Attention Deficit Hyperactivity Disorder Across the Lifespan: The Child, Adolescent, and Adult
Introduction
Features of attention deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD) were first identified in children in the 19th century. Heinrich Hoffman was a German physician and medical writer/illustrator who, in 1854, wrote about a young child, Fidgety Phillip, who had traits of what is now called ADHD.1 It was described over a century ago as a disorder of children in which there was unruly behavior and hyperactivity, mainly noted in boys.2 Attention dysfunction and conduct disorder-like behavior were noted in children diagnosed with encephalitis lethargica (Von Economo’s Disease) between 1916 and 1927.3 The pathophysiology was felt to be encephalitis with subsequent brain damage. A group of children were identified with these same symptoms, but without overt encephalitis; eventually they were diagnosed with minimum brain damage or dysfunction.4 Other terms for ADHD in the 20th century included the hyperkinetic syndrome and hyperactive reaction of childhood.5, 6 In this discussion, the term ADHD (attention-deficit/hyperactivity disorder) is used and refers to both ADD and AHDH.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) of 1980 classified this disorder as ADD and ADHD.1 The DSM-IIIR of 1987 noted that adults may have ADD/ADHD. The 1994 DSM-IV and the 2000 DSM-IV-TR continued with this terminology with the caveat that ADD/ADHD begins in childhood.7 The concept that ADHD can occur in adults who can benefit from ADHD medication was first noted in the literature in 1976.8
ADHD is noted in 3 to 9% of children and adolescents by American research, three times more commonly in males than females; it is noted in 3 to 5% of adults with equal male-to-female ratios if the diagnostic criteria are based on the American Psychiatric Association’s DSM.7, 9, 10, 11 Clinicians in European countries use criteria based on the International Classification of Diseases, use the term attention-deficit/hyperkinetic disorder, and estimate a much lower prevalence for ADHD vs AHDH.10 However, various studies from different countries using similar diagnostic criteria confirm the widespread prevalence of AHDH.12, 13 In 2006, 5 million individuals in the United States were prescribed psychostimulant medication, 3.5 million between ages 3 and 19 years, and 1.5 million between ages 20 and 64 years.14
Section snippets
ADHD: The Child and Adolescent
ADHD is a neurobehavioral disorder with abnormalities in various neurotransmitter systems, including noradrenergic, serotonergic, and dopaminergic.14, 15, 16, 17 There are various degrees of attention dysfunction, impulsivity, and hyperactivity that interfere with day-to-day functioning. Neuroimaging (ie, PET scans) and genetic studies suggest that ADHD is a neurobiological disorder involving neurotransmitter dysfunction in various parts of the central nervous system, especially dopamine
ADHD in the College Student
College students may present with major problems in concentration leading to reduced grades and considerable anxiety over an inability to deal with academic pressures.116 A careful evaluation may reveal ADHD with or without other disorders (TABLE 1, TABLE 2). One must decide whether to treat the co-morbid condition or the ADHD primarily, although each must be treated in some manner. Management includes helping the student understand the ADHD diagnosis, ensure the best academic milieu, arrange
Adult ADHD
Current estimates suggest about half of childhood ADHD continues into adulthood, and a prevalence of approximately 3 to 5% is found in adults over age 20.11, 153, 154, 155, 156 It is important to understand that ADD/ADHD can not only cause major disruption in the lives of children, but also that of adults as well.157, 158, 159 Indeed, ADD/ADHD is not only a pediatric disorder, but a neurobiological disorder across the lifespan. It is not a “pediatric” disease only, but a condition that impacts
Summary
ADHD is a complex and controversial neurobehavioral disorder that affects humans across a life span.3, 12, 154, 156, 209, 210Table 34 provides a summary of the authors’ guidelines for management in adults. Clinicians should work with other local colleagues who can help with a comprehensive neuropsychiatric and psychological evaluation as well as management options. Most adults with ADHD can achieve some benefit from medication (ie, psychostimulants, antidepressants, or atomoxotine).
References (210)
- et al.
Attention-deficit/hyperactivity disorder
Lancet
(2005) Attention-deficit/hyperactivity disorder: a selective overview
Biol Psychiatry
(2005)- et al.
Attention-deficit/hyperactivity disorder in Children and adolescents: interventions for a complex costly clinical conundrum
Pediatr Clin North Am
(2003) - et al.
Behavior modification
Child Adolesc Psychiatr Clin N Am
(2000) - et al.
ADHD comorbidity findings from the MTA study: comparing comorbid subgroups
J Am Acad Child Adolesc Psychiatry
(2001) ADHD in adolescence
J Adolesc Health
(2000)- et al.
