PE4.1 | Attention Deficit Hyperactivity Disorder — Summary & Reflection

KEY TAKEAWAYS

ADHD is a neurodevelopmental disorder characterised by persistent inattention and/or hyperactivity-impulsivity causing functional impairment. DSM-5 recognises three presentations: inattentive (commonly missed, especially in girls), hyperactive-impulsive (most visible), and combined (most common in clinic).

Aetiology: neurobiological (dopamine/norepinephrine deficiency in PFC-striatal circuits), strongly genetic (heritability ~76–80%), with environmental risk factors (prenatal smoking/alcohol, lead, prematurity).

DSM-5 diagnosis requires: ≥6 symptoms in ≥1 domain (<17 yr), onset before age 12, present in ≥2 settings, duration ≥6 months, causing significant impairment, not better explained by another disorder. Multi-informant rating scales (Conners-3, Vanderbilt) are essential.

Management: Psychoeducation (first step always) + behavioural parent training + classroom management + methylphenidate (first-line, 0.3 mg/kg/dose, titrate) + atomoxetine (second-line, SNRI, slower onset) + school accommodations (RPWD Act 2016). Monitor growth and vital signs.

Key traps: ADHD-I missed in girls; video-game focus ≠ no ADHD; onset before 12, not 7; comorbidities (ODD, anxiety, ASD, LD) are the rule not the exception.

REFLECT

Return to Rohan from the opening scenario. His mother says 'He can focus on video games but not homework — so he's just being stubborn.' His father says 'ADHD is just an excuse for bad behaviour.' Having studied this module, how would you explain the neurobiology of ADHD to them in plain language — using the video game paradox as a teaching tool? How would you frame the diagnosis as a strength, not just a deficit? And when you initiate methylphenidate, what would you tell Rohan himself — what words would help an 8-year-old understand why he is taking this medication and what it will do for him?