyperactivity disorder (ADHD). Before 1994, it was classified as attention deficit disorder (ADD) in the Diagnostic and Statistical Manual (DSM).
The 'predominantly inattentive subtype' is similar to the other presentations of ADHD except that it is characterized primarily by problems with inattention or a deficit of sustained attention, such as procrastination, hesitation, and forgetfulness. It differs in having fewer or no typical symptoms of hyperactivity or impulsiveness. Lethargy and fatigue are sometimes reported, but ADHD-PI is a separate condition from the proposed cluster of symptoms known as sluggish cognitive tempo (SCT).Clonidine
Clonidine, sold as the brand name Catapres among others, is a medication used to treat high blood pressure, attention deficit hyperactivity disorder, drug withdrawal (alcohol, opioids, or smoking), menopausal flushing, diarrhea, and certain pain conditions. It is used by mouth, by injection, or as a skin patch. Onset of action is typically within an hour with the effects on blood pressure lasting for up to eight hours.Common side effect include dry mouth, dizziness, headaches, and sleepiness. Severe side effects may include seeing or hearing things that other people do not, heart arrhythmias, and confusion. If rapidly stopped, withdrawal effects may occur. Use during pregnancy or breastfeeding is not recommended. Clonidine lowers blood pressure by stimulating α2 receptors in the brain, which results in relaxation of many arteries.Clonidine was patented in 1961 and came into medical use in 1966. It is available as a generic medication. As of 2019 a month of medication costs the NHS about £8. In the United States this amount costs about US$2.70 as of 2019. In 2016 it was the 76th most prescribed medication in the United States with more than 10 million prescriptions.Diet and attention deficit hyperactivity disorder
For some children, diet is suspected of playing a role in the multiple behavioral and cognitive symptoms of attention deficit hyperactivity disorder (ADHD). Concerns have focused on food additives, blood sugar regulation, food allergies and intolerances, and vitamin, mineral and fatty acid deficiencies.Epidemiology of attention deficit hyperactive disorder
ADHD is estimated to affect about 6 to 7 percent of people aged 18 and under when diagnosed via the DSM-IV criteria. Hyperkinetic disorder when diagnosed via the ICD-10 criteria give rates of between 1 and 2 percent in this age group.Children in North America appear to have a higher rate of ADHD than children in Africa and the Middle East - however, this may be due to differing methods of diagnosis used in different areas of the world. If the same diagnostic methods are used rates are more or less the same between countries.Fasoracetam
Fasoracetam is a research chemical of the racetam family. It is a putative nootropic that failed to show sufficient efficacy in clinical trials for vascular dementia. It is currently being studied for its potential use for attention deficit hyperactivity disorder.Fasoracetam appears to agonize all three groups of metabotropic glutamate receptors and has improved cognitive function in rodent studies. It is orally bioavailable and is excreted mostly unchanged via the urine.Fasoracetam was discovered by scientists at the Japanese pharmaceutical company Nippon Shinyaku, which brought it through Phase 3 clinical trials for vascular dementia, and abandoned it due to lack of efficacy.Scientists at Children's Hospital of Philadelphia led by Hakon Hakonarson have studied fasoracetam's potential use in attention deficit hyperactivity disorder. Hakonarson started a company called neuroFix Therapeutics to try to bring the drug to market for this use; neuroFix acquired Nippon Shinyaku's clinical data as part of its efforts. neuroFix was acquired by Medgenics in 2015. Medgenics changed its name to Aevi Genomic Medicine in 2016. Clinical trials in adolescents with ADHD who also have mGluR mutations started in 2016.Guanfacine
Guanfacine, sold under the brand name Tenex among others, is a medication used to treat attention deficit hyperactivity disorder (ADHD) and high blood pressure. It is a less preferred treatment for ADHD and for high blood pressure. It is taken by mouth.Common side effects include sleepiness, constipation, dry mouth, sexual problems, and headaches. Other side effect may include anxiety, low blood pressure, depression, and urinary problems. Use is not recommended during pregnancy or breastfeeding. It appears to work by activating the α2A receptors in the brain thereby decreasing sympathetic nervous system activity.Guanfacine was approved for medical use in the United States in 1986. It is available as a generic medication. A month supply in the United Kingdom costs the NHS about £60 as of 2019. In the United States the wholesale cost of this amount is about 7.11 USD. In 2016 it was the 156th most prescribed medication in the United States with more than 4 million prescriptions.History of attention deficit hyperactivity disorder
Hyperactivity has long been part of the human condition, although hyperactive behaviour has not always been seen as problematic.The terminology used to describe the symptoms of Attention-Deficit Hyperactivity Disorder, or ADHD, has gone through many changes over history, including "minimal brain damage", "minimal brain dysfunction", "learning/behavioral disabilities" and "hyperactivity". In the second edition of the Diagnostic and Statistical Manual of Mental Disorders, known as DSM-II (1968), the condition was called "Hyperkinetic Reaction of Childhood". It was in the 1980 DSM-III that "ADD (Attention-Deficit Disorder) with or without hyperactivity" was introduced. In 1987 this label was further refined to "ADHD (Attention-Deficit Hyperactivity Disorder)" in the DSM-III-R and subsequent editions, including the current DSM-5.Hyperfocus
Hyperfocus is an intense form of mental concentration or visualization that focuses consciousness on a subject, topic, or task. In some individuals, various subjects or topics may also include daydreams, concepts, fiction, the imagination, and other objects of the mind. Hyperfocus on a certain subject can cause side-tracking away from assigned or important tasks.
