**Part 1**

**Treatment Considerations** 

**1** 

Somnath Banerjee

*United Kingdom* 

**ADHD in Children and Adolescents:** 

*Community Paediatrician, East Kent Hospitals University NHS Foundation Trust, Convenor, UK George Still Forum (National Paediatric ADHD Interest Group)* 

The syndrome of restless, inattentive, and impulsive behaviour known as Attention Deficit Hyperactivity Disorder (ADHD) or Hyperkinetic Disorder (HKD) is a common neurodevelopmental problem in children and adolescents. Children affected with this disorder are at risk of academic failure, substance abuse, and criminality in adolescence and adulthood. ADHD is a reflection of an underlying deficit that may have several ultimate causes such as genetic predisposition, psycho-physiological factors and psychological dysfunction, but a common pathway at the behavioural level (Hill & Cameron, 1999). By labelling children with difficult behaviour as suffering from a disorder, we make it easier to treat and this carries with it the danger of over-diagnosis (Orford, 1998). On the other hand,

Prevalence of ADHD estimates that 3 to 7% children would meet the criteria of Diagnostic and Statistical Manuel-IV (DSM-IV) of American Psychiatric Association's diagnostic criteria (APA, 1994). The ratio of boys to girls is between 3:1 and 9:1 but this may decrease with age (Swanson *et al*., 1998). Part of the difference between sexes may be referral bias (Beiderman *et al*., 1996). Follow-up studies of children with ADHD find that 15% still have the full diagnosis at 25 years, and another 50% are in partial remission, with some symptoms

No genetic marker has been identified in children with ADHD. Neuroimaging studies confirm abnormalities in those regions of the brain that are implicated in ADHD (Swanson *et al*., 1998; Castellanos *et al*., 2002). These studies report significantly smaller asymmetrical prefrontal and basal ganglia structures, in children with ADHD. Correlations of magnetic resonance imaging-based anatomical measures and specific-task performance in children suggest that the right prefrontal cortex is involved in inhibiting attentional and behavioural responses, whereas the basal ganglia seem to be involved in the execution of these responses (Konrad & Eickhoff, 2010). One third of affected individuals have at least one parent who

**1. Introduction** 

**2. Incidence**

**3. Aetiology** 

persisting (Faraone *et al*., 2006).

under-diagnosis is also an issue (Dopheide, 2001).

**A Good Practice Guidance** 
