Adhd

01
WINTER
Template
Epidemiology
02
WINTER
The worldwide-pooled prevalence of 13.4% for any

mental disorder, is very similar to the median prevalence
Template
rates reported in the literature
of:
13% (Verhulst & Koot, 1991),
12% (Verhulst & Koot, 1995),
12% to 15% (Roberts et al., 1998) .
Estimates indicate that 241 million youths around the
world are affected by a mental disorder.
Most common: anxiety disorders (117 million); disruptive
behavior disorder (113 million); ADHD (63 million).
Annual Research Review: A meta-analysis of the worldwide prevalence
of mental disorders in children and adolescents. Polanczyk GV, Salum
GA, Sugaya LS, Caye A, Rohde LA. J Child Psychol Psychiatry. 2015.
Epidemiology
03
WINTER
Including only studies that assessed multiple

diagnoses restricts the
number of prevalence
Template
estimates included for specific disorders and the
resulting pooled estimate.
For example, the estimate of 3.4% (CI 95% 2.64.5)
for ADHD prevalence based on 33 studies is
significantly lower than a previous pooled estimate of
5.29% (95% CI 5.015.56) based on 102 studies that
investigated only this disorder.
Annual Research Review: A meta-analysis of the worldwide prevalence

of mental disorders in children and adolescents. Polanczyk GV1, Salum
GA, Sugaya LS, Caye A, Rohde LA. J Child Psychol Psychiatry. 2015.
Epidemiology
05
WINTER
ADHD in males and females is more similar than different.

Boys with ADHD have more comorbid externalizing problems
and girls with ADHD (especially adolescents) have more
comorbid internalizing problems such as depression and
anxiety (although non-referred samples do not find gender
differences in rates of coexisting psychiatric disorders in
pediatric samples).
Treatment should be tailored according to subtype, level and
type of impairment, and comorbid profiles than based on
gender.
Diagnostic criteria for ADHD should be adjusted according to
gender and possibly lowered or adapted for girls. Alternative
assessment methods that include descriptions of ADHD
symptoms
adapted
to girlsimplications
could be for
considered.
Gender differences
in ADHD:
psychosocial treatments.
Template
Rucklidge JJ1. Expert Rev Neurother. 2008.
Epidemiology
06
WINTER
Routine inquiries about childhood abuse in cases of

adult ADHD are strongly recommended.
The early diagnosisTemplate
of ADHD may facilitate the early
identification of girls who are at high risk for future
mental disorders.
Although ADHD appears more similar than different
in males and females (implicating that psychosocial
treatments should be equally effective across
genders), gender isnt typically considered as a
moderator of treatment outcome and, therefore,
gender by treatment effects are largely unknown.
Gender differences in ADHD: implications for psychosocial treatments.
Rucklidge JJ1. Expert Rev Neurother. 2008.
Epidemiology
08
WINTER
Confirming previous findings, variability in

ADHD prevalence Template
estimates is mostly
explained by methodological characteristics
of the studies. In the past 3 decades, there
was no evidence to suggest an increase in
the number of children in the community who
meet criteria for ADHD when standardized
diagnostic procedures are followed.
ADHD prevalence estimates across three decades: an updated

systematic review and meta-regression analysis. Polanczyk GV1, Willcutt
EG, Salum GA, Kieling C, Rohde LA.vident. Int J Epidemiol. 2014.
Epidemiology
10
WINTER
In 2 consequential studies (Studies 1 and 2):

Study 1, 106 children
Template
(6-14 years). The purpose
was to validate a new DSM-5-based ADHD rating
scale.
Study 2, 420 children (6-14 years). The new rating
scale to estimate the prevalence of ADHD was
used.
The 1st study showed that the new rating scale for
ADHD was valid. The 2nd study revealed that the
prevalence
Fayoum
City was
20.5%,
with
The Prevalenceof
of ADHD
ADHD in in
Fayoum
City (Egypt)
Among
School33.8%
among
boys and
among girls.
Age
Children:
Depending
on a6.8%
DSM-5-Based
Rating Scale.
Aboul-Ata MA, Amin FA. J Atten Disord. 2015.
Epidemiology
11
WINTER
Study showed that the prevalence rate in (3rd grade)

in Assiut city was 6%.
Template
Also study revealed that ADHD was characterized by:
large family size,
convulsions, trauma to the head during early life.
Isolation of child from one or more parents,
delayed developmental milestones,
family history of similar condition
lower cognitive function scores in some subtests.
A Study of Attention Deficit Hyperactivity Disorder Among
Elementary School Children in Assiut City. A. A. Shehata. 1999
Epidemiology
12
WINTER
In elementary schools in Alexandria