Young adults outcome of hyperactive children who received long-term stimulant treatment
J Am Acad Child Adolesc Psychiatry
(1984) - et al.
Emergence of tics in children with attention deficit hyperactivity disorder treated with stimulant medication
Compr Psychiatry
(2001) Attention deficit hyperactivity disorder in the presence of Tourette syndrome
Neurol Clin
(1997)- et al.
Practice parameter for the use of stimulant medication in the treatment of children, adolescents and adults
J Am Acad Child Adolesc Psychiatry
(2002)
Controlled stimulant treatment of ADHD and comorbid Tourette’s syndrome: Effects of stimulant and dose
J Am Acad Child Adolesc Psychiatry
Do typical doses of methylphenidate cause tics in children treated for attention-deficit hyperactivity disorder?
J Am Acad Child Adolesc Psychiatry
Guanfacine treatment of comorbid attention-deficit/hyperactivity disorder and Tourette’s syndrome: preliminary clinical experience
J Am Acad Child Adolesc Psychiatry
Comparison of clonidine response in the treatment of attention-deficit hyperactivity disorder with and without comorbid tic disorders
J Amer Acad Child Adolesc Psychiatry
Attention-deficit/hyperactivity disorder and comorbidity
Pediatr Clin North Am
Attention deficit hyperactivity disorder
The Coulstonian lectures on some abnormal physical conditions in childrenLecture 1
Lancet
Management of ADHD in adults
J Clin Psychiatry
Minimal Brain Dysfunction in Children: Terminology and Identification
The hyperkinetic syndrome in epileptic children
Lancet
Pharmacotherapy of adult ADHD
JCLP/In Session
Diagnosis and treatment of minimum brain dysfunction in adults
Arch Gen Psychiatry
A review of pharmacotherapy of adults with attention-deficit/hyperactivity disorder
J Atten Dis
The worldwide prevalence of ADHD: is it an American condition?
World Psychiatry
The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication
Am J Psychiatry
ADHD in children, adolescents, and adults
Prim Care Clin Office Pract
Attention deficit hyperactivity disorder
Attention deficit disorder in adults
Ann Clin Psychiatry
Attention deficit/hyperactivity disorder in adolescents
Candidate gene studies of attention-deficit/hyperactivity disorder
J Clin Psychiatry
Behavioral assessment
Psychometric testing
Attention Deficit Hyperactivity Disorder
NIMH Research on Treatment for Attention Deficit Hyperactivity Disorder (ADHD): The Multimodal Treatment Study: Questions and Answers
Therapies for hyperactive children: Comparisons, combinations, and compromises
J Consult Clin Psychol
Effects of methyphenidate and expectancy on children with ADHD: behavior, academic performance, and attributions in a summer treatment program and regular classroom settings
J Consult Clin Psychol
Reuters Health. ADHD: Kids with Attention Problems More Likely to Wet Bed
Attention Deficit Hyperactivity Disorder
Academic underachievement, attention deficits, and aggression: comorbidity and implications for intervention
J Consult Clin Psychol
Parenting and family stress treatment outcomes in attention deficit hyperactivity disorder (ADHD): an empirical analysis in the MTA study
J Abnorm Child Psychol
Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation
J Abnorm Child Psychol
Psychopharmacology of ADHD in adolescents
Adolesc Med
Psychopharmacology of ADHD in adolescents: Quo vadis?
Psychiatr Times
Attention deficit hyperactivity disorder
The science of stimulant abuse
Pediatr Ann
The behavior of children receiving benzedrine
Am J Psychiatry
Cited by (83)
Entertainment-education in promoting healthy adolescent behaviors
2023, Encyclopedia of Child and Adolescent Health, First EditionAutism Spectrum Disorder
2022, Comprehensive PharmacologyScaffolding the attention-deficit/hyperactivity disorder brain using transcranial direct current and random noise stimulation: A randomized controlled trial
2021, Clinical NeurophysiologyCitation Excerpt :Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, with significant negative lifetime outcomes (Greydanus et al., 2007).
Repeated administration of methylphenidate produces reinforcement and downregulates 5-HT-1A receptor expression in the nucleus accumbens
2019, Life SciencesCitation Excerpt :Methylphenidate (MPD) is widely prescribed for the treatment of Attention-deficit hyperactivity disorder (ADHD) since 1957 [1].
The Knowledge and Attitude of the Parents of Children with ADHD toward Methylphenidate (Ritalin)
2023, Journal of Health Sciences and Surveillance SystemRole of gender and neurodevelopmental disabilities
2023, Neurodevelopmental Pediatrics: Genetic and Environmental Influences