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November 22, 2025
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Background
ADHD is a developmental disorder which is characterized by attention and distractibility issues, often accompanied by hyperactivity. The Diagnostic and Statistical Manual Fifth Edition (DSM-5) identifies three main types: predominantly inattentive, predominantly hyperactive/impulsive, and combined. Â
Inattentive types exhibit persistent symptoms for six months or more such as difficulty in maintaining attention, following instructions, organization problems, avoiding tasks requiring sustained mental effort, frequently loss of necessary items, and forgetfulness. Â
Hyperactive/impulsive types display persistent symptoms for six months or more such as fidgeting, excessive running, and difficulty in playing quietly. Other criteria include onset before age 12 and symptoms present in multiple settings that is significant impairment in social, academic/occupational functioning, and not explained by other disorders. ADHD severity is determined based on degree of impairment. Â
In a case study involving a 7-year-old boy with behavioral issues, further assessment is necessary before considering treatment. Â
The doctor recommends observation, consultation with the teacher, psychological testing, and individual sessions with the child. Both the physician and parents are cautious about medication use and prioritize exploring in behavioral interventions.Â
Epidemiology
In 2016 about 6.1 million children in the United States aged 2-17 years were diagnosed with ADHD which accounting for 9.4% of this age group. Currently, 5.4 million children have ADHD that constituting 89.4% of those ever diagnosed and 8.4% of all children aged 2-17 in the US. Â
Roughly 62% of children with current ADHD are taking medication while 46.7% have received behavioral treatment within the past year. A study by CDC researchers revealed that by 2011 > 1 in 10 school-aged children (4-17 years) in the US had been diagnosed with ADHD. The prevalence of diagnosed ADHD increased by 42% between 2003 and 2011.Â
A study led by Akinbami and colleagues showed that ADHD prevalence varied across racial and ethnic groups with Mexican children consistently exhibiting lower prevalence rates. From 1998 to 2009Â the ADHD prevalence increased to 10% among children from families with incomes less than 100% of the poverty level and to 11% among those with incomes ranging from 100-199% of the poverty level. ADHD prevalence had rose to 10% in the Midwest and Southern regions of the United States during the same period.Â
In Great Britain the cases reported with incidence rate of < 1% possibly due to cultural differences and variations in ADHD heterogeneity. Childhood ADHD is identified as a risk factor for subsequent conduct and substance abuse issues which can carry significant mortality and morbidity implications.Â
Anatomy
Pathophysiology
ADHD is a disorder characterized by attention deficit hyperactivity disorder, is a brain disorder characterized by a lack of dopamine and norepinephrine. Treatments like psychostimulants and noradrenergic tricyclics have raised concerns about neural deficiencies in areas linked to attention. PET scan imaging suggests that methylphenidate boosts dopamine levels, with dopamine and norepinephrine being linked to ADHD. The brain is primarily implicated in the frontal and prefrontal areas with potential involvement of the parietal lobe and cerebellum. Â
Functional MRI studies have shown different activation patterns in frontostriatal areas during response-inhibition tasks in children with ADHD compared to controls. Studies suggest that malfunctioning in frontostriatal circuits contributes to ADHD’s etiology. Â
In adults with ADHD the dopamine activity in caudate regions is reduced, linked to inattention and enhanced responses to methylphenidate. In preschoolers, structural brain changes are evident with reductions in gray matter volumes in frontal, parietal, and temporal lobes compared to typically developing children.Â
Etiology
The study of family hereditary suggest 70 to 80% ADHD diversity. Dopamine and norepinephrine is crucial in neurotransmitters.Â
Dopamine hypothesis suggests lower dopamine levels. This dysregulation may contribute to ADHD symptoms.Â
Genetics
Prognostic Factors
Prognosis of ADHD depends on factors including early diagnosis, Intervention, and cognitive Profile. The early diagnosis and intervention both have significant impact on prognosis.Â
Some behavioural therapies and medication can control symptoms and help to enhance functioning. The prognosis may affect by some comorbid conditions such as ODD, anxiety, and mood disorders.Â
