Attention-deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders presenting for treatment in children. It carries a high rate of comorbid psychiatric problems such as oppositional defiant disorder (ODD), conduct disorder, mood and anxiety disorders, and cigarette and substance use disorders. Across the lifespan, the social and societal costs of untreated ADHD are considerable, including academic and occupational underachievement, delinquency, motor vehicle safety, and difficulties with personal relationships.
ADHD affects an estimated 4% to 12% of school-aged children worldwide with survey and epidemiologically derived data showing that 4 to 5% of college-aged students and adults have ADHD. In more recent years, the recognition and diagnosis of ADHD in adults have been increasing although treatment of adults with ADHD continues to lag substantially behind that of children. In contrast to a disproportionate rate of boys diagnosed with ADHD relative to girls in childhood, in adults, an equal number of men and women with ADHD are presenting for diagnosis and treatment.
Anxiety often confounds the diagnosis and treatment of ADHD. High rates of the various anxiety symptoms exist in ADHD and may manifest as social, generalized, or panic-like symptoms. Similarly, ADHD increases the likelihood of having a depressive disorder by at least two-fold. Interestingly, recent data suggest that stimulant treatment of ADHD over time may decrease the ultimate risk for anxiety and depressive disorders.
The diagnosis of ADHD is made clinically with scales used in an ancillary manner. The patient’s symptoms, the severity of impairment, possible comorbidity, family history, and psychosocial stressors may be determined during the patient and/or parent interview. In pediatric evaluations, the adolescent’s behavior and parent-child interaction are observed, and the child’s school, medical, and neurological status are evaluated. A number of diagnostic and follow-up scales are available. Symptom scales used with all age groups (to assess home, school, and job performance) include, but are not limited to, the ADHD Symptom Checklist, SNAP-IV Teacher and Parent Rating Scale, Conners Rating Scales-Revised,, Brown Attention-Deficit Disorder Scales for Children, and the ADHD Symptoms Rating Scale. Although these tools quantify behavior deviating from norms, they should not be used alone to make or refute the diagnosis.
The management of ADHD includes consideration of two major areas: non-pharmacological (educational remediation, individual and family psychotherapy) and pharmacotherapy. Support groups for children and adolescents and their families, as well as adults with ADHD, provide an invaluable and inexpensive environment in which individuals are able to learn about ADHD and the resources available for their children or themselves. Support groups can be accessed by calling an ADHD hotline or a large support group organization (i.e. Children and adults with ADHD-CHADD, Adults with ADHD-ADDA,), or by accessing the internet.