Governorate 501 pupils out of 133082 pupils using
Template
the multistage stratified
sampling. Conner's rating
scale Arabic version was used to assess their
attention level.
The study revealed that prevalence was 19.56%.
2nd grade pupils had a significantly higher
prevalence than 1st grades 23.62%, 15.38%,
respectively.
Insignificant differences were found as regards
type of school, sex, average age.
Epidemiologic study of attention deficit hyperactivity disorder
(ADHD) in elementary schools in Alexandria Governorate. Rashed
S, Hidayet NM, Salama HM, Ibrahim AG, Salem WL. 1994
Epidemiology
13
WINTER
However, a significant difference was observed

between pupils with different scholastic achievement
and ADHD where it isTemplate
more significantly encountered
among those with poor level.
Type of family, parent's education and fathers
occupation were found to be significantly affecting
prevalence of ADHD.
Family problems, low educational level of parents
and low socioeconomic status as measured by
parents occupation adversely affect attention of
these pupils.
Epidemiologic study of attention deficit hyperactivity disorder
(ADHD) in elementary schools in Alexandria Governorate. Rashed
S, Hidayet NM, Salama HM, Ibrahim AG, Salem WL. 1994
Epidemiology
14
WINTER
The prevalence of psychiatric disorder in

school children at Template
age 9-12 years in an urban
and rural area was studied.
The sample was 1000 students using parent
questionnaire & teacher questionnaire.
Total prevalence of psychiatric disorder in
children was 23.7% in which ADHD was the
most prevalent disorder 5.8% followed by
enuresis 3.9%.
An epidemiological study of psychiatric disorder in school
children from the age 9-12 in Alexandria Abou Rayan et al,2001
Epidemiology
15
WINTER
As regard the gender, psychiatric disorder

was common in males
27% then females
Template
19.7%.
In another section of the study prevalence
of psychiatric disorder in 100 children 9
12 years attending the outpatient clinic at
the students hospital in Alexandria by
using DSM-IV criteria. The prevalence of
enuresis was 29% followed by attention
deficit disorder 12%.
An epidemiological study of psychiatric disorder in school
children from the age 9-12 in Alexandria Abou Rayan et al,2001
Epidemiology
16
WINTER
4223 children were subjected to:

modified Arabic version of the Connors ADHD Index,
Template
diagnostic criteria of DSM-IV for ADHD,
A socioeconomic standard questionnaire (Fahmy &
El-sherbini 1983),
Stanford Binnet test version 4, Arabic version.
EEG and routine laboratory workup.
Overall prevalence of ADHD was 6.5%; hyperactive
impulsive type (3.51%), then combined type (2.13%),
and lastly inattentive type (0.86%).
"Attention Dedicit Hyperactivity Disorders" An epidemiological study
of preschool and primary school children in Minia city. Soliman GT,
Afify MF, Yehia MA, Abdel-Naem EA, Abd Alkarim SM. 2010.
Epidemiology
17
WINTER
Male to female prevalence ratio was 1.61:1.
Template
There were significant differences regarding:
social state,
scholastic achievement,
first birth order,
large family size,
bottle feeding,
higher abnormal EEG findings and Hb%
between cases and control children.
"Attention Dedicit Hyperactivity Disorders" An epidemiological study

of preschool and primary school children in Minia city. Soliman GT,
Afify MF, Yehia MA, Abdel-Naem EA, Abd Alkarim SM. 2010.
Epidemiology
18
WINTER
A sample size of 1287 students (6-13 years) in 67

government and 10 private primary schools was
Template
selected by multistage systematic random
sampling.
Data was collected using 2 questionnaires: the
modified Arabic version of the Attention Deficit
Disorders Evaluation Scale (ADDES) school
version, and Parents' questionnaire to diagnose
the 3 main subtypes of ADHD.
Attention Deficit Hyperactivity Disorder (ADHD) among Male
Primary School Children in Dammam, Saudi Arabia:
Prevalence and Associated Factors.Al Hamed JH1, Taha

