Attention-deficit/hyperactivity disorder

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD. For an illustrated summary of this Primer, visit: http://go.nature.com/J6jiwl

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Figure 1: The history of attention-deficit/hyperactivity disorder.
Figure 2: The age-dependent decline and persistence of attention-deficit/hyperactivity disorder throughout the lifetime.
Figure 3: Genetics of attention-deficit/hyperactivity disorder.
Figure 4: Brain mechanisms in attention-deficit/hyperactivity disorder.
Figure 5: Developmental course of attention-deficit/hyperactivity disorder in persistent cases.
Figure 6: Assessment guides management.
Figure 7: Management decision tree.
Figure 8: Quality of life and attention-deficit/hyperactivity disorder.

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Acknowledgements

The authors thank M. Mehta for help with incorporating the default mode network into Figure 4. S.V.F. is supported by the K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway, the European Commission's Seventh Framework programme (FP7/2007–2013) under grant agreement no. 602805 and National Institute of Mental Health (NIMH) grants R13MH059126 and R01MH094469. J.B. is supported by grants from the Netherlands Organization for Health Research and Development (ZonMw 60-60600-97-193), the Netherlands Organization for Scientific Research (NWO; grants 1750102007010, 433-09-242 and 056-13-015), and by the European Commission's Seventh Framework programme (FP7/2007-2013) under grant agreement no. 278948 (TACTICS), 602450 (IMAGEMEND), 602805 (AGGRESSOTYPE) and 603016 (MATRICS); and Horizon 2020 research programme (grant agreement no. 643051 (MiND) and 642996 (BRAINVIEW)). His research also receives funding from the US NIH Consortium grant no. U54 EB020403, supported by a cross-NIH alliance that funds Big Data to Knowledge Centers of Excellence. B.F. is supported by grants from NWO (grants no. 433-09-229 and 016-130-669), from the European Commission's Seventh Framework programme (grant agreement no. 278948 (TACTICS), 602450 (IMAGEMEND) and 602805 (Aggressotype)); and Horizon 2020 research programme (grant agreement no. 643051 (MiND)). Her research also receives funding from the NIH Consortium grant no. U54 EB020403, supported by a cross-NIH alliance that funds Big Data to Knowledge Centers of Excellence. J.A.R.-Q. is supported by grants from and Departament de Salut, Government of Catalonia, Spain, Instituto de Salud Carlos III-FIS (PI12/01139), Plan Nacional Sobre Drogas (PNSD2011/0080) and the European Commission's Seventh Framework programme. R.T. is supported by grants from the Canadian Institutes for Health Research (CIHR #245899) and the Institute of Education Sciences (R305A120184). L.A.R. is supported by a grant from the National Counsel of Technological and Scientific Development – CNPq (grant no. 304678/2010-4). E.J.S.S.-B. is supported by grants from the Economic Social Research Council (ES/I037970/1), Medical Research Council (MR/K022474/1), National Institute for Health Research (NIHR PGfAR – RP-PG-0108-10061), MQ Transforming Mental Health (MQ14PP_83), European Commission's Seventh Framework programme (2007–2013) under grant agreement no. 260576 and an unrestricted programme grant from Shire Pharmaceuticals.

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Contributions

Introduction (S.V.F.); Epidemiology (L.A.R.); Mechanisms/pathophysiology (P.A., J.K.B. and S.V.F.); Diagnosis, screening and prevention (R.T., J.A.R.-Q., S.V.F. and E.J.S.S.-B.); Management (J.B. and E.J.S.S.-B.); Quality of life (T.B.); Outlook (B.F. and S.V.F.); Overview of Primer (S.V.F.). Aside from the first and last author, authorship is alphabetical. All authors extensively commented on each other's sections.

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Correspondence to Stephen V. Faraone.

