Attention-deficit/hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood psychiatric disorders. Most children with the disorder continue to exhibit significant symptoms as adults as well. Symptoms include inattention, hyperactivity or restlessness, and poor impulse control. ADHD is associated with a strong genetic component via twin, adoption, and family pedigree studies. Molecular genetic study findings, however, suggest genetic heterogeneity underlying similar ADHD phenotypes with support for many genes with only small effects typically contributing to the disorder. Both the dopaminergic and noradrenergic system appear to be altered in ADHD. Structural and functional alterations in frontal and cingulate cortices, basal ganglia, and cerebellar regions are routinely found in ADHD. These altered neurotransmitter systems and neuroanatomical regions subserve cognitive control and reward responsivity functioning – processes that are impaired in ADHD. Current recommendations for evaluating ADHD include the use of interviews and cross-informant and normed rating scales for children and adults with suspected ADHD. Possible comorbid disorders or disorders that may mimic ADHD should also be evaluated. The efficacy of pharmacological treatment for children and adults is well established. Stimulant medications are the recommended first-line psychopharmacological treatment of ADHD; however there are nonstimulant medications that are efficacious in treating ADHD and associated symptoms. School and parent-based behavioral interventions for ADHD can also address ADHD-associated symptoms in children. The benefits of medication or behavioral interventions may not be sustained after active treatment and monitoring of the treatment cease. There is initial support for the application of cognitive-behavioral treatment of ADHD symptoms in adults. Future research should attempt more targeted treatment informed by advances in neuroscience findings.