AZ, Sabra AA, Bella H. J Egypt Public Health Assoc. 2008.
Epidemiology
19
WINTER
The majority of the boys were from government

schools (83.0%), were of age 6-<9 years (40.5%)
Template
and of Saudi nationality (80.7%).
The overall prevalence of combined ADHD was
16.4%, with a prevalence of 12.4% for
hyperactivity-impulsivity and 16.3% for inattention
disorders respectively.
The study also revealed a variety of family factors
to be significantly associated with development of
ADHD:

Epidemiology
20
WINTER
1. The prevalence of each subtype of ADHD was

higher if the child was the 6th one in the family.
Template
2. The prevalence of hyperactivity-impulsivity
disorder was significantly higher among children
living with single parents than those living with
both parents (25.0% vs. 12.2% respectively).
3. Inattention was significantly higher among those
who had bottle feeding than breastfeeding
(21.2% vs. 14.4% respectively).

Epidemiology
21
WINTER
All epidemiological studies on ADHD conducted from

1966 through the present were reviewed.
Template
Samples were drawn from general community, primary
care clinical settings, and traumatized children.
Data on prevalence, gender differences, risk factors,
comorbidity, and burden of ADHD were reviewed.
ADHD rates in Arab populations were similar to those
in other cultures. Comparisons within Arab studies were
difficult given the variability of methodology and
instruments used.
ADHD in the Arab world: a review of epidemiologic studies. Farah
LG1, Fayyad JA, Eapen V, Cassir Y, Salamoun MM, Tabet CC,
Mneimneh ZN, Karam EG. J Atten Disord. 2009.
Etiology
24
A Sample of 84 ADHD cases out of total 339 children

attending the child guidance clinic of Kolkata, India from
Jan 2012 to Aug 2013.
Of them, 5.95% had diagnosed cases of ADHD among
their siblings and cousins, while nearly 20% had alcohol
dependence and bipolarity among parents.
There was no maternal substance abuse, but disturbed
family situations were found in 32.14% of children with
ADHD, mostly contributed by parental mental illnesses.
Labor/delivery and neonatal complications were also quite
common (nearly 30%) among these children, but no
regular exposure to food additives.
Mitra S, Ray AK. The familial and other environmental risk
factors in children with attention deficit hyperactivity disorder. AP J
Psychol Med 2013
Etiology
25
The extent of ADHD (25%) is similar with other

studies, but the pattern of risk factors are different.
There is complex interaction of:
familial (parental externalizing disorders)
other environmental factors (family situations,
antenatal care).
The role of inadequate maternal and child health
care delivery system is also evident.
Mitra S, Ray AK. The familial and other environmental risk

factors in children with attention deficit hyperactivity disorder. AP J
Psychol Med 2013
Etiology
26
In a population-based, record linkage case-control

study, records of all non-Aboriginal children and
adolescents born in Western Australia and aged
<25 years diagnosed with ADHD and prescribed
stimulant medication (cases= 12,991) were linked
to the Midwives Notification System to obtain
maternal, pregnancy, and birth information. The
control population of 30,071 children was
randomly selected from MNS.
Environmental risk factors by gender associated with attentiondeficit/hyperactivity disorder. Silva D1, Colvin L, Hagemann E,
Bower C. Pediatrics. 2014.
Etiology
27
Mothers of children with ADHD were significantly

more likely to:
be younger,
be single,
have smoked in pregnancy,
have labor induced,
experience threatened preterm labor,
preeclampsia, urinary tract infection in
pregnancy, or early term delivery
irrespective of the gender of the child, compared
with the control group.
Etiology
28
In the fully adjusted model, a novel finding was a

possible protective effect of oxytocin augmentation in
girls.
Low birth weight, postterm pregnancy, small for
gestational age infant, fetal distress, and low Apgar
scores were not identified as risk factors.
Smoking in pregnancy, maternal urinary tract
infection, being induced, and experiencing
threatened preterm labor increase the risk of ADHD,
with little gender difference.
Early term deliveries marginally increased the risk of
ADHD.
Etiology
30
Empirical findings from neurobiological research

into ADHD reflect a shift in the conceptualisation from
simple theoretical views of a few isolated
dysfunctions to more complex models integrating the
heterogeneity of the clinical manifestations.
Thus, findings from structural and functional
neuroimaging suggest the involvement of
developmentally abnormal brain networks related to
cognition, attention, emotion and sensorimotor
functions.
The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder
(ADHD): what every clinician should know. Cortese S. Eur J Paediatr
Neurol. 2012.
Etiology
31
Brain functioning alterations are confirmed by

neurophysiological findings, showing that
individuals with ADHD have:
elevated / power ratios,
less pronounced responses
longer latencies of event-related potentials,
compared with controls.

Neurol. 2012.
Etiology
32
At a molecular level, alterations in any single

neurotransmitter system are unlikely to explain the
complexity of ADHD; rather, the disorder was linked
to dysfunctions in several systems, including
dopaminergic, adrenergic, serotoninergic and
cholinergic pathways.
Genetic studies showing a heritability of 6075%
suggest that a plethora of genes, each with a small
but significant effect, interact with environmental
factors to increase the susceptibility.
Currently, findings from neurobiological research do
not have a direct application in daily clinical practice.
Neurol. 2012.
Impact
34
The Global Burden of Disease Study 2010 (GBD

2010) is the first to include conduct disorder and
ADHD for burden quantification.
A previous systematic review pooled the available
epidemiological data for CD and ADHD, and
predicted prevalence by country, region, age and
sex for each disorder.
Prevalence was then multiplied by a disability weight
to calculate years lived with disability (YLDs).
The global burden of conduct disorder and attentiondeficit/hyperactivity disorder in 2010. Erskine HE1, Ferrari AJ,
Polanczyk GV, Moffitt TE, Murray CJ, Vos T, Whiteford HA, Scott
JG. J Child Psychol Psychiatry. 2014.
Impact
35
As no evidence of deaths resulting directly from

either CD or ADHD was found, no years of life lost
(YLLs) were calculated. Therefore, the number of
DALYs was equal to that of YLDs.
Globally, CD was responsible for 5.75 million
YLDs/DALYs with ADHD responsible for a further
491,500. Collectively, CD and ADHD accounted for
0.80% of total global YLDs and 0.25% of total
global DALYs.
Impact
36
Between 1990 and 2010, global DALYs

attributable to CD and ADHD remained stable
after accounting for population growth and
ageing.
The global burden of CD and ADHD is
significant, particularly in male children.
Appropriate allocation of resources to address
the high morbidity associated with CD and ADHD
is necessary to reduce global burden.
Impact
37
FAMILY
Frequently, difficulties at home or on outings with
carers (for example, when shopping, out in the park,
or visiting other family members) also become more
apparent at preschool age.
Parents may find that:
family members refuse to care for the child,
other children do not invite them to parties or out to
play.
The effect of ADHD on the life of an individual, their family, and

community from preschool to adult life. V Harpin. rch Dis Child. 2005.
Impact
38
FAMILY
Many children with ADHD have very poor sleep
patterns, and although they appear not to need much
sleep, daytime behavior is often worse when sleep is
badly affected.
As a result, parents have little time to themselves;
whenever the child is awake they have to be watching
them.
Not surprisingly, family relationships may be severely
strained, and in some cases break down, bringing
additional social and financial difficulties. This may
cause children to feel sad or even show oppositional
or aggressive behavior.