Clinical History
For 3 to 5 years old: Normal variability in attention and activity levels.Â
For 6 to 12 years old: Academic struggles, task organization difficulties, frequent item loss, interruptions.Â
Physical Examination
Medical HistoryÂ
Vision and Hearing ScreeningÂ
Blood TestsÂ
Thyroid Function TestsÂ
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Adolescence at the age of 13 to 17 years old may bring new challenges. Hence symptoms may become more noticeable as academic and social expectations increase. Â
Adults at the age of >18 years old may need help as the demands of adulthood bring challenges in managing responsibilities.Â
Differential Diagnoses
Intellectual Disabilities Â
Anxiety DisordersÂ
Depressive DisordersÂ
Autism Spectrum Disorders Â
Seizure DisordersÂ
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
ADHD treatment has evolved by focusing on various therapeutic modalities such as environmental restructuring, behavioral therapy, Behavioral Parent Training (BPT), and Behavioral Classroom Management (BCM). Combining behavioral psychotherapy with an appropriate medication regimen, typically utilizing stimulants, has shown success, especially in adults with ADHD. However, common adverse effects include appetite suppression, weight loss, headaches, and mood alterations.Â
Stimulant therapy may exacerbate tic disorders in children predisposed to such conditions, and concerns about their impact on growth remain unclear. Studies have indicated that while psychosis risk exists, it is relatively low, with amphetamine use associated with a slightly higher risk compared to methylphenidate. Stimulant therapy does not appear to increase the likelihood of future substance abuse.Â
Beyond stimulants, other medications like atomoxetine (Strattera) and viloxazine (Qelbree) offer nonstimulant options, with varying degrees of efficacy compared to stimulants. Alternative pharmacological interventions, such as tricyclic antidepressants, clonidine, guanfacine, and modafinil, also present unique considerations and potential side effects.Â
Behavioral psychotherapy plays a significant role in managing ADHD symptoms, aiding in establishing routines, organization, and focus. Psychosocial interventions like BPT and BCM complement pharmacotherapy, particularly in children and adolescents. Nonpharmacological interventions, such as dietary modifications, physical activity, and emerging treatments like trigeminal nerve stimulation (TNS), offer additional avenues for managing ADHD symptoms.Â
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-a-non-pharmacological-approach-for-treating-adhd
Teach parents new behavioural management techniques.Â
Engage individuals with ADHD in structured programs that produces positive behaviours and help develop self-control. Â
Guide individuals to recognize and change the negative thought patterns.Â
Provide a structured environment for individuals with ADHD to create social and communication skills. Â
Role of Stimulants in the treatment of ADHD
Methylphenidate:Â
The FDA-approved it as a primary choice for managing ADHD in children aged 6 and above and is extensively prescribed and available in sustained-release formulations including a delayed-release bedtime dosage form and is extensively prescribed.Â
Dexmethylphenidate:Â
It is a potent d-enantiomer of racemic methylphenidate that inhibits norepinephrine and dopamine reuptake in presynaptic neurons by enhancing their release and is available in extended-release capsules for daily dosing.Â
Dextroamphetamine and amphetamine:Â
This combination drug is available in immediate-release tablets and extended-release capsules which induce central nervous system and respiratory stimulation that primarily affecting the cerebral cortex and reticular activating system.Â
Dextroamphetamine:Â
FDA-approved this for use in children aged 3 and older and is commonly used as a first-line treatment or in cases of methylphenidate intolerance.Â
Serdexmethylphenidate/methylphenidate:Â
It is a fixed-dose combination of dexmethylphenidate and immediate-release dexmethylphenidate, designed for ADHD management in adults and children aged 6 and older.Â
Role of Selective Norepinephrine Reuptake Inhibitors in the treatment of ADHD
Atomoxetine:Â
It is a medication that selectively inhibits the presynaptic norepinephrine transporter to alleviate symptoms of ADHD.Â
Viloxazine:Â
It is a medication that selectively inhibits norepinephrine reuptake may be a potential treatment for ADHD in children and adolescents aged 6-17 years.Â
Use of Atypical Antidepressants
Its brand name is Wellbutrin that inhibits neuronal dopamine reuptake and weakly blocks serotonin and norepinephrine reuptake available in sustained-release formulations.Â