Psychiatrically, it is considered to be a symptom of ADHD together with inattention, and it has been proposed as a symptom of other conditions.Hyperfocus may bear a relationship to the concept of flow. In some circumstances, both flow and hyperfocus can be an aid to achievement, but in other circumstances or situations, the same focus and behavior could be a liability, distracting from the task at hand. However, unlike hyperfocus, "flow" is often described in more glowing terms, suggesting they are not two sides of the same condition under contrasting circumstance or intellect.Hyperkinetic disorder
Hyperkinetic disorder is an outdated term for a psychiatric neurodevelopmental condition emerging in early childhood. Its features included an enduring pattern of severe, developmentally inappropriate symptoms of inattention, hyperactivity, and impulsivity across different settings (e.g., home and school) that significantly impair academic, social and work performance. It was classified in the World Health Organization's ICD-10 and was roughly similar to the "combined presentation" of attention deficit hyperactivity disorder in the American Psychiatric Association's DSM-5. However, in the ICD-11 the entry for hyperkinetic disorder no longer exists and is replaced by attention deficit hyperactivity disorder.Hyperkinetic people display disorganized, poorly controlled and excessive activity; they lack perseverance in tasks involving thought and attention, and tend to move from one activity to the next without completing any. They are frequently accident-prone, reckless and impulsive, and may thoughtlessly (rather than defiantly) break rules. Cognitive impairment and delayed language and motor development are more common in this group than in the general population; and they may experience low self-esteem and engage in dissocial behavior as a consequence of the disorder.
While hyperkinetic children are commonly incautious and unreserved with adults, they might be isolated and unpopular with other children.Hypokalemic sensory overstimulation
Hypokalemic sensory overstimulation is characterized by a subjective experience of sensory overload and a relative resistance to lidocaine local anesthesia. The sensory overload is treatable with oral potassium gluconate. Individuals with this condition are sometimes diagnosed as having attention deficit hyperactivity disorder (ADHD), raising the possibility that a subtype of ADHD has a cause that can be understood mechanistically and treated in a novel way.
It is not to be confused with hot tooth syndrome.Impulse (psychology)
An impulse is a wish or urge, particularly a sudden one. It can be considered as a normal and fundamental part of human thought processes, but also one that can become problematic, as in a condition like obsessive-compulsive disorder, borderline personality disorder, and attention deficit hyperactivity disorder.
The ability to control impulses, or more specifically control the desire to act on them, is an important factor in personality and socialization. Deferred gratification, also known as impulse control is an example of this, concerning impulses primarily relating to things that a person wants or desires.
Many psychological problems are characterized by a loss of control or a lack of control in specific situations. Usually, this lack of control is part of a pattern of behavior that also involves other maladaptive thoughts and actions, such as substance abuse problems or sexual disorders like the paraphilias (e.g. pedophilia and exhibitionism). When loss of control is only a component of a disorder, it usually does not have to be a part of the behavior pattern, and other symptoms must also be present for the diagnosis to be made. (Franklin)Latrophilin 3
Latrophilin 3 is a protein that in humans is encoded by the ADGRL3 gene.Low arousal theory
The low arousal theory is a psychological theory explaining that people with attention-deficit hyperactivity disorder (ADHD) and antisocial personality disorder seek self-stimulation by excessive activity in order to transcend their state of abnormally low arousal. This low arousal results in the inability or difficulty to sustain attention on any task of waning stimulation or novelty, as well as explaining compulsive hyperactive behavior.A person with low arousal reacts less to stimuli than one without. This individual, according to Hare (1970) is "in a chronic state of 'stimulus-hunger'". To further explain, Mawson and Mawson (1977) claim that he or she needs more "sensory inputs" to feel normal.Methylphenidate
Methylphenidate, sold under the trade name Ritalin, among others, is a stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is a first line medication for ADHD. It is taken by mouth or applied to the skin. Different formulations have different durations of effect.Common side effects include trouble sleeping, anxiety, and weight loss. More serious side effects may include psychosis, allergic reactions, prolonged erections, abuse, and heart problems. Methylphenidate is believed to work by improving the action of catecholamines in the brain. It achieves this by blocking dopamine and norepinephrine reuptake by neurons. Methylphenidate is a central nervous system (CNS) stimulant of the phenethylamine and piperidine classes.Methylphenidate was first made in 1944 and was approved for medical use in the United States in 1955. It was originally sold by CIBA, now Novartis Corporation. It is estimated that in 2013 2.4 billion doses of methylphenidate were taken worldwide. About 80% of this was taken by people in the United States making it the 47th most prescribed medication in that country. It is available as a generic medication. In the United States the wholesale cost of the immediate release formulation is less than US$0.30 per dose as of 2018.Patrick Fugit
Patrick Raymond Fugit (; born October 27, 1982) is an American actor, known for his roles in the films Almost Famous (2000), White Oleander (2002), Saved! (2004) and Wristcutters: A Love Story (2007). He is also known for his role as Kyle Barnes in the Cinemax series Outcast.
Attention deficit hyperactivity disorder (F90, 314)
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Emotional and behavioral disorders (F90–F98, 312–314)