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Attention Deficit Hyperactivity Disorder (ADHD) Part 1 [Diagnosis, Prevalence, and Neurobiology] ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active. Signs and Symptoms - It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends. A child with ADHD might: daydream a lot forget or lose things a lot squirm or fidget talk too much make careless mistakes or take unnecessary risks have a hard time resisting temptation have trouble taking turns have difficulty getting along with others Types There are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual: 1. Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines. 2. Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others. 3. Combined Presentation: Symptoms of the above two types are equally present in the person. Because symptoms can change over time, the presentation may change over time as well. Causes of ADHD Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies link genetic factors with ADHD.1 In addition to genetics, scientists are studying other possible causes and risk factors including: Brain injury Exposure to environmental risks (e.g., lead) during pregnancy or at a young age Alcohol and tobacco use during pregnancy Premature delivery Low birth weight Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD. Diagnosis of ADHD as per DSM V Typically, ADHD symptoms arise in early childhood. According to the DSM-5, several symptoms are required to be present before the age of 12. Many parents report excessive motor activity during the toddler years, but ADHD symptoms can be hard to distinguish from the impulsivity, inattentiveness and active behavior that is typical for kids under the age of four. In making the diagnosis, children should have six or more symptoms of the disorder present; adolescents 17 and older and adults should have at least five of the symptoms present. The DSM-5 lists three presentations of ADHD—Predominantly Inattentive, Hyperactive-Impulsive and Combined. 1. ADHD predominantly inattentive presentation Fails to give close attention to details or makes careless mistakes Has difficulty sustaining attention Does not appear to listen Struggles to follow through with instructions Has difficulty with organization Avoids or dislikes tasks requiring sustained mental effort Loses things Is easily distracted Is forgetful in daily activities 2. ADHD predominantly hyperactive-impulsive presentation Fidgets with hands or feet or squirms in chair Has difficulty remaining seated Runs about or climbs excessively in children; extreme restlessness in adults Difficulty engaging in activities quietly Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor Talks excessively Blurts out answers before questions have been completed Difficulty waiting or taking turns Interrupts or intrudes upon others ADHD combined presentation The individual meets the criteria for both inattention and hyperactive-impulsive ADHD presentations.