This drug is used to inhibit serotonin and norepinephrine reuptake and induce beta-receptor down-regulation and is available in sustained-release forms like Effexor XR.Â
use-of-intervention-with-a-procedure-in-treating-adhd
The real-time monitoring of brain activity is recorded in neurofeedback is a type of biofeedback.Â
A non-invasive process called transcranial magnetic stimulation in this it stimulates brain nerve cells with magnetic fields. Â
In deep brain stimulation the electrodes are inserted into brain regions during the invasive DBS operation. Â
use-of-phases-in-managing-adhd
The assessment phase begins with the identification of ADHD symptoms. This may involve input from parents, teachers, and healthcare professionals. Â
To achieve specific goals for the individual with ADHD a proper plan should be programmed. Physicians should call for follow-up appointments to examine patients treatment response and progress. Â
Medication
ER orally disintegrating tablet/oral suspension:
12.5
mg
Orally 
once a day
Dyanavel XR oral suspension:
Initial dose: 2.5 or 5 mg orally once daily morning
Increase up to 10 mg per day every day for 4 to 7 days until the required response is achieved (Do not exceed 20 mg/day)
Immediate release:
Initial dose: 5 mg orally disintegrating tablet once or twice a day
Increase 5 mg at weekly intervals until the required response is achieved (preferred to be given in intervals of 4 to 6 hours at the early morning)
Initial dose:
5
mg
Orally 
once or twice a day (administer in the early morning)
Increase 5 mg at weekly intervals until the required response is achieved (usual effective dose: 20 to 25 mg divided into two doses per day)
40
mg
Orally 
once a day
Increase after 3 days to 40 mg twice a day (at the morning and night)
40
mg
Capsule
Orally 
once a day
increase the dose to 80 mg after 3 days
25
mg
Capsule
Orally 
every 6-8 hours
Initially, 150 mg/day orally
Standardize to 150-450 mg/day based on efficacy and tolerability
Administer as sustained or extended-release formulations
dextroamphetamine transdermalÂ
apply to the application site at least 2 hours prior when the effect is needed
application should be removed within 9 hours after it has been applied
starting dose for the patch is 9 mg/9 hour, with the option to increase the dosage up to 18 mg/9 hour as needed
amphetamine/dextroamphetamineÂ
(immediate-release)
starting dose is 5 mg, taken orally once or twice a day
dose may be escalated by 5 mg per week if necessary
40 mg per day is the maximum dose limit higher doses are rarely necessary
(extended-release)
“Starting treatment for the first time or transitioning from another medication”
20 mg orally everyday
Starting dose: 200 mg orally once a day
After one week, the dosage may be increased by 200 mg per week. The maximum daily dose should not exceed 600 mg/day, depending on the patient's response and ability to tolerate the medication
Dosage Modifications
Renal impairment
Mild-to-moderate: No need to modify the dosage
Severe: Commence with 100 mg per day and can be raised by 50 to 100 mg/day every week also should not go beyond 200 mg/day
Hepatic impairment
Dose modification not suggested
Dosing Considerations
Before starting
Assess for any personal or familial history of bipolar disorder, depression, or suicidal tendencies
During therapy
Be aware of any clinical deterioration and the emergence of suicidal ideation or actions: This is particularly important during the early stages of treatment and after any alterations to the dosage
200
mg
once a day
2
months
ER orally disintegrating tablet/oral suspension: :
For >6 years: 6.3 mg orally once daily (Increase 3.1 mg or 6.3 mg at weekly intervals) (NMT 12.5 mg/day)
Or
2.5 or 5 mg oral suspension once every morning, increase gradually to 10 mg/day every 4 to 7 days until the required response is obtained (NMT 20 mg/day)
Immediate release:
For 3 to 5 years: 2.5 mg initially orally disintegrating tablets once daily, increase gradually 2.5 mg every week until required response is obtained
Maintain 5 to 40 mg/day in divided doses after initial recovery
For >6 years: 5 mg initially orally disintegrating tablets once daily, increase gradually 2.5 mg every week until required response is obtained
Maintain 5 to 40 mg/day in divided doses after initial recovery
Immediate release::
For 3 to 5 years: 2.5 mg initially oral tablet/solution once daily, increase gradually 2.5 mg every week until required response is obtained
Maintain 5 to 40 mg/day in divided doses after initial recovery
For >6 years: 5 mg initially oral tablet/solution once daily, increase gradually 2.5 mg every week until required response is obtained
