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Clinical Condition Guide

Attention-Deficit/
Hyperactivity Disorder

A neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development.

  • 5-7%
    Prevalence
  • ~7
    Onset Age
  • 2:1
    Ratio
  • 70-80%
    Response Rate

DSM-5-TR Diagnostic Criteria

  • Predominantly Inattentive

    6+ inattention symptoms (5+ for ages 17+)

    • • Fails to give close attention to details
    • • Difficulty sustaining attention
    • • Does not seem to listen
    • • Does not follow through on instructions
    • • Difficulty organizing tasks
    • • Avoids tasks requiring sustained mental effort
    • • Loses things necessary for tasks
    • • Easily distracted
    • • Forgetful in daily activities

  • Predominantly Hyperactive-Impulsive

    6+ hyperactivity-impulsivity symptoms (5+ for ages 17+)

    • • Fidgets with hands/feet or squirms
    • • Leaves seat when remaining seated expected
    • • Runs/climbs inappropriately (restlessness in adults)
    • • Unable to engage quietly in leisure
    • • On the go or driven by a motor
    • • Talks excessively
    • • Blurts out answers
    • • Difficulty waiting turn
    • • Interrupts or intrudes on others

  • Combined Presentation

    Meets criteria for both inattention AND hyperactivity-impulsivity

    Most common presentation (~60% of diagnosed cases). Symptoms from both categories present simultaneously.

Assessment Protocols

Validated tools for screening and severity tracking

  • ASRS-5

    Adult ADHD Self-Report Scale

    6-item screener validated for adult ADHD detection in clinical settings.

    Scoring:

    4+ symptoms (often/very often) suggests ADHD; full 18-item version available for detailed assessment

    Time:2-5 minutes (screener), 5-10 minutes (full)

  • Conners 3

    Conners Detailed Behavior Rating Scales

    Multi-informant assessment for children/adolescents covering ADHD symptoms and related problems.

    Scoring:

    T-scores: <60 average, 60-64 high average, 65-69 elevated, 70+ very elevated

    Time:15-20 minutes per rater

  • CAARS

    Conners Adult ADHD Rating Scales

    Criterion-standard adult ADHD assessment with self-report and observer forms.

    Scoring:

    T-scores guide severity; DSM-5-TR symptom count aids diagnosis

    Time:10-15 minutes

  • BRIEF

    Behavior Rating Inventory of Executive Function

    Assesses real-world executive function deficits across 8 domains.

    Scoring:

    T-scores ≥65 clinically elevated; examines working memory, planning, organization

    Time:10-15 minutes

Causes & Etiology

  • Neurobiological

    • Frontostriatal circuit dysfunction (prefrontal cortex, basal ganglia)
    • Dopamine and norepinephrine dysregulation
    • Delayed cortical maturation (3-5 year lag in children)
    • Reduced volume in caudate nucleus, corpus callosum, cerebellum

  • Genetic

    • Heritability: 70-80% (strongest genetic component in psychiatry)
    • Polygenic risk involving 100+ genes
    • DRD4, DRD5, DAT1, 5-HTT genes implicated
    • First-degree relatives have 4-5x increased risk

  • Environmental

    • Prenatal exposure: nicotine, alcohol, lead
    • Prematurity and low birth weight
    • Traumatic brain injury in early childhood
    • Severe early deprivation (e.g., institutional rearing)

  • Neuropsychological

    • Executive function deficits: working memory, inhibition, planning
    • Delay aversion (preference for immediate rewards)
    • Temporal processing impairments
    • Arousal/activation regulation difficulties

Scientific Sources

Evidence-Based

  • ASRS Validation

    Kessler RC, Adler L, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale. Psychol Med. 2005;35(2):245-256.

  • DSM-5-TR Criteria

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.

  • Stimulant Medication Efficacy

    Faraone SV, Biederman J. Efficacy of Adderall for Attention-Deficit/Hyperactivity Disorder: a meta-analysis. J Atten Disord. 2002;6(2):69-75.

  • Neurobiological Mechanisms

    Volkow ND, Wang GJ, et al. Evaluating dopamine reward pathway in ADHD. JAMA. 2009;302(10):1084-1091.

  • Genetic Studies

    Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Mol Psychiatry. 2019;24(4):562-575.

  • Multimodal Treatment (MTA Study)

    MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for ADHD. Arch Gen Psychiatry. 1999;56(12):1073-1086.

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