By Mu-Hong Chen, M.D

Attention deficit hyperactivity disorder (ADHD) is a pervasive neurodevelopmental disorder that begins in early childhood, and manifests the inability to marshal and sustain attention, modulate the activity level, and moderate impulsive actions. ADHD affects approximately 5% of children and adolescents and approximately 3% of adults, with a male-to-female ratio between 3:1 and 4:1. The prevalence of ADHD in children population (< 18 years) is approximately 8% in Taiwan. The pathophysiology of ADHD is unclear and it appears to have a complex etiology. Multiple genetic and environmental factors act together to develop a spectrum of neurobiological vulnerability. One of the current basic hypotheses for ADHD pathophysiology is the deficiency of dopamine and norepinephrine in the multiple brain regions modulating attention and executive function, such as prefrontal cortex.

Diagnosis

1. The diagnostic criteria of ADHD were firstly described in DSM-III in early 1980 and the newest diagnostic criteria of ADHD were issued in DSM-5 in May 2013.

1. A comprehensive diagnostic interview (children, parents, and teachers)
2. Neuropsychological examinations.

Clinical courses

Symptoms of hyperactivity would decrease gradually when children grow up, but inattention and impulsivity always persist to the adulthood. Other psychiatric comorbidities, such as tic disorder, behavioral disorders, mood disorders, and substance use disorder, are high.

Treatment

Key words in ADHD Treatment: Seeing, Understanding, and Supporting.

1. Medications: Methylphenidate, Atomoxetine
2. Psychotherapy: Cognitive behavioral therapy, Social skill training
3. Behavioral therapy: Behavioral parent training, Behavioral classroom management, Behavioral peer interventions, Life arranging skills…
4. Family therapy
5. Occupational therapy

Medications could normalize the deficiency of dopamine and norepinephrine in ADHD brains and Psychotherapy, Behavioral therapy, Family therapy, and Occupational therapy could modulate the ADHD-related behaviors and cognitive problems. The balance between medications and non-pharmacological treatment is very important in ADHD treatment.

Prognosis and Outcomes

Optimal intervention and treatment for ADHD could facilitate the brain development, reduce the risk of subsequent mood disorders, behavioral disorders, and substance use disorders, and improve the overall functioning, including academic performance and work performance.