From the Guidelines
Yes, ADHD (Attention-Deficit/Hyperactivity Disorder) is a proven and well-established neurodevelopmental condition recognized by major medical and psychiatric organizations worldwide. ADHD involves persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning and development. The condition has been extensively studied for decades, with research showing differences in brain structure, function, and neurotransmitter systems in people with ADHD, as noted in a recent study published in Pharmacology and Therapeutics 1. Diagnosis typically involves comprehensive assessment by healthcare professionals using standardized criteria, such as those outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or the International Classification of Diseases, Tenth Revision (ICD-10).
Key Points
- Treatment often includes medication, such as stimulants like methylphenidate/Ritalin or amphetamine/Adderall at individualized doses, or non-stimulants like atomoxetine/Strattera, as well as behavioral therapy, educational support, and lifestyle modifications.
- Brain imaging studies have demonstrated differences in regions involved in attention and executive function, while genetic studies show ADHD has a heritability rate of approximately 74%, as discussed in a clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents published in Pediatrics 1.
- The existence of ADHD as a legitimate neurobiological condition is firmly established in medical science, with evidence from various studies, including a 2011 clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents published in Pediatrics 1.
- While some debate exists about overdiagnosis in certain populations, the legitimacy of the diagnosis of ADHD and the appropriate diagnostic criteria and procedures required to establish a diagnosis, identify comorbid conditions, and effectively treat with both psychosocial and pharmacologic interventions are clear, as stated in a recent study published in Pediatrics 1.
Recommendations
- The primary care clinician should initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity, as recommended in a clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents published in Pediatrics 1.
- Treatment should be individualized and may include a combination of medication, behavioral therapy, and lifestyle modifications, as discussed in a study published in Pharmacology and Therapeutics 1.
From the FDA Drug Label
The specific etiology of ADHD is unknown, and there is no single diagnostic test. 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.
ADHD is a recognized condition in the medical community, as indicated by its inclusion in the DSM-IV and its treatment with medications such as atomoxetine. However, the exact cause of ADHD is not known.
- The diagnosis of ADHD is based on the presence of specific symptoms, including hyperactive-impulsive or inattentive symptoms, that cause impairment and were present before age 7 years.
- There is no single diagnostic test for ADHD, and diagnosis requires a comprehensive evaluation of the patient, including medical, psychological, educational, and social resources 2.
From the Research
Definition and Diagnosis of ADHD
- Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing disorder affecting children, adolescents, and adults 3.
- The diagnosis of ADHD is based on the observance of specific behaviors in multiple settings, and although there are differences in specific areas of the brain, and a high heritability estimate (∼76%), they are not diagnostically specific 4.
- The clinical presentation and course of the disorder have been extensively characterized, and efficacious medication-based treatments are available and widely used 5.
Treatment of ADHD
- Several treatment strategies are available for ADHD, ranging from pharmacological to dietary interventions, and an informed selection or prioritization of treatments is becoming harder for clinicians 3.
- Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy, and behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy 4.
- Combined methylphenidate and atomoxetine pharmacotherapy has been shown to be effective in reducing ADHD symptoms, with significant improvement in symptoms observed in 9 out of 12 patients in one study 6.
- A systematic review and meta-analysis found that methylphenidate and atomoxetine were effective in reducing hyperactivity and inattention in children and youth with autism spectrum disorder (ASD) and co-occurring ADHD symptoms 7.
Efficacy and Safety of ADHD Treatments
- The efficacy and safety of pharmacotherapy for the treatment of ADHD symptoms in children and youth with ASD have been evaluated in several studies, with findings suggesting that methylphenidate and atomoxetine are effective and tolerable treatments 7.
- However, the quality of evidence for all interventions was low/very low, and consideration of the benefits weighed against the limitations of safety/efficacy data and lack of data evaluating long-term continuation is necessary to guide clinical decision-making 7.
- Methylphenidate was associated with a nonsignificant elevated risk of dropout due to adverse events, and common side effects of combined methylphenidate and atomoxetine pharmacotherapy included irritability, appetite reduction, palpitations, and headache 6, 7.