Attention Deficit Hyperactivity Disorder (ADHD) - Description

Page Contents

• Other Names
• ICD-9
• Description
• Genetics
• Prognosis
• Prevalence
• Impact
• Pearls And Alerts
• Helpful Articles

Other Names

Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder, ADD

ICD-9

314.0, Attention deficit disorder

Optimal coding requires a 5th digit, as detailed below.

314.0 – Attention Deficit Disorder, predominantly inattentive type (if only sufficient symptoms for inattention have been met)

314.01 – Attention Deficit Disorder, predominantly hyperactive-impulsive type (if only sufficient symptoms of hyperactivity-impulsivity have been met) or Attention Deficit Disorder, Combined type (if sufficient symptoms of both inattention and hyperactivity-impulsivity have been met)

314.8 – Attention Deficit Disorder, residual type

314.9 – Attention Deficit Disorder Not Otherwise Specified (for individuals with prominent symptoms of inattention or hyperactivity-impulsivity who do not meet the full criteria)

See ADHD ICD9 ( 97 KB) for more detail and associated codes.

Description

Attention deficit hyperactivity disorder (ADHD) is a chronic disorder, beginning in childhood (ages 4-18), characterized by some combination of hyperactivity, impulsivity, and/or inattention. Three major types of ADHD are currently described. For more information, see the Presentations and Diagnostic Criteria sections below. These symptoms are present in the affected child to such a degree that they significantly interfere in at least two areas of the child's life, such as in the home and classroom. These symptoms are also in excess of what one would expect for the child's age and developmental level. While the etiology is still not clear, medications that successfully treat ADHD all affect norepinephrine and/or dopamine. Growing evidence suggests that at least a subtype of ADHD is caused by defects in the dopamine and norepinephrine transporter proteins within the nerve cell wall. [Vaidya: 2008] [Kollins: 2008] [Kim: 2006] The new AAP guidelines New AAP ADHD guidelines (AAP.org/Pediatrics) ( 640 KB) also note that there is a group of children who might not meet full criteria, and should therefore not be treated with medications, that might respond to behavioral intervention and school support (inattention or hyperactivity/impulsiveness symptoms).

ADHD is a disorder that can be treated safely and with good efficacy. If left untreated, it carries significant morbidity, including an increased risk of substance abuse in adolescents. [Wilens: 2008] [Biederman: 2009] The new AAP guidelines note that undertreated children may also be at more risk of later problems including substance abuse. New AAP ADHD guidelines (AAP.org/Pediatrics) ( 640 KB)

Genetics

Although ADHD clearly runs in families, and twin and adoption studies support a strong genetic component, the genetic mechanisms are not yet well understood. (see [Smith: 2009] and [Faraone: 2005]) ADHD inheritability is complex; markers on at least 7 chromosomes and genes for dopamine and serotonin receptors, transporters, and associated enzymes have been found to be statistically associated with ADHD. Environmental factors are also shown to play a role in some cases. See [Pliszka: 2007] for a discussion.

Prognosis

Although many children show improvement in adolescence, many individuals may need support/treatment for this condition through adulthood. There are no controlled long-term studies, but children who have received treatment during childhood appear to suffer fewer effects as they get older than children who were not treated. [Biederman: 2009]

Prevalence

ADHD is one of the most common chronic disorders of childhood; estimates vary, but approximately 8-12% of children in the US meet criteria for ADHD diagnosis. [Pliszka: 2007] Boys demonstrate symptoms of ADHD more commonly than girls, with a ratio of 4:1 for the hyperactive type and 2:1 for the inattentive type. Recent studies indicate that less than 14% of children with ADHD receive indicated treatment. For a discussion, see [Pliszka: 2007].

Impact

ADHD impacts the child, the child's family, and society. Children with ADHD have a decreased quality of life compared to typically developing controls [Klassen: 2004] and are more likely to have conduct disorder and substance abuse as teenagers, especially if untreated or undertreated as children. [Wilens: 2008] [Pliszka: 2007] New AAP ADHD guidelines (AAP.org/Pediatrics) ( 640 KB) Parents of children with ADHD report significant impact on parent emotional health and family function. [Klassen: 2004] Medical costs are higher for children with ADHD, affecting families and society as a whole. [Leibson: 2003] [Leibson: 2006] One estimate suggests that medical costs for children with ADHD, including outpatient visits, pharmaceutical costs, and emergency department visits for untreated or inadequately treated individuals, are more than double those for individuals without ADHD. [Leibson: 2001]

Pearls And Alerts

Helpful Articles

PubMed search on ADHD

Salmeron PA.
Childhood and adolescent attention-deficit hyperactivity disorder: diagnosis, clinical practice guidelines, and social implications.
J Am Acad Nurse Pract. 2009;21(9):488-97. PubMed abstract

Brimble MJ.
Diagnosis and management of ADHD: a new way forward?.
Community Pract. 2009;82(10):34-7. PubMed abstract

Attention Deficit Hyperactivity Disorder (ADHD) Module Authors

The authors listed above are responsible for the overall Attention Deficit Hyperactivity Disorder (ADHD) Module. Authors contributing to individual pages in the module are listed on those pages.

Page Bibliography

Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV.
Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study.
Pediatrics. 2009;124(1):71-8. PubMed abstract

Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P.
Molecular genetics of attention-deficit/hyperactivity disorder.
Biol Psychiatry. 2005;57(11):1313-23. PubMed abstract

Kim JW, Kim BN, Cho SC.
The dopamine transporter gene and the impulsivity phenotype in attention deficit hyperactivity disorder: a case-control association study in a Korean sample.
J Psychiatr Res. 2006;40(8):730-7. PubMed abstract

Klassen AF, Miller A, Fine S.
Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder.
Pediatrics. 2004;114(5):e541-7. PubMed abstract

Kollins SH, Anastopoulos AD, Lachiewicz AM, FitzGerald D, Morrissey-Kane E, Garrett ME, Keatts SL, Ashley-Koch AE.
SNPs in dopamine D2 receptor gene (DRD2) and norepinephrine transporter gene (NET) are associated with continuous performance task (CPT) phenotypes in ADHD children and their families.
Am J Med Genet B Neuropsychiatr Genet. 2008;147B(8):1580-8. PubMed abstract

Leibson CL, Barbaresi WJ, Ransom J, Colligan RC, Kemner J, Weaver AL, Katusic SK.
Emergency department use and costs for youth with attention-deficit/hyperactivity disorder: associations with stimulant treatment.
Ambul Pediatr. 2006;6(1):45-53. PubMed abstract

Leibson CL, Katusic SK, Barbaresi WJ, Ransom J, O'Brien PC.
Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder.
JAMA. 2001;285(1):60-6. PubMed abstract

Leibson CL, Long KH.
Economic implications of attention-deficit hyperactivity disorder for healthcare systems.
Pharmacoeconomics. 2003;21(17):1239-62. PubMed abstract

Pliszka S.
Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder.
J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921. PubMed abstract

Smith AK, Mick E, Faraone SV.
Advances in genetic studies of attention-deficit/hyperactivity disorder.
Curr Psychiatry Rep. 2009;11(2):143-8. PubMed abstract

Vaidya CJ, Stollstorff M.
Cognitive neuroscience of Attention Deficit Hyperactivity Disorder: current status and working hypotheses.
Dev Disabil Res Rev. 2008;14(4):261-7. PubMed abstract

Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, Biederman J.
Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents.
Arch Pediatr Adolesc Med. 2008;162(10):916-21. PubMed abstract