Attention-deficit hyperactivity disorder: a clinical review of the concept, diagnosis and management

Abstract

The history of psychiatry is the history of therapeutic enthusiasm with all of the triumph and tragedy, hubris and humility that this brings. As a result, the emergence of any new diagnosis, such as attention-deficit hyperactivity disorder (ADHD), needs to be greeted with caution, rigour and scientific objectivity, as well as compassion, therapeutic engagement and optimism. Although there is now little doubt that ADHD is a valid, useful diagnostic concept, and progress has been made, there is still considerable work to be done to establish its incidence, prevalence and biological underpinnings, as well as optimal therapeutic strategies. As with all mental illnesses, it is likely that knowledge will develop over many decades and diagnostic criteria will be refined in parallel. In the absence of definitive biological understanding, there should be particular caution about over-exuberant diagnostic expansionism unless it is accompanied by compelling evidence of therapeutic benefit for those diagnosed.

Understanding ADHD: Toward an Innovative Therapeutic Intervention

“…The three subtypes of ADHD currently recognized are predominantly inattentive (IA); predominantly hyperactive-impulsive (HI); and the “combined” type, a blend of the other two, which is the most common [ 26 ]. Clinicians use diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) manuals to evaluate patients for a proper ADHD diagnosis [ 27 ]. This diagnosis includes reviewing symptoms present in home and school settings from parent, teacher, and patient perspectives through questionnaires; interviews; and reviewing records, such as academic transcripts.…”

“…The standard of care for patients with ADHD varies with age and manifest intensity of the condition. However, according to the National Institute for Health and Care Excellence (NICE) standards, before medication, lifestyle should be the initial focus for adjustments [ 27 ]. This includes regulating what the patient eats, verifying the quality of what the patient eats, and making sure that the patient is on an age- and physical condition-appropriate exercise regimen.…”

“…This includes regulating what the patient eats, verifying the quality of what the patient eats, and making sure that the patient is on an age- and physical condition-appropriate exercise regimen. For very young children, this is the primary treatment aside from training their guardians, due to a common aversion to medicating young children [ 27 ]. Properly educating all parties involved in a child’s care is a standard across all variations as misinformation about ADHD is prevalent.…”

“…Psychological approaches, in the form of group and individual therapy for parents and patients, are recommended along with medication in those with less-inhibiting forms of ADHD, whereas medication is recommended first with more inhibiting forms of ADHD. The three most used and researched medications are methylphenidate, atomoxetine, and dexamphetamine [ 27 ]. Each is specific to a set of symptoms and manifestations of ADHD.…”

“…They come along with their own side effects, typically some sort of small to large behavioral change. This change can manifest as anything from high aggression to more frequent intrusive and suicidal thoughts [ 27 ]. These treatment methods are typically recommended by the diagnosing primary physician.…”