What is Attention Deficit Hyperactivity Disorder (ADHD)?

[mme_highlight] Attention Deficit Hyperactivity Disorder is the most common neurobehavioral disorder of childhood and one of the most common of all diseases in childhood. The main symptoms are lack of attention, hyperactivity and impulsivity. Most children with ADHD improve with a combination of medication and behavioral treatment. [/mme_highlight]

Attention Deficit Hyperactivity Disorder is the most common neurobehavioral disorder of childhood and one of the most common of all diseases in childhood, affecting 8 to 10% of children aged 4 to 17 years. The main symptoms are lack of attention, hyperactivity, and impulsivity. ADHD can have a tremendous impact in the academic achievement, general well-being and social development of children.

How common is ADHD?

Statistical data shows that ADHD is, in fact, a very common disorder. A systematic review and meta-analysis characterizing the worldwide prevalence of ADHD reported that its prevalence was 5.3%. However, our data refers only to diagnosed cases of ADHD and many children with this condition remain undiagnosed, thus not counting to data.
However, at first sight, it seems that the incidence and prevalence of ADHD has been increasing, which can be misleading. The truth is that it is the frequency of diagnosis – and not necessarily the disease – that is increasing, maybe in relation with progressive clinician awareness to ADHD. Note also that in 1998 the incidence among boys was 10 times higher than in girls, and five times higher in 2010.

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Incidence of ADHD between 1998 and 2010 (UK)

1) Overall incidence in population (all ages)

– 1998: 6.9 cases per 100 000 inhabitants

– 2007: 12.2 cases per 100 000 inhabitants

– 2010: 8.8 cases per 100 000 inhabitants

2) Incidence among children and adolescents 6 to 17 years old

– 1998: 39.3 cases per 100 000 inhabitants 6-17 years old

– 2007: 79 cases per 100 000 inhabitants 6-17 years old

– 2010: 59.7 cases per 100 000 inhabitants 6-17 years old

Incidence – number of new cases within a specified time period in a population.
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Prevalence of ADHD between 1998 and 2010 (UK)

1) Overall prevalence in population (all ages)

– 1998: 30.5 cases per 100 000 inhabitants

– 2007: 88.9 cases per 100 000 inhabitants

– 2010: 81.5 cases per 100 000 inhabitants

2) Prevalence among children and adolescents 9 to 17 years old

– 1998: 192.4 cases per 100 000 inhabitants 9-17 years old

– 2007: 549.8 cases per 100 000 inhabitants 9-17 years old

– 2010: 506.4 cases per 100 000 inhabitants 9-17 years old

Prevalence – The total number of cases of a disease in a given population at a specific time.
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What are the symptoms of ADHD?

Hyperactivity: this includes restlessness, excessive talking, difficulty to remain seated when required to do so and difficulty to play quietly. Hyperactivity generally is acknowledged by 4 years old, usually peaks around 7 to 8 years of age, becoming less noticeable in adolescents.
Impulsivity: this can become apparent as a difficulty waiting turns, answering too quickly, disruptive classroom behavior or interrupting peers’ activities. The time course is the same as hyperactivity, but usually impulsivity remains a problem throughout life.
Inattention: this can present as difficulty to memorize, easy distraction, losing things, disorganization, underachievement in school and poor concentration.

These three symptoms are used to divide AHDA in three subtypes: the predominantly inattentive type (formerly known as attention deficit), the predominantly hyperactive-impulsive type and the combined one.

What are the causes for ADHD?

The causes for this condition remain unclear, but some theories have been discussed. Studies have shown that the disease is caused by an imbalance of the chemicals acting in the brain, which can be inherited. Exposure to tobacco smoke before birth may also be implied.

What diseases can be associated with ADHD?

Over 65% of those with ADHD also have other associated diseases, like dyslexia, developmental coordination disorder, Tourette’s syndrome, autistic spectrum disorders and substance abuse. ADHD is also associated with disrupted parent–child relationships and increased parent stress levels. Many studies investigated the relationship between self-esteem and ADHD, however, the results remain controversial.
The study below suggests that lower self-esteem is more likely in children with ADHD, which puts the focus on the importance of an early detection of psychological well-being in children with ADHD to prevent long-term impact.

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Scores in the subscales of a self-esteem scale: ADHD vs. non ADHD children and adolescents

(study design: A total of 85 children and adolescents with ADHD and 26 without the condition were included in the study. To assess the self-esteem all the clinical and control children and adolescents completed the Self-Esteem Multidimensional Test (TMA), which has 6 subscales –personal, skills, emotional, school, family, body.

	ADHD children	Non-ADHD children (controls)
Personal	92.96	105.65
Skills	89.16	101.34
Emotional	94.44	106.31
School	89.47	105.04
Family	91.57	106.31
Body	98.43	114.42
Total score	90.96	107.31

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When to seek for medical help?

If you suspect your child may have ADHD you should start by talking to your child’s teacher, this way you will know if your child has difficulties in different settings (home and school), which is important to make a diagnosis of ADHD. Then, you should find medical advice.

What are the available treatments for ADHD?

Most children with ADHD improve signiﬁcantly with a combination of medication and behavioral treatment. Behavioral treatment alone is general recommended for pre-school aged children, while stimulant medicines are the first-line attention deficit hyperactivity disorder (ADHD) treatment for school-aged children. Methylphenidate and amphetamines are the most commonly prescribed stimulants; they aim to improve the communication between the different areas of your child’s brain. These drugs must be taken as prescribed and under medical supervision.

Summary and Recommendations

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common developmental disorders.
The presenting symptoms of the disease are hyperactivity, impulsivity and inattention.
ADHD can negatively interfere with the general well-being of children, their social life, academic performance and development of social skills.
A combination of medication and behavioral treatment has proven to be effective in most children with ADHD.

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References

Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, Wolraich M, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128:1007.
Holden SE, Jenkins-Jones S, Poole CD et al. The prevalence and incidence, resource use and financial costs of treating people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). Child Adolesc Psychiatry Ment Health. 2013 Oct 11;7(1):34.
Zwi M, Jones H, Thorgaard C, York A et al. Parent training interventions for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003018.
Mazzone L, Postorino V, Reale L et al. Self-esteem evaluation in children and adolescents suffering from ADHD. Clin Pract Epidemiol Ment Health. 2013 Jul 11; 9:96-102.
http://www.parentsmedguide.org/ParentGuide_English.pdf (accessed 21/10/2013)

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