Attention Deficit Hyractivity Disorder: An overview

Clinical signs and epidemiology: ADHD is a common childhood psychiatric disorder which is characterized by inattention, excessive motor activity and pronounced impulsiveness. Its prevalence is estimated between 3-12% of children worldwide and it most commonly affects school age boys. There are three distinctive clinical sub-types of the disorder, namely the inattentive, the hyperkinetic/impulsive and the combined type. It is a serious medical condition which is associated with marked academic and interpersonal impairment. A significant percentage of ADHD patients suffer from a variety of psychiatric co-morbidities such as disruptive behavior disorders, tic disorders, learning disorders, affective and anxiety disorders. Contrary to lay beliefs, it tends to persist through adolescence and adulthood in almost 70% of cases and may lead to severe long-term consequences including substance abuse, criminal behavior, accidents, academic and occupational underachievement, unstable interpersonal relationships [1].

Pathogenesis: Research has shown that ADHD is a neurodevelopmental disorder with a strong genetic component. Neuroimaging studies have shown dysfunction in brain areas which are involved in attention and executive functions including the Prefrontal Cortex, the Limbic System, the Basal Ganglia and the Cerebellum. These functions are a constellation of cognitive skills which allow individuals to organize, plan, regulate and monitor their affect and behavior. The most influential neurobiological model of ADHD reports that the core deficit seems to be impaired response inhibition due to disturbed noradrenergic and dopaminergic neurotransmission which leads to ADHD clinical manifestations [2, 3].

Management: Pharmacological interventions constitute first-line ADHD treatment and have proven quite effective in the treatment of core symptoms. The most commonly used medications are psychostimulants and atomoxetine with a clinical response rate of 60%. However, recent large-scale studies have reported the need of a more integrated therapeutic approach that would also encompass educational and psychosocial interventions. Combined treatment regimens have been associated with better overall outcomes [4].

Conclusion: ADHD is a well-established neuropsychiatric disorder of childhood with significant morbidity, which merits proper clinical investigation and intervention.

References: 1. Antshel KM, Hargrave TM, Simonescu M, Kaul P, Hendricks K, Faraone SV. (2011). Advances in understanding and treating ADHD. BMC Med.10;9:72. Review. 2. Purper-Ouakil D, Ramoz N, Lepagnol-Bestel AM, Gorwood P, Simonneau M. (2011). Neurobiology of attention deficit/hyperactivity disorder. Pediatr Res. 69(5 Pt 2):69R-76R. Review. 3. Del Campo N, Chamberlain SR, Sahakian BJ, Robbins TW. (2011). The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biol Psychiatry. 15;69(12):e145-57. Review. 4. Murray DW, Arnold LE, Swanson J, Wells K, Burns K, Jensen P, Hechtman L, Paykina N, Legato L, Strauss T.(2008). A clinical review of outcomes of the multimodal treatment study of children with attention-deficit/hyperactivity disorder (MTA). Curr Psychiatry Rep. 10(5):424-31. Review.

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