Inattention in children can manifest in bad time management, forgetfulness, disorganization, and task avoidance; while hyperactivity can manifest in ways such as difficulty waiting for their turns, difficulty in being still, excessive physical activities such as running and climibing. 

ADHD in Childhood

The exact causes and triggers for ADHD development are unknown, but there are some speculated risk factors. 

ADHD is NOT caused by excess sugar, poor parenting/schooling, too much TV/video games, stress, or food allergies. These things may make symptoms worse, but they are NOT causes.

Causes of ADHD

Sections:
- Prevalence in Children and Adolescents
- Prevalence in Adults
- Prevalence by Gender
- Prevalence by Race/Ethnicity
- Prevalence within Families

ADHD: Prevalence Rates

According to the DSM-V, diagnostic criteria for ADHD is as follows:
- A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
- Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
- Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, etc.)
- There is clear evidence that symptoms interfere with, or reduce the quality of social, academic, or occupational functioning.
- The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better explained by another mental disorder.

ADHD: Diagnostic Criteria

Symptoms are grouped into 3 types:

- Inattentive: easily distracted, forgetful, daydreams frequently, and disorganized.
- Hyperactive-Impulsive: fidgety, excitable, high-energy, struggles with patience, interrupts others
- Combined: displays a mix of symptoms from the above two types.

Symptoms can change as a person grows and develops, and some even "grow out of their ADHD".  It is possible for symptoms to disappear or resurface during one's lifetime.

Symptoms of ADHD

Those diagnosed with ADHD often find that their ADHD diagnosis impacts the strength and stability of their relationships. Some examples of potentially affected relationships include childhood friendships, familial relationships, romantic partnerships, and relationships with oneself.

Relationships and ADHD

Considering the abundance of pediatric diagnoses, with a large increase since diagnostic changes in the 1980s and changes in Medicare coverage, this disorder's diagnosis has been met with a fair amount of criticism. Particularly regarding pediatric diagnosis, many critics claim ADHD is over-diagnosed, assigning a disability to a child simply being a child and medicating them to enforce compliance. Some critics proclaim this increase in medication of children for ADHD is to push drugs on the population and make a buck. 
Over-prescribing does exist in some areas, however, on the whole, it does not appear to be the case. Not every individual with ADHD is prescribed medication. Just because diagnoses have increased, doesn't mean they're all false positives. Diagnostic criteria has changed as our understanding of the disorder has changed. Though this is still hotly debated, additional research is encouraged to formulate an opinion. 

ADHD Diagnosis Controversies

Though there is no cure, there are treatments to help manage symptoms. There are two types of treatment options for ADHD:

- Behavior Therapy (including parental training).
- Medication.

Like most treatments for mental disorders and psychological issues, the best treatment is often a combination of therapy and medication. 

For children with ADHD younger than 6 years old, parent training in behavior management  is recommended as the first line of treatment, before medication is tried. For children 6 years old and older, it's recommended to try medication and behavior therapy together.

ADHD: Treatment Options

There are three diagnostic types of ADHD:
- Inattentive Type (Formerly known as Attention-Deficit Disorder)
- Hyperactive-Impulsive Type
- Combined Type (exhibits symptoms of both Inattentive type and Hyperactive/Impulsive type)

ADHD: Types

- Children
- Adults
- College Students
- Parents of Children with ADHD

Experiences of ADHD by Population Group

Though there is no cure, there are treatments to help manage symptoms. Like most treatments for mental disorders and psychological issues, the best treatment is often a combination of therapy and medication. For children with ADHD, therapy is often recommended for their parents/guardians so they know how to better handle the symptoms their child manifests. 

Regarding medications, stimulants are the most frequently prescribed. However, other kinds are prescribed, as stimulants don't work for everyone.

- Stimulants
- Non-stimulants
- Anti-depressants

ADHD Treatment

The MTA (1999) was a study aiming to evaluate the effectiveness of ADHD treatments for children. The study was conducted over a 14-month period.

