[The course of attention deficit hyperactivity disorder (ADHD) over the life span].
Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder, associated with the maturation of the nervous system and appearing on a standard proceeding with special cognitive impairments. For many years ADHD was concerned as a typical childhood disorder. Long-term studies though, showed that an important percentage of children with ADHD grew as adults with ADHD. The clinical picture varies with the developmental stage. In pre-school years (3-5 years) the clinical picture is characterized by excessive physical activity, difficulty in cooperation with peers and non-compliance to the recommendations of adults. In school age (6-12 years), apart from the nuclear symptoms of the disorder, as described in the classification systems, i.e. inattention, hyperactivity and impulsivity, oppositional behavior often occurs, conflicts with peers and academic problems. In adolescence hyperactivity lessens, conflicts with parents continue and high risk behaviors often appear. In adults physical activity usually decreases significantly, while inattention and impulsivity still remain. With the passing of time the number of symptoms are usually reduced, however the impact and impairment caused by the disorder remain. The diagnosis of ADHD in adults requires a retrospective diagnosis of ADHD in childhood. Since childhood, comorbid disorders are common, most times continuing until adult life. The Oppositional Defiant Disorder during childhood is related to the presenting of Antisocial Personality Disorder in adults. On the other hand, emotional disorders, which are also rather common in children, adolescents and adults with ADHD, can be due to either common biological mechanisms or the long-standing effect of psychosocial and environmental factors which follow people with ADHD. The relationship between ADHD and substance abuse has been a subject of research, with the view of the existence of Conduct Disorder being necessary for a person to present a Substance Use Disorder, currently prevailing. Smoking and alcohol drinking do not seem to require this mediation and ADHD can be itself a predictor for smoking and alcoholism. Stimulant treatment in childhood offers some protective effect against drug abuse and alcoholism in adolescence. The diagnosis of Borderline Personality Disorder is common in adults with ADHD and the most common reason is the overlap of symptoms between the two disorders. The question is whether the diagnosis of Borderline Personality Disorder in adults is appropriate and useful in the presence of ADHD, because when ADHD proceeds the symptoms and the impairment in functioning are due to this disorder. In general, when another diagnosis or several symptoms as a part of another disorder are also present, treatment of the primary disorder, i.e. ADHD, is beneficial and effective for all the presenting problems.
Department of Child and Adolescent Psychiatry, "Sismanoglio" General Hospital of Athens, Athens, Greece.
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Koumoula
D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000523:psychology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult