[Epidemiology, treatment and prevention of attention deficit/hyperactivity disorder: a review].
Attention deficit/hyperactivity disorder (ADHD) is characterized by inattentiveness and/or impulsiveness and hyperactivity, which are unsuited for the developmental stage or age. Although mechanisms leading to the onset of the disease are unclear, this condition seriously hinders childrens' social or learning functions, and recently it was selected as a target disease for a special supporting education program by the Minitry of Education, Culture, Sports, Science and Technology, together with learning disorders and high-functioning pervasive developmental disorders in Japan. In spite of the increasing social interest in ADHD, the epidemiological evidence including data for incidence, prevalence, gender differences, and etiology remain insufficient. In Western countries, as represented by the United States, operational diagnostic criteria such as DSM-IV are widely used and several diagnostic processes using structured interviews have been established. However, the diagnostic criteria have not been consistent even within DSM as shown by DSM-IV and DSM-III-R, and therefore basic epidemiological evidence was not consistent in the previous studies. Regarding the etiology of ADHD, exposure to addictive substances during the pregnancy period caused by maternal smoking or drinking, and familial socioeconomic status are considered important environmental factors. In addition, a family history of mental disorders and polymorphisms of dopamine-related genes such as DRD4 or SLC6A3 have been noted as genetic factors concerning the development of ADHD. However, in Japan, no studies of these subjects or gene-environment interactions have so far been performed. Thus, epidemiological assessment of other than Western populations is needed. In the clinical situation, it is important to grasp the timing of treatment and target problems on the basis of changes of children's ability to control their attention or behavior, and environmental factors associated with growth processes. Especially, comorbidity such as conduct disorder or oppositional defiant disorder is a critical problem. Thus, considering that ADHD is a multifactorial disease, a comprehensive therapic strategy involving medication, education, judicature, and administration should be established for primary and secondary prevention.
Yoshimasu
Kouichi
K
Department of Hygiene, School of Medicine, Wakayama Medical University.
Yamashita
Hiroshi
H
Kiyohara
Chikako
C
Miyashita
Kazuhisa
K
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control / Q000628:therapy*; D002648:Child; D004777:Environment; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015201:Meta-Analysis as Topic