- ADHD treatments evaluated by the MTA
- MTA participant selection
- Major Findings of the MTA 
- Limitations of the MTA
- MTA: after the study
- MTA research sites
- MTA references

Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study

Research suggests that ADHD-related impairment results from deficits in one or more of several neurological processes, including:
 - Response inhibition and Working memory ("Cool" executive functioning)
 - Delay Aversion ("Hot" executive functioning)
 - Temporal Processing and Cognitive-energetic state

Etiology of ADHD

- Depression
- Anxiety Disorders
- Bipolar disorder
- SUDs (Substance-Use Disorders)
- Personality Disorders

ADHD: Common Psychiatric Comorbidities

In the 1920s, Hans Hoffman provided one of the earliest documented descriptions of symptoms now associated with ADHD. While caring for his son, Hoffman observed behaviors such as a short attention span, difficulty concentrating on schoolwork, and the need for repeated review of simple material to learn it.

Hans Hoffman's Early Observations of ADHD Symptoms

The modern concept of ADHD formed from the realization that hyperactivity (fidgetiness, restlessness, poor impulse control) and inattention (distractibility, concentration issues) were often co-occurring symptoms. This understanding solidified in the 1970s and led to the inclusion of 'attention deficit disorder with and without hyperactivity' in the DSM-III in 1980, establishing the foundation for the current diagnosis.

Evolution of the ADHD Diagnosis in the DSM

For a significant portion of individuals, ADHD is a lifelong condition that persists into adulthood for about 60% of diagnosed children. This persistence is strongly associated with a high rate of other mental health conditions. A study revealed that nearly 81% of adults with persistent ADHD also had at least one comorbid disorder, a rate substantially higher than the 47% found in adults whose childhood ADHD did not persist.

ADHD Persistence and Comorbidity in Adulthood

The significant role of genetics in ADHD is supported by twin and adoption studies. A comprehensive 2009 review by Burt revealed that the median concordance rate for identical twins was .66, substantially higher than the .20 rate for fraternal twins. The same review identified a concordance rate of .09 for unrelated adoptive siblings, suggesting that while genetics are primary, environmental factors may also contribute to the disorder's development.

Evidence for Genetic Influence on ADHD from Twin and Adoption Studies

The heritability of ADHD's core symptoms is estimated to be very high, reinforcing the disorder's strong genetic roots. A 2010 review of studies by Nikolas & Burt found that the heritability of inattention was 71%, while the heritability of hyperactivity was 73%.

Heritability Estimates for Core ADHD Symptoms

Attention-Deficit Hyperactivity Disorder (ADHD) is characterized by inattention and hyperactivity-impulsivity and is divided into three subtypes:
- primarily inattentive
- primarily hyperactive-impulsive
- combined

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- Intellectual and Developmental Disabilities (IDD)
- Learning disabilities
- Autism Spectrum Disorder (ASD)
- Downs Syndrome
- Fetal Alcohol Syndrome (FAS)
- Cerebral Palsy
- Attention-Deficit Hyperactivity Disorder (ADHD)
- Phenylketonuria (PKU)
- Hypoxia
- Fragile X Syndrome (FXS)
- Rett Syndrome
- Developmental Dyslexia
- Auditory Processing Disorder (APD)

Examples of developmental disorders

- Social Anxiety Disorder (SAD)
- Attention-Deficit Hyperactivity Disorder (ADHD)
- Autism Spectrum Disorder (ASD)
- Learning Impairment Disorders
- Down's Syndrome
- William's Syndrome
- Disability Cultural Centers (DCCs)

Student Diversity - Disabilities

Conduct problems and impulsivity in child psychopathy were later studied as combinations of Attention-Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). Studies show the combination of symptoms of ADHD, ODD/CD, and exhibiting high callous-unemotional (CU) traits in children are more likely to have psychopathic tendencies.

