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Mental Health

Attention-deficit/hyperactivity disorder (ADHD)

Neurodevelopmental disorder characterized by by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc), not appropriate for a person’s age.

Swimmer Michael Phelps holds the record for winning the most Olympic medals. He has ADHD and was hyperactive as a child. “I was always the kid who was running around,” he said. “I literally couldn’t sit still.” His mother used his love of swimming to help him focus. | Understood/Amanda Morin

Neurodevelopmental disorder characterized by by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc), not appropriate for a person’s age.

  • M/C neurobehavioral disorder in children
  • Normal intelligence present
  • Affects 5% (children & adolescents) and 2.5% (adults) worldwide.

History

History of attention-deficit/hyperactivity disorder
History of attention-deficit/hyperactivity disorder. | Faraone, S. V, Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., … Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1(1), 15020. https://doi.org/10.1038/nrdp.2015.20

Etiology

enetics of ADHD
Genetics of attention-deficit/hyperactivity disorder. | Faraone, S., Asherson, P., Banaschewski, T. et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 1, 15020 (2015). https://doi.org/10.1038/nrdp.2015.20
Developmental course of ADHD
Developmental course of attention-deficit/hyperactivity disorder in persistent cases. | Faraone, S. V, Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., … Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1(1), 15020. https://doi.org/10.1038/nrdp.2015.20

Clinical features

Attention deficit hyperactivity disorder (ADHD)
The Calgary Guide | http://calgaryguide.ucalgary.ca/

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) clinical types:

  • Predominantly inattentive (ADHD-PI or ADHD-I)
    • ≥ 6 hyperactivity-impulsivity symptoms
    • < 6 inattention symptoms
  • Predominantly hyperactive-impulsive (ADHD-PH or ADHD-HI) (M/C sybtype)
    • ≥ 6 inattention symptoms
    • < 6 hyperactivity-impulsivity symptoms
  • Combined type (ADHD-C)
    • ≥ 6 symptoms each of inattention and hyperactivity-impulsivity

Case studies:

…sort of

Diagnosis

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria:

  • Developmentally inappropriate behaviour compared to normal children of same age
  • Must begin before 12 years age
  • Must last for ≥ 6 months
  • Must be present in ≥ 2 settings
  • Must be reported as such by independent observers
  • Must not be secondary to another disorder
Quality of life in ADHD
Quality of life and attention-deficit/hyperactivity disorder. | Faraone, S., Asherson, P., Banaschewski, T. et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 1, 15020 (2015). https://doi.org/10.1038/nrdp.2015.20

Management

Management decision tree
Management decision tree. | Faraone, S., Asherson, P., Banaschewski, T. et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 1, 15020 (2015). https://doi.org/10.1038/nrdp.2015.20

Pharmacological management:

  • Stimulants: Methylphenidate (DOC), amphetamine and their derivatives
    • Newer mode of administration: Osmotic controlled release oral delivery system (OROS)
  • Alternatives (non-stimulant medications): Atomoxetine (SNRI), guanfacine, clonidine (α-agonist)

Cognitive behavioural therapy (CBT)

Summary

ADHD
ADHD. (2015). Nature Reviews Disease Primers, 1(1), 15027. https://doi.org/10.1038/nrdp.2015.27

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