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Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is the term designated by the American Psychiatric Association in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to refer to the set of three core psychological symptoms—inattention, excessive activity, and impulsivity—when those symptoms begin by age 12, persist for at least 6 months, and interfere with individuals’ development and ability to perform the tasks of everyday living. This entry further describes ADHD and discusses its prevalence, the development of the understanding of ADHD and diagnostic criteria for the disorder, risk and protective factors, treatments for ADHD, measurement issues in the evaluation of ADHD, and promising advances in diagnosis and treatment of ADHD from a neuroscience perspective.

For individuals with severe symptoms, the effects of ADHD can have lifelong negative effects on all aspects of cognitive, emotional, and social development, leading to difficulties in learning to read, poor memory, academic failure and dropping out of school, problems at work, alcohol and drug abuse, disruptive relationships with parents, friends, and coworkers, and criminal behavior. According to the Centers for Disease Control and Prevention, 6.4 million children aged between 4 and 17 years, or about 11% of children in that age range, had received a diagnosis of ADHD as of 2011. Centers for Disease Control and Prevention estimates show that boys are more than twice as likely as girls to have the diagnosis. The toll that ADHD can take on personal lives as well as its costs to the economy and society make this topic particularly relevant to the issues of research, measurement, and evaluation.

Effective identification, diagnosis, intervention, and prevention of ADHD remain a significant challenge and depend on the development of greater insights into the nature and progression of ADHD. To achieve this understanding, the development of reliable and valid measurement instruments and research to create powerful strategies for prevention and intervention for individuals with ADHD are needed.

The Concept and Diagnosis of ADHD

The three core symptoms of ADHD impact thinking, feelings, and behavior. Specifically, inattention refers to the inability to focus and sustain attention on relevant information. Typical indicators include making careless mistakes, frequent forgetting and losing of items, failing to complete assignments, and difficulties in organizing and planning. Hyperactivity/impulsivity refers to the inability to control one’s thoughts, emotions, and behavior. Indicators include constantly moving and running around, fidgeting and squirming, and interrupting the activities and conversations of others.

ADHD is an incurable, chronic condition that varies in severity from mild to severe. Once considered primarily a childhood disorder due largely to the negative impact the three symptoms have on school performance, ADHD emerges as early as age 3 and continues into adulthood for about 50% of those diagnosed with ADHD as children. Although estimates of ADHD vary widely depending on access to caregivers, estimates of its prevalence range from about 5% to 7% of the world population.

The conception of ADHD has evolved over time as researchers, clinicians, and educators have contributed to the development of knowledge on the topic. Problematic behaviors in children involving their inability to focus and sustain attention and to control activity level and emotional and behavioral impulses when necessary became an issue of concern during the early 1900s with the introduction of universal education. During the 1930s and 1940s, emphasis was placed on the role of brain damage as the source of hyperactivity, but the lack of reliable and valid measures of that damage led to a change in focus. In 1980, in the DSM-3, the American Psychiatric Association introduced the term attention deficit disorder with and without hyperactivity, placing the emphasis on the attention deficit and impulsivity rather than hyperactivity.

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