Impact
39
ADULT LIFE
As many as 60% of individuals with ADHD in
childhood continue to have difficulties in adult life.
Childhood ADHD does not preclude high
educational and vocational achievements (for
example, Masters degree or medical qualification).
However, ADHD is a disorder that may affect all
aspects of a childs life.
COMORBIDITIES
Comorbid disorders may impact on individuals with
ADHD throughout their lives. It is estimated that at
least 65% of children with ADHD have 1 or more
comorbid conditions.
Impact
40
PROBLEMS ASSOCIATED WITH TREATMENT

Growth deficits in children receiving stimulant
treatment for ADHD have long been the subject of
scientific discussion.
Conflicting results reported with some authors
indicating that stimulants do indeed affect growth in
children, but that this only occurs during active
treatment phase and does not compromise final
height.

Impact
41
HEALTHCARE COSTS
In the UK have not been fully estimated, but evidence
from the USA suggests that they are increased
compared with age matched controls.
A population based, historical cohort study followed
4880 individuals from 1987 to 1995 and compared the
nine year median medical cost per person:
ADHD medical costs were US$4306, whereas nonADHD medical costs were US$1944.

Prevention: Primary
44
Many, but not all, studies link exposure to toxins such

as mercury, lead, pesticides, and in utero smoking
exposure to higher levels of autism and/or ADHD.
Some studies have reported many nutritional
deficiencies in autism/ADHD patients. Numerous
studies reported that supplemental nutrients such as
3 fatty acids, vitamins, zinc, magnesium, and
phytochemicals may provide moderate benefits to
autism/ADHD patients.
Nutritional and environmental approaches to preventing and treating
autism and attention deficit hyperactivity disorder (ADHD): a review.
Curtis LT1, Patel K. J Altern Complement Med. 2008
Prevention: Primary
45
Avoidance of food allergens, food chemicals, and

chelation therapy may also provide some relief to
autism/ADHD patients.
Larger studies are needed to determine optimum
multifactorial treatment plans involving:
nutrition,
environmental control,
medication,
behavioral/education/speech/physical therapies.
Nutritional and environmental approaches to preventing and treating
autism and attention deficit hyperactivity disorder (ADHD): a review.
Curtis LT1, Patel K. J Altern Complement Med. 2008
Prevention: Primary
46
For ADHD and other neurodevelopmental