Maintain 5 to 40 mg/day in divided doses after initial recovery
For >6 years: Initial dose:
5
mg
Orally 
once or twice a day (administer in the early morning)
Increase 5 mg at weekly intervals until the required response is achieved (usual effective dose: 20 to 25 mg divided into two doses per day)
Children > 6 years to 13 years
For weight <30kg:
200 - 300
mg
Tablet
Oral
once a day
For weight >30kg: 300 to 425 mg once a day
Children > 6 years to 13 years::
For weight <30kg: 200 mg to 340 mg once a day
For weight >30kg: 300 to 425 mg once a day
40
mg
Capsule
Orally 
once a day
increase the dose to 80 mg after 3 days
150
mg
Tablet
Orally 
once a day
0.5mg/kg/day orally, increase to a maximum 2mg/kg/day or 100mg
(Off-Label)
Immediate-release
Initially, 3 mg/kg per day or 150 mg/day orally
Standardize to 6 mg/kg/day or a maximum of 300 mg each day
Do not exceed more than 150 mg
Extended-Release
Initially, 3 mg/kg per day or 150 mg/day orally
Standardize to 6 mg/kg/day or a maximum of 300 mg each day
Sustained-Release
Initially, 3 mg/kg per day or 150 mg/day orally
Standardize to 6 mg/kg/day or a maximum of 300 mg each day
dextroamphetamine transdermalÂ
Age 6-17 years:
patch should be applied to the skin at least 2 hours prior should be removed within 9 hours of application
starting dose is a 4.5 mg/9 hour patch
dose may be increased by 4.5 mg per week
but the maximum dose is 18 mg/9 hour
amphetamine/dextroamphetamineÂ
(immediate-release)
Age 3-5 Years:
starting dose is 2.5 mg per day, taken orally
daily dose may be increased by 2.5 mg each week
Age 6-17 Years:
starting dose is 5 mg, to be taken orally once or twice per day
dose may be increased by 5 mg every week
maximum dose is typically 40 mg per day, and only in rare circumstances would a higher dose be necessary
(extended-release)
Age 6-12 Years:
“Starting treatment for the first time or transitioning from another medication”
starting dose is to take either 5 or 10 mg orally once per day in the morning
dose may be increased by 5 to 10 mg each week as needed
The maximum daily dose is 30 mg
Age 13-17 Years:
“Starting treatment for the first time or transitioning from another medication”
Starting dose is 10 mg, taken orally once per day
dose of the medication may be raised to 20 mg if the symptoms deteriorate
The maximum daily dose is 30 mg
For <6 years: Safety and efficacy not determined
For 6 to 11 years
Starting dosage: 100 mg orally once a day
The dosage may be raised by 100 mg every week but should not exceed 400 mg/day
This is subject to the individual's response to the medication and their ability to tolerate it
For 12 to 17 years
Starting dose: 200 mg taken orally once a day
After a week, the dosage may be raised by 200 mg per week, up to a maximum of 400 mg/day, based on the individual's response and ability to tolerate the medication
Dosage Modifications
Renal impairment
Mild-to-moderate: No need to modify the dosage
Severe: Commence with 100 mg per day and can be raised by 50 to 100 mg/day every week also should not go beyond 200 mg/day
Hepatic impairment
Dose modification not suggested
Dosing Considerations
Before starting
Assess for any personal or familial history of bipolar disorder, depression or suicidal tendencies
During therapy
Be aware of any clinical deterioration and the emergence of suicidal ideation or actions: This is particularly important during the early stages of treatment and after any alterations to the dosage
Indicated for ADHD
200-300 mg orally every day
Oral administration of 0.1 mg of extended-release tablets in children who are six years or older at bedtime when initiated. Increase in dose with 0.1 mg/day every week until the desired response is shown, which is not exceeded by 0.4 mg/day
Discontinuation needs to gradually taper the dose, which should not exceed 0.1 mg every week or three days
Future Trends
ADHD is a developmental disorder which is characterized by attention and distractibility issues, often accompanied by hyperactivity. The Diagnostic and Statistical Manual Fifth Edition (DSM-5) identifies three main types: predominantly inattentive, predominantly hyperactive/impulsive, and combined. Â
Inattentive types exhibit persistent symptoms for six months or more such as difficulty in maintaining attention, following instructions, organization problems, avoiding tasks requiring sustained mental effort, frequently loss of necessary items, and forgetfulness. Â
Hyperactive/impulsive types display persistent symptoms for six months or more such as fidgeting, excessive running, and difficulty in playing quietly. Other criteria include onset before age 12 and symptoms present in multiple settings that is significant impairment in social, academic/occupational functioning, and not explained by other disorders. ADHD severity is determined based on degree of impairment. Â