Conduct Problems and Impulsivity in Psychopathy

Centers for Disease Control and Prevention. (2021, January 26). What is ADHD? Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/facts.html. 

What is ADHD? CDC

Bhargava, H. (2021, February 22). ADHD: Symptoms, Types, Testing, and Treatment. WebMD. https://www.webmd.com/add-adhd/childhood-adhd/attention-deficit-hyperactivity-disorder-adhd. 

ADHD WebMD

Centers for Disease Control and Prevention. (2020, September 21). Symptoms and Diagnosis of ADHD. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/diagnosis.html. 

ADHD DSM-5 Diagnosis Guidelines CDC 

Parekh, R. (2017). What Is ADHD? American Psychiatric Association. https://www.psychiatry.org/patients-families/adhd/what-is-adhd. 

What is ADHD?

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Autism Spectrum Disorder is a neurodevelopmental disorder that affects communication and behavior. It displays symptoms such as impaired communication, lack or impairment in social skills and interactions, and repeated patterns of behaviors that interfere with an individual's ability to cognitively function. These symptoms are almost always present in early development, and are considered to be on a 'spectrum' because of the differences in severity of these symptoms.


Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life. Boys tend to be diagnosed more often than girls by approximately 4x. There is also an overrepresentation of transgender or gender nonconforming people with ASD.

Autism Spectrum Disorder

Phenylketonuria (PKU) is a recessive hereditary disorder, meaning that two copies of the mutated gene implicated in PKU disease processes must be inherited in order for an individual to display symptoms of this disorder. It’s one of the most common inherited metabolic disorders. The mutated genes cannot produce the enzyme that normally metabolizes the compound phenylalanine, found in certain food products, into tyrosine. The build-up of phenylalanine in the brain can become toxic, leading to intellectual disability when the build-up interferes with myelination in the central nervous system. If a baby with PKU ingests food with phenylalanine, the build-up during the post-birh period stunts brain development. Because of its preventable nature, and because the test is inexpensive and accurate, many governments have passed laws for mandatory PKU testing shortly after birth, and this has prevented many cases of intellectual disability.
PKU can be prevented by regulating the level of phenylalanine intake, especially early in life. After the post-birth brain development period has passed, the low phenylalanine diet can be relaxed somewhat since the danger to brain development has passed. 
For pregnant women with PKU, however, this isn’t the case. When a fetus is in utero, it’s protected by its mother’s metabolism. For non-PKU having mothers, this means the baby is especially protected during this time. However, if the mother has PKU and ingests a diet with typical or high levels of phenylalanine - while it won’t damage HER brain - it will cause improper brain development in the fetus. 

Phenylketonuria (PKU)

Hypoxia describes a deficiency in oxygen. If newborns experience birth complications such that they experience a lack of oxygen at birth, they are more likely to have an intellectual disability, or significant difficulties with intellectual functioning and adaptive behavior. 

Hypoxia

Fragile X syndrome is perhaps the most common genetic form of intellectual disability. It results when the trinucleotide repeats (i.e., CGG repeats) in the long arm of the X chromosome number more than 200 repeats, as opposed to the normal 6-50 repeats. This extension of repeats leaves this region of DNA fragile, or prone to breakage. Specifically, the overexpansion causes methylation and transcriptional repression of the Fragile X Mental Retardation 1 gene (*FMR1*), which encodes an important RNA-binding protein that inhibits RNA translation into proteins known as fragile X retardation protein (FMRP). The condition affects 1 in 3600 males and 1 in 8000 females. The reason for this large discrepancy between incidences in biological sexes is due to the fact that genetic females have two X chromosomes rather than one X like genetic males do. Generally speaking, females have one normally functioning *FMR1* on the non-mutated chromosome in each cell, which allows their symptoms to be milder since the amount of abnormal *FMR1* is more variable than in males.