disorders, primary prevention initiatives include
programs that promote maternal health during
pregnancy, such as warnings against alcohol and
cigarette use, as well as initiatives to reduce
environmental toxins, such as lead and mercury.
These initiatives will not eradicate ADHD, but they
may lower incidence rates.
Preventive interventions for ADHD: a neurodevelopmental
perspective. Halperin JM, Bdard AC, Curchack-Lichtin JT.
Neurotherapeutics. 2012.
Prevention: Secondary 47
Summary of key action statements (quality of evidence
B/strong recommendation unless stated otherwise):
The primary care clinician should:
1- Initiate an evaluation for any child 4 through 18
years of age who presents with academic or
behavioral problems and symptoms of inattention,
hyperactivity, or impulsivity.
ADHD Clinical Practice Guideline for the Diagnosis, Evaluation, and
Treatment of Attention-Deficit Hyperactivity Disorder in Children and
Adolescents. American Academy of Pediatrics AAP clinical recommen
dations for the diagnosis and evaluation of ADHD in children.
Pediatrics2011.
2- Determine that DSM criteria were met to make a
diagnosis & rule out any alternative cause (including
documentation of impairment in more than 1 major
setting); information should be obtained primarily from
reports from parents or guardians, teachers, and other
school and mental health clinicians involved in the
child's care.
Pediatrics2011.
3- Include assessment for other conditions that might
coexist with ADHD in the evaluation, including
emotional or behavioral (e.g., anxiety, depressive,
oppositional defiant, and conduct disorders),
developmental (e.g., learning and language disorders
or other neurodevelopmental disorders), and physical
(eg, tics, sleep apnea) conditions.
Pediatrics2011.
4- Recognize ADHD as a chronic condition and,
therefore, consider patients as with special health care
needs. Management of children and youth with special
health care needs should follow the principles of the
chronic care model and the medical home.
Pediatrics2011.
5- Treat children and youth with ADHD depending on patient's age:
a. For preschool-aged children (4-5 years of age): prescribe
evidence-based parent- and/or teacher-administered behavior
therapy as the 1st line of treatment (quality of evidence A/strong
recommendation) and may prescribe Methylphenidate if the
behavior interventions do not provide significant improvement and
there is moderate-to-severe continuing disturbance in the child's
function. In areas where evidence-based behavioral treatments are
not available, the clinician needs to weigh the risks of starting
medication at an early age against the harm of delaying diagnosis
and treatment.
Pediatrics2011.
b. For elementary school-aged children (6-11 years of age),
prescribe FDA-approved medications (quality of evidence A/strong
recommendation) and/or evidence-based parent- and/or teacheradministered behavior therapy as treatment for ADHD, preferably
both. The evidence is particularly strong for stimulant medications
and sufficient but less strong for Atomoxetine, extended-release
Guanfacine, and extended-release Clonidine (in that order) (quality
of evidence A/strong recommendation). The school environment,
program, or placement is a part of any treatment plan.
Pediatrics2011.
c. For adolescents (12-18years of age), prescribe FDA -approved
medications with the assent of the adolescent (quality of evidence
A/strong recommendation) and prescribe behavior therapy as
treatment (quality of evidence C/recommendation), preferably both.
6- Titrate doses of medication for ADHD to achieve maximum
benefit with minimum adverse effects.
Pediatrics2011.
44 of the 2,904 non-duplicate screened records were included in
the analyses. When the outcome measure was based on ADHD
assessments by raters closest to the therapeutic setting, all
dietary (SMD=0.21-0.48) and psychological (SMD=0.40-0.64)
treatments produced statistically significant effects. However,
when the best probably blinded assessment was employed,
effects remained significant for free fatty acid supplementation
(SMD=0.16) and artificial food color exclusion (SMD=0.42) but
were substantially attenuated to non-significant levels for other
treatments.
Nonpharmacological interventions for ADHD: systematic review and
meta-analyses of randomized controlled trials of dietary and
psychological treatments. Sonuga-Barke EJ1, Brandeis D, Cortese S,
Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der
Oord S, Dpfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski
T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC,
Sergeant J; European ADHD Guidelines Group. Am J Psychiatry. 2013.
Free fatty acid supplementation produced small but significant
reductions in ADHD symptoms even with probably blinded
assessments, although the clinical significance of these effects
remains to be determined. Artificial food color exclusion
produced larger effects but often in individuals selected for food
sensitivities. Better evidence for efficacy from blinded
assessments is required for behavioral interventions,
neurofeedback, cognitive training, and restricted elimination diets
before they can be supported as treatments for core ADHD
symptoms.
Nonpharmacological interventions for ADHD: systematic review and
meta-analyses of randomized controlled trials of dietary and
psychological treatments. Sonuga-Barke EJ1, Brandeis D, Cortese S,
Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der
Oord S, Dpfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski
T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC,
Sergeant J; European ADHD Guidelines Group. Am J Psychiatry. 2013.
Prevention: Tertiary
57
Tertiary prevention uses treatment that is unlikely to

be curative but will manage or limit complications
after the disorder has manifested.
Common examples are:
use of insulin for diabetes,
alcohol and drug abuse treatment programs,
most relevant here, psychostimulants or parent
training for individuals with ADHD.
Preventive interventions for ADHD: a neurodevelopmental
perspective. Halperin JM1, Bdard AC, Curchack-Lichtin JT.
Neurotherapeutics. 2012.
Prognosis
58
By use of the Danish national registers, 1.92 million

were followed up individuals, including 32061 with
ADHD, from their 1st birthday through to 2013.
mortality rate ratios (MRRs), adjusted for calendar
year, age, sex, family history of psychiatric disorders,
maternal and paternal age, and parental educational
and employment status, by Poisson regression, were
estimated to compare individuals with and without
ADHD.
During follow-up (24.9 million person-years), 5580
cohort members died.
Mortality in children, adolescents, and adults with attention deficit
hyperactivity disorder: a nationwide cohort study. Dalsgaard S, stergaard
SD, Leckman JF, Mortensen PB, Pedersen MG. The lancet 2015
Prognosis
59
The mortality rate per 10000 person-years was 5.85