In a case study involving a 7-year-old boy with behavioral issues, further assessment is necessary before considering treatment. Â
The doctor recommends observation, consultation with the teacher, psychological testing, and individual sessions with the child. Both the physician and parents are cautious about medication use and prioritize exploring in behavioral interventions.Â
In 2016 about 6.1 million children in the United States aged 2-17 years were diagnosed with ADHD which accounting for 9.4% of this age group. Currently, 5.4 million children have ADHD that constituting 89.4% of those ever diagnosed and 8.4% of all children aged 2-17 in the US. Â
Roughly 62% of children with current ADHD are taking medication while 46.7% have received behavioral treatment within the past year. A study by CDC researchers revealed that by 2011 > 1 in 10 school-aged children (4-17 years) in the US had been diagnosed with ADHD. The prevalence of diagnosed ADHD increased by 42% between 2003 and 2011.Â
A study led by Akinbami and colleagues showed that ADHD prevalence varied across racial and ethnic groups with Mexican children consistently exhibiting lower prevalence rates. From 1998 to 2009Â the ADHD prevalence increased to 10% among children from families with incomes less than 100% of the poverty level and to 11% among those with incomes ranging from 100-199% of the poverty level. ADHD prevalence had rose to 10% in the Midwest and Southern regions of the United States during the same period.Â
In Great Britain the cases reported with incidence rate of < 1% possibly due to cultural differences and variations in ADHD heterogeneity. Childhood ADHD is identified as a risk factor for subsequent conduct and substance abuse issues which can carry significant mortality and morbidity implications.Â
ADHD is a disorder characterized by attention deficit hyperactivity disorder, is a brain disorder characterized by a lack of dopamine and norepinephrine. Treatments like psychostimulants and noradrenergic tricyclics have raised concerns about neural deficiencies in areas linked to attention. PET scan imaging suggests that methylphenidate boosts dopamine levels, with dopamine and norepinephrine being linked to ADHD. The brain is primarily implicated in the frontal and prefrontal areas with potential involvement of the parietal lobe and cerebellum. Â
Functional MRI studies have shown different activation patterns in frontostriatal areas during response-inhibition tasks in children with ADHD compared to controls. Studies suggest that malfunctioning in frontostriatal circuits contributes to ADHD’s etiology. Â
In adults with ADHD the dopamine activity in caudate regions is reduced, linked to inattention and enhanced responses to methylphenidate. In preschoolers, structural brain changes are evident with reductions in gray matter volumes in frontal, parietal, and temporal lobes compared to typically developing children.Â
The study of family hereditary suggest 70 to 80% ADHD diversity. Dopamine and norepinephrine is crucial in neurotransmitters.Â
Dopamine hypothesis suggests lower dopamine levels. This dysregulation may contribute to ADHD symptoms.Â
Prognosis of ADHD depends on factors including early diagnosis, Intervention, and cognitive Profile. The early diagnosis and intervention both have significant impact on prognosis.Â
Some behavioural therapies and medication can control symptoms and help to enhance functioning. The prognosis may affect by some comorbid conditions such as ODD, anxiety, and mood disorders.Â
For 3 to 5 years old: Normal variability in attention and activity levels.Â
For 6 to 12 years old: Academic struggles, task organization difficulties, frequent item loss, interruptions.Â
Medical HistoryÂ
Vision and Hearing ScreeningÂ
Blood TestsÂ
Thyroid Function TestsÂ
Adolescence at the age of 13 to 17 years old may bring new challenges. Hence symptoms may become more noticeable as academic and social expectations increase. Â
Adults at the age of >18 years old may need help as the demands of adulthood bring challenges in managing responsibilities.Â
Intellectual Disabilities Â
Anxiety DisordersÂ
Depressive DisordersÂ
Autism Spectrum Disorders Â
Seizure DisordersÂ
ADHD treatment has evolved by focusing on various therapeutic modalities such as environmental restructuring, behavioral therapy, Behavioral Parent Training (BPT), and Behavioral Classroom Management (BCM). Combining behavioral psychotherapy with an appropriate medication regimen, typically utilizing stimulants, has shown success, especially in adults with ADHD. However, common adverse effects include appetite suppression, weight loss, headaches, and mood alterations.Â
