Introduction
ADHD is a neurodevelopmental disorder, that can cause higher than normal levels of hyperactivity
and impulsivity and may present itself as extreme difficulty in sitting still for long period of time or
trouble focusing attention on a single task. The first recorded mention of ADHD dates to 1902,
where a pediatrician described children who could not control their behavior like typical children.
Whilst ADHD is commonly seen in children, the worldwide prevalence of adults with ADHD is
estimated to be about 2.5% roughly translated to 200 million worldwide, with a dominance leaning
towards men who are three times frequently diagnosed than females.
Current view of ADHD
In 2000, with the publication of the latest edition of the DSM (DSM-IV-TR), the best description of
ADHD as it is still known today was born with the distinction made between Attention
Deficit/Hyperactivity Disorder Combined type , ADHD predominantly Inattentive Type, ADHD
Predominantly Hyperactive-Impulsive Type and ADHD Not other specified (American Psychiatric
Association diagnostic and statistic manual, 2000)
ADHD DSM-V CRITERIA
A. Either 1 or 2 or 3

1) Six (or more) of the following symptoms on inattention have persisted for at least 6
months to a degree that is maladaptive and inconsistent with developmental level:

Inattention
a) Often fails to give attention to details or makes careless mistakes in schoolwork,
work, or other activities
b) Often has difficulty sustaining attention in tasks or play activities
c) Often does not seem to listen when spoken to directly
d) Often does not follow through on instructions and fails to finish schoolwork, chores,
or duties in the workplace (not due to oppositional behavior or failure to understand
instructions)
e) Often had difficulty organizing tasks and activities
f)
Often avoids, dislikes or is reluctant to engage in tasks that require sustained
mental effort (such as schoolwork or homework)
I
g) Often loses things necessary for tasks or activities (e.g., toys, school assignments,
pencils, books, or tools)0
h) Is often easily distracted extraneous stimuli
i)
Is often forgetful in daily activities
2) Six (or more) of the following symptoms of hyperactivity impulsivity have persisted for at
least 6 months to a degree that is maladaptive and with developmental level:
a) Hyperactivity
a) Often fidgets with hands or feet
b) Often leaves seat in classroom or in other situations in which remaining seated
expected
c) Often runs about or climbs excessively in situations in which it is inappropriate (in
adolescents or adults, may be limited to subjective feelings of restlessness)
d) Often has difficulty playing or engaging in leisure activities quietly
e) Is often “on the go” or often acts as if “driven by a motor”
f)
Often talks excessively
b) Impulsivity
a) Often blurts out answers before questions have been completed
b) Often has difficulty awaiting turn
c) Often interrupts or intrudes on other (e.g., butts into conversations or games)
3) Combined – child exhibits six or more symptoms of inattention, hyperactivity and impulsivity
for greater than six months

B. Some hyperactive -impulsive or inattentive symptoms that caused impairments were
present before 7 years of age.

C. Some impairment from the symptoms is present in 2 or more settings ( e.g., at school
or work or at home)

D. There mut be clear evidence of clinically significant impairment in social, academic, or
occupational functioning.

E. The symptoms do not occur exclusively during the course of a pervasive developmental
disorder, schizophrenia, or other psychotic disorder and are not better accounted for by
another mental disorder (e.g., mood disorder anxiety disorder, dissociative disorder, or
personality disorder
Criticisms of the DSM-IV-TR Diagnostic criteria
Clinicians and researchers have pointed out numerous problems with the DSM-IV-TR criteria for
ADHD:
1. The diagnostic criteria for children do not necessarily apply very well to adults with less
than symptoms can be clearly impaired, even though they do not exhibit the minimum
number (6) of symptoms required for a diagnosis (McGough & McCracken, 2006).
2. According to the criteria, if symptoms do not arise until after age 7, the diagnosis ADHD
is not, strictly speaking, applicable (American Psychiatric Association, 2000). However,
research studies that examined people whose symptoms arose after age 7 (generally by
age 12) found that the symptoms were virtually identical to those of people with an earlier
onset of the disorder, which suggests that the cutoff is not meaningful (Ferrone et al.,
2006; McGough & Barkley, 2004)
3. Third, symptoms of hyperactivity may be different in females that in males: Girls who have
hyperactive symptoms may talk more than other girls or may be more emotionally reactive,
rather than hyperactive with their bodies (QUINN ,2005).
Some researchers propose that ADHD is underdiagnosed in girls, who are less likely to have
behavioral problems at school and are less likely to be referred for evaluation (Quinn, 2005).
Before diagnosing ADHD, however , a mental health clinician should be sure that any difficulties
in finishing tasks are a result of attentional problems, and not an oppositional attitude or difficulty
in understanding the instructions. Example a child could have simply not have been paying
attention when she or he was instructed to set up that dinner table or reminded of chores. And
lastly when diagnosing adults with ADHD, clinicians should seek collaboration from school
records or family members.
Comorbid Disorders
In addition to the primary symptoms of ADHD, children with this disorder often show other
adjustment problems. One such problem is school performance: ADHD children are at risk grade
retention, being placed in special education classes, and dropping of school (Barkley,1981;
Semrud-Clikeman et al., 1991; Weiss & Hechtman, 1993). And third half of children with ADHD
meet criteria for learning disability.