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Competing interests

S.V.F. has received income, travel expenses and/or research support from, and/or has been on an advisory board for, and/or participated in continuing medical education programmes sponsored by: Pfizer, Ironshore, Shire, Akili Interactive Labs, CogCubed, Alcobra, VAYA Pharma, Neurovance, Impax, NeuroLifeSciences, Otsuka, McNeil, Janssen, Novartis, Eli Lilly and the US NIH. With his institution, S.V.F. has US patent US20130217707 A1 for the use of sodium–hydrogen exchange inhibitors in the treatment of ADHD. He receives royalties for books published by Guilford Press: Straight Talk about Your Child's Mental Health; Oxford University Press: Schizophrenia: The Facts; and Elsevier: ADHD: Non-Pharmacologic Treatments. J.K.B. has been a consultant to, a member of an advisory board for, and/or speaker for: Janssen-Cilag BV, Eli Lilly, Shire, Lundbeck, Roche and Servier. He receives research support from the NIH, the European Commission's Seventh Framework programme, the Marie Curie programme and the Netherlands Organization for Scientific Research (NWO). R.T. is an advisory board member for, has served as consultant for, received travel awards from, and/or received software licenses from: the Canadian ADHD Resource Alliance (CADDRA), Shire, Purdue, the Ministry of Education of Newfoundland and Labrador, BioMed Central and Pearson-Cogmed. She receives authorship royalties from Springer and Cambridge University Press. E.J.S.S.-B. has received speaker fees, consultancy, research funding and/or conference support from: Shire, Janssen-Cilag, Neurotech solutions, Medice and the Universities of Leuven, Aarhus and Copenhagen. He has received book royalties from Oxford University Press and Jessica Kingsley, the latter related to the New Forest Parenting Programme. T.B. has served in an advisory or consultancy role for, received conference support from, received speakers' fees from, and/or been involved in clinical trials sponsored by: Hexal Pharma, Eli Lilly, Medice, Novartis, Otsuka, Oxford outcomes, PCM Scientific, Shire and Vifor Pharma. The present work is unrelated to the above grants and relationships. J.B. has received research support or honoraria from: The US Department of Defense, American Academy of Child and Adolescent Psychiatry (AACAP), Alcobra, Forest Research Institute, Ironshore, Lundbeck, Magceutics Inc., Merck, PamLab, Pfizer, Shire, SPRITES, Sunovion, Vaya Pharma/Enzymotec, Massachusetts General Hospital (MGH) Psychiatry Academy, American Professional Society of ADHD and Related Disorders (APSARD), ElMindA, McNeil and the NIH. He has a US patent application pending (Provisional number #61/233,686) through MGH corporate licensing on a method to prevent stimulant abuse. He has received departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid by Ingenix, Prophase, Shire, Bracket Global, Sunovion and Theravance; these royalties were paid to the Department of Psychiatry at MGH. J.A.R.-Q. has been on the speakers' bureau for, acted as consultant for and/or received travel awards from: Eli Lilly, Janssen-Cilag, Novartis, Shire, Lundbeck, Ferrer and Rubió in the past 3 years. The ADHD Program chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the past 3 years: Eli Lilly, Janssen-Cilag, Shire, Rovi and Rubió. B.F. has received speaker fees from Merz. L.A.R. has been on the speakers' bureau for, on the advisory board for, received travel grants from and/or acted as a consultant for: Eli Lilly, Janssen-Cilag, Novartis and Shire in the past 3 years. He receives authorship royalties from Oxford University Press and ArtMed. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the past 3 years: Eli Lilly, Janssen-Cilag, Novartis and Shire. P.A. has been on the speakers' bureau for, on the advisory board for and/or has received unrestricted educational and research awards from: Janssen-Cilag, Novartis, Shire, Qbtech, Vifor Pharma, GW Pharmaceuticals, PCM Scientific and Eli Lilly. All fees related to these activities are paid to Kings College London.

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Faraone, S., Asherson, P., Banaschewski, T. et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 1, 15020 (2015). https://doi.org/10.1038/nrdp.2015.20

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