Stimulant therapy may exacerbate tic disorders in children predisposed to such conditions, and concerns about their impact on growth remain unclear. Studies have indicated that while psychosis risk exists, it is relatively low, with amphetamine use associated with a slightly higher risk compared to methylphenidate. Stimulant therapy does not appear to increase the likelihood of future substance abuse.Â
Beyond stimulants, other medications like atomoxetine (Strattera) and viloxazine (Qelbree) offer nonstimulant options, with varying degrees of efficacy compared to stimulants. Alternative pharmacological interventions, such as tricyclic antidepressants, clonidine, guanfacine, and modafinil, also present unique considerations and potential side effects.Â
Behavioral psychotherapy plays a significant role in managing ADHD symptoms, aiding in establishing routines, organization, and focus. Psychosocial interventions like BPT and BCM complement pharmacotherapy, particularly in children and adolescents. Nonpharmacological interventions, such as dietary modifications, physical activity, and emerging treatments like trigeminal nerve stimulation (TNS), offer additional avenues for managing ADHD symptoms.Â
Psychiatry/Mental Health
Teach parents new behavioural management techniques.Â
Engage individuals with ADHD in structured programs that produces positive behaviours and help develop self-control. Â
Guide individuals to recognize and change the negative thought patterns.Â
Provide a structured environment for individuals with ADHD to create social and communication skills. Â
Psychiatry/Mental Health
Methylphenidate:Â
The FDA-approved it as a primary choice for managing ADHD in children aged 6 and above and is extensively prescribed and available in sustained-release formulations including a delayed-release bedtime dosage form and is extensively prescribed.Â
Dexmethylphenidate:Â
It is a potent d-enantiomer of racemic methylphenidate that inhibits norepinephrine and dopamine reuptake in presynaptic neurons by enhancing their release and is available in extended-release capsules for daily dosing.Â
Dextroamphetamine and amphetamine:Â
This combination drug is available in immediate-release tablets and extended-release capsules which induce central nervous system and respiratory stimulation that primarily affecting the cerebral cortex and reticular activating system.Â
Dextroamphetamine:Â
FDA-approved this for use in children aged 3 and older and is commonly used as a first-line treatment or in cases of methylphenidate intolerance.Â
Serdexmethylphenidate/methylphenidate:Â
It is a fixed-dose combination of dexmethylphenidate and immediate-release dexmethylphenidate, designed for ADHD management in adults and children aged 6 and older.Â
Psychiatry/Mental Health
Atomoxetine:Â
It is a medication that selectively inhibits the presynaptic norepinephrine transporter to alleviate symptoms of ADHD.Â
Viloxazine:Â
It is a medication that selectively inhibits norepinephrine reuptake may be a potential treatment for ADHD in children and adolescents aged 6-17 years.Â
Psychiatry/Mental Health
Its brand name is Wellbutrin that inhibits neuronal dopamine reuptake and weakly blocks serotonin and norepinephrine reuptake available in sustained-release formulations.Â
This drug is used to inhibit serotonin and norepinephrine reuptake and induce beta-receptor down-regulation and is available in sustained-release forms like Effexor XR.Â
Psychiatry/Mental Health
The real-time monitoring of brain activity is recorded in neurofeedback is a type of biofeedback.Â
A non-invasive process called transcranial magnetic stimulation in this it stimulates brain nerve cells with magnetic fields. Â
In deep brain stimulation the electrodes are inserted into brain regions during the invasive DBS operation. Â
Psychiatry/Mental Health
The assessment phase begins with the identification of ADHD symptoms. This may involve input from parents, teachers, and healthcare professionals. Â
To achieve specific goals for the individual with ADHD a proper plan should be programmed. Physicians should call for follow-up appointments to examine patients treatment response and progress. Â
ADHD is a developmental disorder which is characterized by attention and distractibility issues, often accompanied by hyperactivity. The Diagnostic and Statistical Manual Fifth Edition (DSM-5) identifies three main types: predominantly inattentive, predominantly hyperactive/impulsive, and combined. Â
Inattentive types exhibit persistent symptoms for six months or more such as difficulty in maintaining attention, following instructions, organization problems, avoiding tasks requiring sustained mental effort, frequently loss of necessary items, and forgetfulness. Â
