What is attention-deficit/hyperactivity disorder?
What does ADHD look like?
Risk Factors
- Heritability is 76% based on twin studies
- Implicated genes: DAT1, DRD4, DRD5, DBH, 5-HTT, HTR1B, and SNAP-25
- Perinatal stress
- Low birth weight
- Traumatic brain injury
- Maternal smoking during pregnancy
- Severe early deprivation
- Frequent digital media use
Prognosis
- Generally considered a lifelong condition, but 1/3 to 1/2 of individuals with experience remission of symptoms by adulthood
- Childhood ADHD is associated with worse educational, occupational, economic, social, and health-related outcomes
- Children are two times more prone to all types of accidental injuries
- Adolescents are at higher risk of earlier substance use and greater difficulty with substance use
- Can negatively affect the ability to drive safely
- Deficits in executive function, including inhibitory control, working memory, and effortful attention
Differential Diagnosis
- Oppositional defiant disorder
- Conduct disorder
- Disruptive mood dysregulation disorder
- Specific learning disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Major depressive disorder
- Autism spectrum disorder
- Bipolar I/II disorder
- Borderline personality disorder
- Psychotic disorder
- Substance use disorders
- Medication with cognitive dulling side effect
- Medication with psychomotor activation
- Unsafe or disruptive learning environment
- Family dysfunction or poor parenting
- Child abuse or neglect
- Attachment disorders
- Intellectual giftedness
- Sleep disorders
- Traumatic brain injury
- Seizure disorders
- Hearing impairment or vision impairment
- Thyroid disorders
- Hypoglycemia
- Anemia
- Lead poisoning
- Fragile X syndrome
- Phenylketonuria
- Neurofibromatosis
- Fetal alcohol spectrum disorder
- Intellectual disability
How is ADHD investigated?
Thorough assessment of psychosocial factors, including:
- Medical history
- Rule out other medical conditions
- Nutrition and lifestyle - sleep, exercise, screen time, high risk activities
- Complete childhood developmental history
- Having third party objective perspective is critical
- Perinatal history
- Developmental milestones
- Psychoeducational assessments and report cards
- Impact of symptoms on learning, socialization, and independent functioning
- Temperament
- Symptoms of ADHD prior to age 12
- Presence of any life events that were of emotional concern in childhood (e.g. abuse, bullying, divorce, loss, deaths, attachment issues)
ADHD Checklist
- Clinican/client rater
- Checklist of the 9 DSM items
SNAP-IV 26
- Teacher/parent rater
- 26-item rating scale
Conner's Rating Scale-Revised
- Teacher/parent/client rater
References
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.
[3] Karam, R. G., Breda, V., Picon, F. A., Rovaris, D. L., Victor, M. M., Salgado, C. A., Vitola, E. S., Silva, K. L., Guimarães-da-Silva, P. O., Mota, N. R., Caye, A., Belmonte-de-Abreu, P., Rohde, L. A., Grevet, E. H., & Bau, C. H. (2015). Persistence and remission of ADHD during adulthood: A 7-year clinical follow-up study. Psychological medicine, 45(10), 2045–2056.
[4] Ra, C. K., Cho, J., Stone, M. D., De La Cerda, J., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., & Leventhal, A. M. (2018). Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents. JAMA, 320(3), 255–263.
[5] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.