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What is Attention Deficit Hyperactivity Disorder (ADHD) and how is it treated?

9 de February, 2024

We share an opinion article from Dr. Inês Oliveira, Child Psychiatrist at CNS – Campus Neurológico, in which she explains what ADHD consists of, how it is diagnosed, and treated.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

The worldwide prevalence of ADHD in children and adolescents is 5 to 7%, affecting approximately 6% of school-aged children, 3% of adolescents, and 2.5% of adults, with significant cognitive, behavioral, and socio-emotional repercussions. The key symptoms of this condition are:

  • Hyperactivity (difficult to control restlessness);
  • Impulsivity (difficulty waiting one’s turn, controlling/inhibiting responses, planning);
  • Inattention (difficulty initiating/maintaining/completing tasks, tendency towards disorganization).

Several of the symptoms appear before the age of 12, in at least two contexts, and have been present for more than 6 months. There are three distinct presentations of ADHD, depending on the type of symptoms that are most pronounced: Predominantly Inattentive Type, Predominantly Hyperactive/Impulsive Type, and Combined Type.

ADHD is more prevalent in males, with this disparity being more pronounced in the Predominantly Hyperactive/Impulsive Type of ADHD (4:1). It is noteworthy that ADHD is more commonly underdiagnosed in females. This fact has been associated with the tendency for the disorder to manifest with less hyperactivity and fewer aggressive behaviors in females. However, studies point to greater impulsivity in this population, as well as more neurological signs.

The symptoms can be minimal or absent in some contexts, for example, when there are frequent rewards for appropriate behaviors, close supervision, in a novel context, during especially interesting activities, among others. On the other hand, unstructured situations exacerbate the symptoms.

The symptoms manifested vary throughout life. Impulsivity and inattention persist throughout adolescence, while hyperactivity tends to decrease.

ADHD is a chronic condition that persists into adulthood in more than 50% of cases. Its etiology is multifactorial, involving both genetic and environmental factors. Having a first-degree relative with the disorder increases the risk of the disease by 8 times.

The diagnosis is clinical, based on semi-structured interviews and observations of the child or adolescent, and it is essential to gather information from multiple sources. It is challenging to make an accurate diagnosis in preschool-aged children. A correct differential diagnosis is important, considering other neurodevelopmental disorders, other psychiatric disorders (Anxiety Disorders, Depressive Disorders, Conduct Disorders, etc.), and other conditions, including side effects of medications, thyroid function alterations, auditory or visual acuity deficits, sensory processing difficulties, among others.

In 60-70% of cases, comorbidities are present, including Oppositional Defiant Disorder and/or other Behavioral Disorders, Anxiety Disorders, Depressive Disorders, Learning Disabilities, Language Disorders, and Substance Use Disorders.

Intervention should be personalized and include psychopedagogical support, school intervention, psychoeducation, and skills training. In preschool-age, first-line treatment includes parental skills training and behavioral interventions/individual therapeutic intervention. Pharmacological treatment should only be used in cases of difficult aggression control. In school-age, pharmacological treatment is part of first-line treatment. Throughout the intervention, the diagnosis should be reevaluated, and possible comorbidities should be ruled out. There are assessment scales and psychological tests that can be useful for quantifying the severity of symptoms and assisting in monitoring treatment response.

The prognosis varies depending on the type of ADHD, its severity and impact in various contexts, the presence of comorbidities, the existence of protective factors, and the treatment/supports that the child/adolescent and their family receive throughout their development. Studies indicate that adults with ADHD have a lower ability to cope with stressful events and a higher risk of dropping out of school, unemployment, traffic accidents, substance misuse, and a higher number of depressive episodes.

Dr. Inês Oliveira

Child Psychiatrist

CNS – Campus Neurológico