Hyperactive/impulsive types display persistent symptoms for six months or more such as fidgeting, excessive running, and difficulty in playing quietly. Other criteria include onset before age 12 and symptoms present in multiple settings that is significant impairment in social, academic/occupational functioning, and not explained by other disorders. ADHD severity is determined based on degree of impairment. Â
In a case study involving a 7-year-old boy with behavioral issues, further assessment is necessary before considering treatment. Â
The doctor recommends observation, consultation with the teacher, psychological testing, and individual sessions with the child. Both the physician and parents are cautious about medication use and prioritize exploring in behavioral interventions.Â
In 2016 about 6.1 million children in the United States aged 2-17 years were diagnosed with ADHD which accounting for 9.4% of this age group. Currently, 5.4 million children have ADHD that constituting 89.4% of those ever diagnosed and 8.4% of all children aged 2-17 in the US. Â
Roughly 62% of children with current ADHD are taking medication while 46.7% have received behavioral treatment within the past year. A study by CDC researchers revealed that by 2011 > 1 in 10 school-aged children (4-17 years) in the US had been diagnosed with ADHD. The prevalence of diagnosed ADHD increased by 42% between 2003 and 2011.Â
A study led by Akinbami and colleagues showed that ADHD prevalence varied across racial and ethnic groups with Mexican children consistently exhibiting lower prevalence rates. From 1998 to 2009Â the ADHD prevalence increased to 10% among children from families with incomes less than 100% of the poverty level and to 11% among those with incomes ranging from 100-199% of the poverty level. ADHD prevalence had rose to 10% in the Midwest and Southern regions of the United States during the same period.Â
In Great Britain the cases reported with incidence rate of < 1% possibly due to cultural differences and variations in ADHD heterogeneity. Childhood ADHD is identified as a risk factor for subsequent conduct and substance abuse issues which can carry significant mortality and morbidity implications.Â
ADHD is a disorder characterized by attention deficit hyperactivity disorder, is a brain disorder characterized by a lack of dopamine and norepinephrine. Treatments like psychostimulants and noradrenergic tricyclics have raised concerns about neural deficiencies in areas linked to attention. PET scan imaging suggests that methylphenidate boosts dopamine levels, with dopamine and norepinephrine being linked to ADHD. The brain is primarily implicated in the frontal and prefrontal areas with potential involvement of the parietal lobe and cerebellum. Â
Functional MRI studies have shown different activation patterns in frontostriatal areas during response-inhibition tasks in children with ADHD compared to controls. Studies suggest that malfunctioning in frontostriatal circuits contributes to ADHD’s etiology. Â
In adults with ADHD the dopamine activity in caudate regions is reduced, linked to inattention and enhanced responses to methylphenidate. In preschoolers, structural brain changes are evident with reductions in gray matter volumes in frontal, parietal, and temporal lobes compared to typically developing children.Â
The study of family hereditary suggest 70 to 80% ADHD diversity. Dopamine and norepinephrine is crucial in neurotransmitters.Â
Dopamine hypothesis suggests lower dopamine levels. This dysregulation may contribute to ADHD symptoms.Â
Prognosis of ADHD depends on factors including early diagnosis, Intervention, and cognitive Profile. The early diagnosis and intervention both have significant impact on prognosis.Â
Some behavioural therapies and medication can control symptoms and help to enhance functioning. The prognosis may affect by some comorbid conditions such as ODD, anxiety, and mood disorders.Â
For 3 to 5 years old: Normal variability in attention and activity levels.Â
For 6 to 12 years old: Academic struggles, task organization difficulties, frequent item loss, interruptions.Â
Medical HistoryÂ
Vision and Hearing ScreeningÂ
Blood TestsÂ
Thyroid Function TestsÂ
Adolescence at the age of 13 to 17 years old may bring new challenges. Hence symptoms may become more noticeable as academic and social expectations increase. Â
Adults at the age of >18 years old may need help as the demands of adulthood bring challenges in managing responsibilities.Â
Intellectual Disabilities Â
Anxiety DisordersÂ
Depressive DisordersÂ
Autism Spectrum Disorders Â
Seizure DisordersÂ