Fragile X Syndrome

Down syndrome is a developmental disorder that causes varying degrees of physical and cognitive disability. It is the most common genetic condition and is caused by a chromosomal abnormality in which there is an extra copy of chromosome 21. 

Down Syndrome

Fetal Alcohol Syndrome is a specific diagnosis within the broader Fetal Alcohol Spectrum Disorder. It occurs when a mother consumes alcohol during pregnancy, especially during the critical period of the 3rd or 4th week of gestation. This exposure damages the developing nervous system, leading to distinct anatomical and behavioral abnormalities.

Fetal Alcohol Syndrome (FAS)

Learning disabilities are cognitive disorders that impact specific areas of cognition, such as language or reading. They are classified as specific neurological impairments, distinguishing them from global intellectual or developmental disabilities. A key characteristic is that they often affect individuals with average to above-average intelligence, meaning the disability is confined to a particular cognitive area and is not an indicator of overall intellectual capability.

Learning Disabilities

Attention-Deficit Hyperactivity Disorder (ADHD)

Cerebral Palsy is the most common motor disability in children, and it is caused by abnormal development or damage to the brain. This results in an impaired ability to move and maintain posture. In mild cases, individuals may walk a bit awkwardly while severe cases may need a caretaker and special equipment.

Cerebral Palsy

Rett Syndrome is a rare X-linked disorder usually caused by spontaneous (de novo) mutations in the methyl-CpG-binding protein 2 (*MeCP2*) gene. It affects almost exclusively genetic females (1 in 10,000 females). This is because genetic males only have one X chromosome and therefore don’t have dosage compensation occurring, lessening the amount of the mutated gene circulating. Genetic males with the syndrome either die in utero or in infancy due to the severity of the mutation phenotype. For 6 - 18 months persons with Rett Syndrome experience normal development, hitting the usual developmental milestones, until said development suddenly stops and regression begins. There’s usually a mild improvement in some social skills at around age 5, but regression (mental and physical) will continue for the rest of the person’s life.


Rett Syndrome

Individuals with Intellectual and Developmental Disabilities

IDD 

A 10-year-old student consistently scores in the high-average range on intelligence tests that measure problem-solving and abstract reasoning. However, the student struggles significantly with reading, frequently confusing letters and having difficulty sounding out words, which is well below the expected level for their age and overall intelligence. Which of the following best categorizes this student's specific challenge?

In a foundational 1943 paper, psychiatrist Leo Kanner detailed a unique neurodevelopmental condition he termed "early infantile autism." His observations in a group of children highlighted key characteristics, including an inability to form close emotional bonds, abnormalities in speech and language, repetitive behaviors, and a strong intolerance for minor changes in their environment or routines.

Leo Kanner's 1943 Description of Early Infantile Autism

Social anxiety disorder (SAD) affects about 4% of the worldwide population and is slightly more common in women. Also known as social phobia, it is defined as a persistent,and potentially debilitating fear of meeting new people, being watched, or criticized by others. Some with social anxiety may attempt to avoid anxiety-triggering situations by self-isolating or cancelling plans. It is a profound fear of the judgement of peers, particularly public humiliation. It is NOT shyness or introversion but can sprout from childhood shyness. In a social sense, social anxiety is not just feeling nervous or shy in certain social situations like starting a new job or the first day of school. Social anxiety disorder is a disorder that interferes with everyday life and relationships due to fearing situations where you can be embarrassed or viewed negatively and intense fear of situations where a person with SAD expects the worst. 

Social Anxiety Disorder (Social Phobia)

- What is a Disability?
- What is a DCC?
- History of DCCs
- List of DCCs
- DCC References

Disability Cultural Centers (DCCs)

Oppositional Defiant Disorder (ODD) is defined as a behavior disorder with characteristics such as hostility and defiant behavior with authority figures, peers, and family.

Oppositional Defiant Disorder (ODD)

Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
1. Aggression to people and  animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violations of rules
 
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
 
If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder
 
Specify age onset:  Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years

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