among individuals with ADHD compared with 2.21 in
those without (corresponding to a fully adjusted MRR
of 2.07, 95% CI 1.702.50; p<00001). Accidents
were the most common cause of death. Compared
with individuals without ADHD, the fully adjusted MRR
for individuals diagnosed with ADHD at ages younger
than 6 years was 186 (95% CI 0.933.27), and it was
1.58 (1.212.03) for those aged 617 years, and 4.25
(3.055.78) for those aged 18 years or older.
Prognosis
60
After exclusion of individuals with oppositional defiant

disorder, conduct disorder, and substance use
disorder, ADHD remained associated with increased
mortality (fully adjusted MRR 1.50, 1.111.98), and
was higher in girls and women (2.85, 1.564.71) than
in boys and men (1.27, 0.891.76).

Prognosis
61
116 adolescents and young adults with childhood

ADHD were followed up on average 6.6 years later.
ADHD outcome variables were interview-based
parent-reported ADHD symptoms and impairment.
Childhood predictors included:
parent- and teacher-rated ADHD symptoms and
co-occurring behaviours;
actigraph measures of activity level;
socio-economic status (SES);
cognitive measures previously associated with
ADHD.
Childhood predictors of adolescent and young adult outcome in ADHD.
Cheung CH, Rijdijk F, McLoughlin G, Faraone SV, Asherson P, Kuntsi J.
J Psychiatr Res. 2015.
Prognosis
62
Of the sample, 79% continued to meet clinical criteria of ADHD

in adolescence and young adulthood. Higher parent-rated
symptoms and movement intensity in childhood, but not
teacher-rated symptoms, predicted symptoms at follow up.
Co-occurring symptoms of oppositional behaviors, anxiety,
social and emotional problems were also significant predictors,
but these effects disappeared after controlling for ADHD
symptoms. IQ and SES were significant predictors of both
ADHD symptoms and impairment at follow up, but no other
cognitive measures significantly predicted outcome.
Childhood severity of ADHD symptoms, as measured by parent
ratings and actigraph movement intensity, also predicts later
ADHD outcome.
Childhood predictors of adolescent and young adult outcome in ADHD.
Cheung CH, Rijdijk F, McLoughlin G, Faraone SV, Asherson P, Kuntsi J.
J Psychiatr Res. 2015.
Prognosis
60
Outcomes from 351 studies were grouped into 9

major categories:
academic,
antisocial behavior,
driving,
non-medicinal drug use/addictive behavior,
obesity,
occupation,
services use,
self-esteem,
social function outcomes.
A systematic review and analysis of long-term outcomes in attention
deficit hyperactivity disorder: effects of treatment and non-treatment.
Shaw M1, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE.
BMC Med. 2012.
Prognosis
60
Broad trends emerged:

(1)without treatment, people with ADHD had
poorer long-term outcomes in all
categories compared with people without
ADHD,
(2)Treatment improved long-term outcomes
compared with untreated, although not
usually to normal levels.
A systematic review and analysis of long-term outcomes in attention
deficit hyperactivity disorder: effects of treatment and non-treatment.
Shaw M1, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE.
BMC Med. 2012.
Prognosis
69
There are multiple unique measures used to measure

quality of life in adult ADHD, ranging from general
quality of life scales to those specifically designed for
use in ADHD.
ADHD was found to significantly worsen the quality of
life in adults. Treatment with Atomoxetine and mixed
amphetamine salts shown beneficial effects on quality
of life even in cases without symptomatology
improvement.
Pharmacological treatment and early diagnosis have a
positive impact on outcomes, longterm prognosis, and
quality of life in adults with ADHD.
The quality of life of adults with attention deficit hyperactivity disorder: a
systematic review. Agarwal R1, Goldenberg M, Perry R, IsHak WW.
Innov Clin Neurosci. 2012.
Prognosis
70
Difficulties of adults with ADHD show that they have