ADHD treatment has evolved by focusing on various therapeutic modalities such as environmental restructuring, behavioral therapy, Behavioral Parent Training (BPT), and Behavioral Classroom Management (BCM). Combining behavioral psychotherapy with an appropriate medication regimen, typically utilizing stimulants, has shown success, especially in adults with ADHD. However, common adverse effects include appetite suppression, weight loss, headaches, and mood alterations.Â
Stimulant therapy may exacerbate tic disorders in children predisposed to such conditions, and concerns about their impact on growth remain unclear. Studies have indicated that while psychosis risk exists, it is relatively low, with amphetamine use associated with a slightly higher risk compared to methylphenidate. Stimulant therapy does not appear to increase the likelihood of future substance abuse.Â
Beyond stimulants, other medications like atomoxetine (Strattera) and viloxazine (Qelbree) offer nonstimulant options, with varying degrees of efficacy compared to stimulants. Alternative pharmacological interventions, such as tricyclic antidepressants, clonidine, guanfacine, and modafinil, also present unique considerations and potential side effects.Â
Behavioral psychotherapy plays a significant role in managing ADHD symptoms, aiding in establishing routines, organization, and focus. Psychosocial interventions like BPT and BCM complement pharmacotherapy, particularly in children and adolescents. Nonpharmacological interventions, such as dietary modifications, physical activity, and emerging treatments like trigeminal nerve stimulation (TNS), offer additional avenues for managing ADHD symptoms.Â
Psychiatry/Mental Health
Teach parents new behavioural management techniques.Â
Engage individuals with ADHD in structured programs that produces positive behaviours and help develop self-control. Â
Guide individuals to recognize and change the negative thought patterns.Â
Provide a structured environment for individuals with ADHD to create social and communication skills. Â
Psychiatry/Mental Health
Methylphenidate:Â
The FDA-approved it as a primary choice for managing ADHD in children aged 6 and above and is extensively prescribed and available in sustained-release formulations including a delayed-release bedtime dosage form and is extensively prescribed.Â
Dexmethylphenidate:Â
It is a potent d-enantiomer of racemic methylphenidate that inhibits norepinephrine and dopamine reuptake in presynaptic neurons by enhancing their release and is available in extended-release capsules for daily dosing.Â
Dextroamphetamine and amphetamine:Â
This combination drug is available in immediate-release tablets and extended-release capsules which induce central nervous system and respiratory stimulation that primarily affecting the cerebral cortex and reticular activating system.Â
Dextroamphetamine:Â
FDA-approved this for use in children aged 3 and older and is commonly used as a first-line treatment or in cases of methylphenidate intolerance.Â
Serdexmethylphenidate/methylphenidate:Â
It is a fixed-dose combination of dexmethylphenidate and immediate-release dexmethylphenidate, designed for ADHD management in adults and children aged 6 and older.Â
Psychiatry/Mental Health
Atomoxetine:Â
It is a medication that selectively inhibits the presynaptic norepinephrine transporter to alleviate symptoms of ADHD.Â
Viloxazine:Â
It is a medication that selectively inhibits norepinephrine reuptake may be a potential treatment for ADHD in children and adolescents aged 6-17 years.Â
Psychiatry/Mental Health
Its brand name is Wellbutrin that inhibits neuronal dopamine reuptake and weakly blocks serotonin and norepinephrine reuptake available in sustained-release formulations.Â
This drug is used to inhibit serotonin and norepinephrine reuptake and induce beta-receptor down-regulation and is available in sustained-release forms like Effexor XR.Â
Psychiatry/Mental Health
The real-time monitoring of brain activity is recorded in neurofeedback is a type of biofeedback.Â
A non-invasive process called transcranial magnetic stimulation in this it stimulates brain nerve cells with magnetic fields. Â
In deep brain stimulation the electrodes are inserted into brain regions during the invasive DBS operation. Â
Psychiatry/Mental Health
The assessment phase begins with the identification of ADHD symptoms. This may involve input from parents, teachers, and healthcare professionals. Â
To achieve specific goals for the individual with ADHD a proper plan should be programmed. Physicians should call for follow-up appointments to examine patients treatment response and progress. Â
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