Academic journal article International Journal of Child Health and Human Development

Attention Deficit Hyperactivity Disorder in Adolescence

Academic journal article International Journal of Child Health and Human Development

Attention Deficit Hyperactivity Disorder in Adolescence

Article excerpt

Introduction

Research over the past two decades has demonstrated that attention-deficit/hyperactivity disorder (ADHD) occurs frequently and causes considerable suffering in patients and their families. ADHD begins in early childhood, and persists through adolescence and into adulthood in 70% of patients (1). The prevalence of adolescent ADHD varies across studies perhaps due to the different methodological approaches utilized. A large national parent survey revealed that 11.2% of 11-14 year olds and 13.6% of 15-17 year olds were reported as diagnosed with ADHD (2). A more sophisticated epidemiological survey of adolescents, with face to face interviews, estimated the ADHD life time prevalence of 13-17 years olds at 7.9% (3). ADHD affects far more boys than girls. However, data from a recent 11 yearlong follow up study found that girls also have significant morbidity and disability associated with the disorder (4).

Pathognomonic biological tests are not yet available so a comprehensive clinical assessment, buttressed by use of validated and normed rating scales, and structured diagnostic interviews, remains the gold-standard diagnostic approach. The search for biological markers has recently produced interesting findings, suggesting that such tests could be available in the near future. For instance, data show that ADHD is a highly heritable condition for which potentially responsible candidate genes have been identified and characteristic neuroanatomical as well as neurophysiological findings have been confirmed (5). Furthermore, current diagnostic criteria (6) yield similar prevalence rates across the US and Europe and the condition is found in most other parts of the world (7). These data suggest there is a strong neurobiological contribution to ADHD and support the use of medication treatments. The present paper outlines current pharmacological ADHD treatment options focusing on their safety and efficacy.

Assessment and treatment principles

A thorough differential diagnostic evaluation is essential, as adolescents can present with distractibility, inattention, and behavioral dysregulation (i.e., core symptoms of ADHD) due to a variety of other reasons, such as environmental stressors and other psychiatric or medical problems. Exposing those without ADHD to treatment would not alleviate their condition, and could potentially worsen their symptoms. While a comprehensive outline of assessment procedures and nonpharmacological treatments can be consulted elsewhere (8), a few basic principles will be noted here.

Diagnosis

DSM-IV-TR (6) provides diagnostic criteria which are utilized worldwide. For patients to meet ADHD criteria, they must have either A: six or more from a list of 9 symptoms of inattention for at least 6 months, to a degree that is maladaptive or B: six or more of a list of 9 symptoms of hyperactivity-impulsivity for at least 6 months, to a degree that produces impairment in social, school, or occupational functioning. Furthermore, some symptoms that cause impairment should have been present before age seven and some impairment from the symptoms must be present in two or more settings (e.g., at school/work and at home). In addition, symptoms cannot be better accounted for by another mental disorder (although they may co-exist with those of another mental disorder; i.e., comorbidity).

Diagnostic work up

ADHD is diagnosed from comprehensive psychiatric/medical histories and relevant physical and mental status examinations. All other assessments and/or tests that may be used support these primary methods. If a patient has a current or past medical problem, a thorough medical history is mandatory and consultation with specialists may be recommended. In addition to meeting with the adolescent, evaluators should also conduct an in person interview of the caretakers and seek information from teachers either in person, by phone, or via completion of rating scales. Psychological testing is not essential but can be helpful, especially if learning disorders are also present. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.