significantly higher rates of:
marital dissatisfaction and discord,
higher divorce rates,
parenting difficulties.
Work-related problems also negatively affect the longterm outcome of the disorder, as adults with ADHD are
found more often to:
perform poorly, quit, or to have been fired from jobs;
have a history of poorer educational performance;
achieve significantly less formal training;
have lower-ranking occupational positions than
ADHD
in children and adults: diagnosis and prognosis. Kieling R1,
controls.
Rohde LA. Curr Top Behav Neurosci. 2012.
Prognosis
71
Longitudinal studies shown that ADHD persists into

adulthood in approximately 65% of cases, with
differences in remission rates being attributed both to
the different definitions and to the natural history of
the disorder. Childhood ADHD severity and childhood
treatment are thought to significantly predict
persistence.
National Comorbidity Survey Replication found 38.3%
of adults with ADHD had a comorbid mood disorder;
47.1% had a comorbid anxiety disorder; 15.2% had
substance use disorder; and 19.6% had other
impulse-control disorders. (highly comorbid disorder)
ADHD in children and adults: diagnosis and prognosis. Kieling R1,
Rohde LA. Curr Top Behav Neurosci. 2012.
05

Adhd

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Adhd

Uploaded by

Copyright:

Available Formats

01

The worldwide-pooled prevalence of 13.4% for any

Including only studies that assessed multiple

Annual Research Review: A meta-analysis of the worldwide prevalence

ADHD in males and females is more similar than different.

Rucklidge JJ1. Expert Rev Neurother. 2008.

Routine inquiries about childhood abuse in cases of

Confirming previous findings, variability in

ADHD prevalence estimates across three decades: an updated

In 2 consequential studies (Studies 1 and 2):

Study showed that the prevalence rate in (3rd grade)

In elementary schools in Alexandria

However, a significant difference was observed

The prevalence of psychiatric disorder in

As regard the gender, psychiatric disorder

4223 children were subjected to:

Male to female prevalence ratio was 1.61:1.

"Attention Dedicit Hyperactivity Disorders" An epidemiological study

A sample size of 1287 students (6-13 years) in 67

Prevalence and Associated Factors.Al Hamed JH1, Taha

The majority of the boys were from government

Prevalence and Associated Factors.Al Hamed JH1, Taha

1. The prevalence of each subtype of ADHD was

Prevalence and Associated Factors.Al Hamed JH1, Taha

All epidemiological studies on ADHD conducted from

A Sample of 84 ADHD cases out of total 339 children

The extent of ADHD (25%) is similar with other

Mitra S, Ray AK. The familial and other environmental risk

In a population-based, record linkage case-control

Mothers of children with ADHD were significantly

In the fully adjusted model, a novel finding was a

Empirical findings from neurobiological research

Brain functioning alterations are confirmed by

The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder

At a molecular level, alterations in any single

The Global Burden of Disease Study 2010 (GBD

As no evidence of deaths resulting directly from

Between 1990 and 2010, global DALYs

The effect of ADHD on the life of an individual, their family, and

The effect of ADHD on the life of an individual, their family, and

PROBLEMS ASSOCIATED WITH TREATMENT

The effect of ADHD on the life of an individual, their family, and

The effect of ADHD on the life of an individual, their family, and

Many, but not all, studies link exposure to toxins such

Avoidance of food allergens, food chemicals, and

For ADHD and other neurodevelopmental

Tertiary prevention uses treatment that is unlikely to

By use of the Danish national registers, 1.92 million

The mortality rate per 10000 person-years was 5.85

After exclusion of individuals with oppositional defiant

Mortality in children, adolescents, and adults with attention deficit

116 adolescents and young adults with childhood

Of the sample, 79% continued to meet clinical criteria of ADHD

Outcomes from 351 studies were grouped into 9

Broad trends emerged:

There are multiple unique measures used to measure

Difficulties of adults with ADHD show that they have

Longitudinal studies shown that ADHD persists into

You might also like