What is Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which requires an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms for at least 6 months, with multiple symptoms present in two or more settings, and evidence that these symptoms interfere with or reduce the quality of functioning 1.

Key Characteristics of ADHD

• Inattentive symptoms: poor attention to detail, difficulty concentrating, seems preoccupied, difficulty in shifting focus, difficulty with completing tasks, organizational challenges, reluctance to engage in tasks that require sustained mental effort, difficulty keeping track of personal belongings, easily distracted, and frequently forgetful
• Hyperactive-impulsive symptoms: frequent fidgeting, difficulty sitting still, feeling of inner restlessness or agitation, often loud and disruptive, always on the go, difficulty waiting in line, often talks excessively, frequently interrupts others, and often intrudes into others’ activities

Diagnostic Criteria

The diagnosis of ADHD requires a comprehensive evaluation, including a clinical interview, physical examination, and assessment of symptoms using standardized tools such as the Adult ADHD Self-Report Scale (ASRS-V1.1) 1.

Treatment

Treatment typically involves a combination of medication and behavioral therapy, with the goal of improving symptoms, functioning, and quality of life. First-line medications include stimulants like methylphenidate and amphetamine-based medications, as well as non-stimulant options like atomoxetine and guanfacine 1.

Importance of Early Diagnosis and Treatment

Early diagnosis and consistent treatment can significantly improve quality of life, academic/work performance, and relationships for those with ADHD, by addressing the underlying symptoms and improving executive functions like attention, impulse control, and working memory 1.

From the FDA Drug Label

A diagnosis of ADHD (DSM-IV) implies the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and that were present before age 7 years. The symptoms must be persistent, must be more severe than is typically observed in individuals at a comparable level of development, must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and must be present in 2 or more settings, e.g., school (or work) and at home.

Attention Deficit Hyperactivity Disorder (ADHD) is a condition characterized by the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and were present before age 7 years. The symptoms must be:

• Persistent
• More severe than typically observed in individuals at a comparable level of development
• Cause clinically significant impairment in social, academic, or occupational functioning
• Present in 2 or more settings, such as school and home 2 2. Key symptoms for diagnosis include:
• Inattentive Type: lack of attention to details, lack of sustained attention, poor listener, etc.
• Hyperactive-Impulsive Type: fidgeting, leaving seat, inappropriate running, etc.
• Combined Type: both inattentive and hyperactive-impulsive criteria must be met.

From the Research

Definition and Overview of ADHD

• Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition associated with impaired function and increased risk of poor outcomes in children, young people, and adults with the condition 3.
• ADHD is one of the most commonly diagnosed psychiatric disorders in childhood, and it often persists into adulthood 4, 5.
• The condition is characterized by symptoms of inattention, distractibility, impulsivity, and emotional lability 6, 7.

Symptoms and Diagnosis of ADHD

• The clinical presentation of ADHD in adults involves the symptom triad of inattention, hyperactivity, and impulsivity, although hyperactivity is often internalized 7.
• Symptoms of inattention may be masked by anxiety symptoms or obsessive-like compensation strategies 7.
• ADHD is often associated with other psychiatric disorders, including mood disorders, anxiety disorders, and substance-use disorders 7.
• The diagnostic procedure for ADHD in adults should be systematic, and a full examination should assess medical conditions associated with ADHD to provide personalized care 7.

Treatment Options for ADHD

• Currently approved pharmacological treatments for ADHD include stimulant and non-stimulant medications, which have been shown to be effective in treating the symptoms of ADHD and improving functional outcomes 3.
• Psychostimulant treatment is recommended as a first-line therapy in the management plan because it has a substantial impact on alleviating the core symptoms of ADHD 5.
• Medications, especially psychostimulants, are effective for alleviating ADHD symptoms with a large effect size, and their safety and tolerance are satisfactory 7.
• Non-pharmacological interventions, such as cognitive-behavioral therapy and psycho-education, are also useful in the management of ADHD 4, 7.