There is no conclusive evidence that any of the subtypes of ADHD are more strongly
associated with learning disabilities. Also, it is not clear what accounts for this correlation
between academic difficulties and ADHD. It may be that the symptoms of ADHD impair
children’s abilities to learn up to their potentials.

Children with ADHD are likely to have peer difficulties; children with ADHD combined type
are likely to be unpopular or rejected by peers , and those with ADHD primarily inattention
type are more likely to be shy and withdrawn (Cantwell & Baker, 1992; Carlson, Lahey , &
Neper, 1986; Lahey et al.,1984,1987).

Children with ADHD have high rates of emotional disorders. Many have comorbid anxiety
disorder, and other have comorbid depressive disorder. And children with primarily
inattention type are more likely to exhibit depression and anxiety than those with combined
Type.

The most significant correlate of ADHD and conduct problems/Aggression; estimates of
children that have a co-diagnosis of ADHD and conduct disorder range from 30-90%.
Etiology
ADHD is a disorder with multiple etiologies. Combinations of genetics, neurological, and
environmental factors contribute to pathogenesis and phenotypes.

Evidence from family, twin, and adoption studies have suggested strongly that ADHD is a
highly hereditary polygenic disorder. Gene variants predicting risk for ADHD are important
for brain development, cell migration, and encoding for catecholamine receptor and
transporter genes. The identification of gene sets affecting neurotransmitter pathways in
the brain has suggested that rare copy number variants or the accumulation of larger
deletions and duplications influencing gene transcription are more commonly found in
individuals with ADHD.

Non-inherited neurological factors affecting brain development or resulting in brain injury
have been implicated in ADHD pathogenesis. The contribution of pregnancy and birth
complications is mixed, but strong evidence supports greater ADHD risk following in utero
exposure to alcohol or tobacco and low birth weight. Hypoxic-anoxic brain injury, epilepsy
disorders, and traumatic brain injury also contribute to ADHD risk.

Exposure to environmental toxins (specially lead, organophosphate pesticides, and
polychlorinated biphenyls) has been linked to ADHD symptoms. Except for children
experiencing exceptional early deprivation, a causal relationship between family
environment and psychosocial adversity and ADHD is unclear.

Neuroimaging studies point to ADHD as a disorder of early brain development. Based on
volumetric and functional MRI studies, differences are found in the structural development
and functional activation in the prefrontal cortex, basal ganglia, anterior cingulate, and
cerebellum. Activity among these areas depends on the catecholaminergic brain circuitry.
Despite weak evidence for deficits in these neurotransmitters, their role is sustained by
their distributions in those areas of the brain involved in ADHD and positive response of
ADHD patients to medications that modulate the neurotransmission of catecholamines. A
delay in cortical maturation has been documented, with peak cortical thickness attained n
the cerebrum at 7 years in typically developing children and at 10 years in those with
ADHD.
ADHD Treatment
Children ages 4-6 years
.The first line of treatment should include
Parenting training in behavior management

Behavior therapy is an effective treatment for ADHD that can improve a child’s
behavior ,self-control and self-esteem. It is most effective in young children when
it is relieved by parents.

When parents become trained in behavior therapy , they learn skills and strategies
to help their child with ADHD succeed at school, at home and in relationships.

Therapists should teach parents skills and strategies that use positive
reinforcement , structure ,and consistent discipline to manage their child’s
behavior.

Therapists should teach parents positive way to interact and co0mmuinicate with
their child.

They should assign activities for parents to practice with their child.
Classroom Treatment strategies for ADHD
There are some school based management strategies shown to be effective for
ADHD students: Behavioral classroom management and organizational training.
The behavioral classroom management approach encourages a student’s positive
behaviors in the classroom, through a reward systems or daily report card, and
discourages their negative behaviors. This teacher led approach has been shown
to influence student behavioral a constructive manner, increasing academic
engagement. Although tested mostly in elementary school’s behavioral classroom
management has been shown to work in students of all ages.
Organizational training teaches children time management, planning skills, and
ways to keep school materials organized in order to optimize student learning and
reduce distractions. This management strategy has been tested with children and
adolescents.