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The most widely used diagnostic manuals for attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), are the Diagnostic and Statistical Manual for Mental Health Disorders, 5th Edition (DSM-5TM) and the International Classification of Diseases 10th Revision (ICD-10).1,2

Symptoms of ADHD can vary between patients in terms of severity and combination of inattention, hyperactive and impulsive symptoms. ADHD, its symptoms and its impact may also vary through a patient’s lifespan.3-6 A worldwide meta-analysis of 86 studies in children and adolescents and 11 studies in adults indicated that the predominantly inattentive type of ADHD was the most common subtype in all samples, with the exception of pre-school children, in whom the predominantly hyperactive-impulsive type was the most common (Figure).7

Figure: The prevalence of ADHD presentations changes with patient age, according to preliminary evidence from a cross-sectional meta-analysis of 97 studies (n=175,800). Reproduced with kind permission from Willcutt EG. Neurotherapeutics 2012; 9: 490-499.7

Prevalence of ADHD presentations changes with patient age, according to preliminary evidence from a cross-sectional meta-analysis

Other investigations have reported different ADHD presentation prevalence in children and adolescents, adults and clinically referred patients:

  • A study of 413 clinically referred children and adolescents with ADHD reported that 61% of participants were combined type, 30% were inattentive type and 9% were hyperactive-impulsive type.8
  • A US study recruited 107 clinically referred adult outpatients (aged 18–55 years) with ADHD and used structured interviews to determine ADHD presentation. Results indicated that 62% of the adults were combined type, 31% were inattentive type and 7% were hyperactive-impulsive type ADHD.9
  • Data obtained from clinically referred patients typically include a higher proportion of combined inattentive-hyperactive-impulsive individuals. It has been proposed that people meeting criteria for combined type ADHD may be more likely to be referred for clinical services.7

ADHD symptoms and their impact may also vary across an individual’s lifespan.3-6

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
  2. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Available at: www.who.int/entity/classifications/icd/en/bluebook.pdf. Last updated 1993; 1: 1-263. Accessed February 2019.
  3. Caci H, Asherson P, Donfrancesco R, et al. Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey. CNS Spectr 2015; 20: 112-121.
  4. Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: results from the European Lifetime Impairment Survey. Eur Psychiatry 2014; 29: 316-323.
  5. Holmberg K, Bölte S. Do symptoms of ADHD at ages 7 and 10 predict academic outcome at age 16 in the general population? J Atten Disord 2014; 18: 635-645.
  6. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
  7. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9: 490-499.
  8. Faraone SV, Biederman J, Weber W, et al. Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred sample. J Am Acad Child Adolesc Psychiatry 1998; 37: 185-193.
  9. Wilens TE, Biederman J, Faraone SV, et al. Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. J Clin Psychiatry 2009; 70: 1557-1562.
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