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ATTENTION DEFICIT HYPERACTIVITY DISORDER
Nasirova Nodira Khapizovna
Children's neurologist
Abstract:
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental
disorder characterized by difficulty maintaining attention, hyperactivity, and impulsivity. Its
prevalence among children reaches 5–15%, while in adults it remains at 6–7%. These
disorders are caused by a complex interaction of genetic (up to 80%) and environmental
factors. Pathogenesis includes disorders of the dopaminergic and noradrenergic systems —
the prefrontal cortex and basal ganglia: this is ensured by the genes of dopamine transporters
and receptors (DAT1, DRD4, etc.). Diagnosis is based on the DSM 5 criteria using scales
(e.g., the Conners questionnaire). Treatment involves a multidisciplinary approach:
psychostimulants (methylphenidate, amphetamines), non-steroidal drugs (atomoxetine,
reboxetine), psychotherapeutic and behavioral methods. In adults, ADHD is associated with
a higher risk of comorbid disorders, due to poor concentration and impulsivity, professional
and social functioning suffers. The purpose of the article is to present the current state of
knowledge about ADHD: pathogenesis, clinical features, diagnosis and therapy.
Key words:
Attention deficit hyperactivity disorder, ADHD, Neuropsychiatric disorders,
Attention deficit, Impulsivity, Hyperactivity, Methylphenidate, Atomoxetine, DSM-5,
Behavioral therapy, ADHD diagnostics, ADHD in adults, Neurotransmitters (dopamine,
norepinephrine), Genetic factors of ADHD, Comorbid disorders.
Introduction
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder
that begins in childhood and often persists into adulthood. Prevalence among children is
estimated at about 5%, and among adults - 2-3%, depending on the method of study and age.
History and relevance
The term "ADHD" officially entered clinical use with the publication of DSM-III in 1987,
and its diagnostic criteria continued to evolve over time, including taking into account
gender characteristics and changes in manifestation in women. For example, girls often
exhibit more "internal" hyperactivity - daydreaming, distraction, while boys demonstrate
more "external" hyperactivity, which previously led to underdiagnosis in girls.
The COVID 19 pandemic and the remote learning format have led to a significant increase
in ADHD diagnostics in adults. Increased availability of information and self-monitoring of
symptoms have encouraged many adults who remain undiagnosed to seek diagnosis.
Etiology and pathophysiology
ADHD is a multifactorial disorder caused by a complex interaction of genetic and
environmental factors. Studies have shown that heritability is up to 80%, as evidenced by
data from twins and family studies.
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Pathophysiology is associated with dysfunction of the catecholamine neurotransmitter
systems - dopamine and norepinephrine. They are critical for the functioning of the
prefrontal cortex and striatal structures responsible for attention, executive functions and
motivation. MRI studies reveal structural changes: decreased volume of the prefrontal cortex,
basal ganglia, cerebellum, as well as white matter abnormalities in the frontostriatal tracts.
Disturbances in other neurotransmitter systems (serotonin, GABA, glutamate) that affect
impulsivity, motivation, motor and executive functions are also noted.
Clinical picture and diagnosis
Symptoms are characterized by attention deficit, hyperactivity, impulsivity. For diagnosis
according to DSM 5 it is necessary:
at least 6 symptoms for children (<17 years), or 5 symptoms for adults;
severity of these symptoms for at least 6 months;
presence of symptoms in two or more life contexts (e.g., home and school or work);
onset of symptoms before age 12 (with possible exceptions).
Diagnostic tools include questionnaires (e.g., Conners scale), medical and educational
history, observations.
Significance of the problem
ADHD has a significant impact on academic performance, social adaptation and
professional functioning. In adults, it is closely associated with an increased risk of
comorbid disorders, relationship difficulties, addiction, and inattention to time frames,
which often leads to chronic dissatisfaction.
Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder
that is not limited to childhood, but often persists or manifests itself in adulthood. The
average prevalence is about 5% in children and 2-3% in adults.
