In this review of the literature, the authors addressed topics relating to childhood ADHD, including prevalence, diagnosis and associated comorbidities, in addition to discussing the burden of the disorder on the social and economic life of the family.
ADHD is one of the most common psychiatric disorders among children/adolescents (6% of school-age children worldwide according to a 2007 systematic review; 5% of children aged ≤18 years). Based on a meta-analysis published in 2006, the disorder may continue into adulthood with a persistence rate of 15% at 25 years of age, and a partial remission rate of approximately 65%. Children with ADHD demonstrate poorer long-term outcomes than controls without ADHD in different life domains.*
There is a shift in the comorbidity profile associated with ADHD as the patient progresses through different stages of development. In early childhood, children with ADHD might only present with intellectual deficits and autism spectrum disorder. In late childhood, other comorbidities† are commonly associated with ADHD. Conduct disorder, major depressive disorder and bipolar disorder are more prevalent during adolescence, whilst personality and substance use disorders are commonly associated with adult ADHD.
Children with ADHD often quarrel with their parents, peers and teachers, which strains the relationships with their families. In addition, families of children with ADHD incur higher annual expenses relative to those of children without the disorder, and this is driven by costs of comorbidity treatment, medication use, transportation to a hospital, accidents, loss of a job, and criminality.
Treatment guidelines emphasise the role of the family in the management of ADHD. Psychological/behavioural interventions constitute the first-line treatments for children with ADHD. When resorting to pharmacotherapy, stimulants should be tried before non-stimulants.
This review highlighted the evolving nature of the core symptoms of ADHD and its associated comorbidities, and emphasised the negative impact of the disorder on the family. The authors stressed that early treatment is necessary to alleviate the burden of ADHD.
*Educational achievement; occupational status; relationship issues; risk-taking behaviour; substance use
†Intellectual disabilities; anxiety disorders; tic disorders; oppositional defiant disorder; disruptive mood dysregulation disorder
Usami M. Functional consequences of attention-deficit hyperactivity disorder on children and their families. Psychiatry Clin Neurosci 2016; 70: 303-317.