The key mechanism is a violation of neurotransmitter regulation, primarily dopamine and
norepinephrine, with the involvement of the prefrontal cortex, striatum, cerebellum and
frontostriatal pathways - the basis of attention, self-control and emotions. Genetic
predisposition (heritability up to 80%) is combined with environmental influences - prenatal
factors, developmental environment, stress.
The diagnosis of ADHD is based solely on clinical assessment (DSM 5), as biomarkers are
not yet available. This requires a thorough history, behavioral observation, and analysis of
symptoms in different contexts. If ADHD remains untreated, serious consequences are
possible: decreased academic and professional performance, risk of addiction, mental health
problems, and social adaptation. Early diagnosis and comprehensive treatment are the key to
improving quality of life.
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Recommendations
Raise awareness of ADHD, especially among women and adults, where symptoms often
remain undiagnosed.
Promote access to qualified diagnostics and therapy.
Continue research into neurobiological mechanisms (including modern genetic and
neuroimaging methods).
Develop comprehensive treatment models that include drug therapy, behavioral support, and
educational interventions.
Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder,
most often diagnosed in childhood, but symptoms may persist into adulthood. Its prevalence
among children is 5–15%, and in adults, 2–7%. The causes of ADHD are complex: they
include both genetic determinants (up to 80%) and environmental factors — perinatal
trauma, maternal smoking during pregnancy, low birth weight, etc. Pathophysiologically, the
disease is associated with disturbances in neurotransmitter regulation — dopamine and
norepinephrine; genetically important DAT1, DRD4, COMT. The clinical picture includes
attention deficit, hyperactivity, impulsivity. In adults, the symptoms manifest themselves
differently: hyperactivity is replaced by internal anxiety, but problems with concentration
and organization remain. Diagnosis is based on DSM IV/V criteria, using assessment scales
(Conners, observations of parents and teachers) and requires symptoms in different areas of
life for at least 6 months. Treatment is complex: drug therapy (psychostimulants,
atomoxetine, reboxetine), psychotherapy and behavioral correction. In adults, ADHD is
accompanied by an increased risk of substance abuse and comorbidity
Main section
1. Epidemiology
In children: 5–15%.
In adults: 2.58% — persistent, up to 6.76% symptomatic ADHD
2. Etiology and pathogenesis
Genetics: heritability up to 80%, dopamine system genes are involved (DAT1, DRD4,
COMT).
Environment: maternal smoking, hypoxia, prematurity, environmental stress.
Neurophysiology: decreased volume of the prefrontal cortex, basal ganglia, cerebellum
3. Clinical picture
In children: excessive activity, irritability, learning and behavioral difficulties
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In adolescents: hyperactivity turns into internal fussiness, problems with responsibility and
self-organization persist
In adults: difficulties in the professional sphere, correlation with antisocial behavior and
addiction
4. Diagnostics
DSM IV/V criteria
Conners questionnaire - assessed by parents and a teacher, repeated after 6 months if
necessary
Diagnosis requires the presence of symptoms in different environments and stability for at
least 6 months
5. Treatment
Psychostimulants: methylphenidate, amphetamines - effective in ~75% of children
Atomoxetine (not a psychostimulant): safer, stable symptom control in 6-8 weeks
Reboxetine: proven short-term and long-term effectiveness in children and adults
Behavioral therapy: mandatory support, regardless of medication
Approach in adults: multimodal, taking into account comorbidity and social consequences
Conclusion
Attention deficit hyperactivity disorder is a common neurodevelopmental disorder with
onset in childhood and possible continuation into adulthood. The main cause is genetic
factors (up to 80%), supplemented by environmental influences (perinatal hypoxia, maternal
smoking, etc.). Pathophysiologically, the key role is played by disorders of the dopamine
and noradrenergic systems, as well as structural changes in the brain - the prefrontal cortex,
basal ganglia, cerebellum. Diagnosis is based on clinical criteria (DSM 5) and standardized
questionnaires, while it requires observation of symptoms in different conditions and for a
long time. Treatment should be comprehensive, including psychostimulants, alternative
drugs (atomoxetine, reboxetine) and psychotherapeutic correction. In adults, ADHD
manifestations lead to significant social and professional problems, requiring integrated
treatment.
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