ADHD: A CLINICAL REVIEW 1

Attention Deficit/Hyperactivity Disorder: A Clinical Review

PNWU School of Occupational Therapy

Ruby Guevara and Adriana Turtura

OTH 525: Human Capacities II

Dr. Wendell Nakamura

February 5, 2024
ADHD: A CLINICAL REVIEW 2

Attention Deficit/Hyperactivity Disorder: A Clinical Review

According to the National Institute of Mental Health (NMIANIMH; 2023), attention-

deficit hyperactivity disorder (ADHD) affects 11% of school-age children. Indications typically

arise in early childhood, with three presentations: Predominantly Inattentive, Hyperactive-

Impulsive, and Combined. Symptoms include difficulty paying attention, sustaining attention,

listening, following instructions, organization, mental effort, losing things, distraction,

forgetfulness, and hyperactivity (NMIANIMH, 2023). Researchers are not sure what causes

ADHD, however Faraone et al. (2021) noted many studies suggest genes play a large part. In

addition to genetics, researchers are also studying how brain injuries, nutrition, and social

environments might play a role in developing the condition (Farone et al., 2021). While some

rResearch indicates that boys are more likely to develop ADHD than girls,; however, someother

studies suggest that since the disorder is commonly associated with hyperactivity symptoms,

many girls who suffer from Predominantly Inattentive ADHD may miss out on receiving a

diagnosis. It is common for these girls to manifest the condition as adolescents or young adults

upon reaching adulthood (NMIANIMH, 2023).

ADHD is a neurodevelopmental disorder linked to executive functioning, which is

regulated by the brain's prefrontal cortex. Wilkins (2023) states research has shown that this part

of the brain is smaller in kids with ADHD. According to Thomas (2022), ADHD is associated

with low levels of dopamine and noradrenaline leading to dysfunctional neural networking in the

prefrontal cortex and basal ganglia. This leads to decreased alertness, attention span, and

working memory, difficulty initiating and sustaining activities, and difficulty staying still or in

one place. One piece of evidence for this theory is that stimulant medications such as Adderall
ADHD: A CLINICAL REVIEW 3

are often successful in reducing ADHD symptoms, and these medications suppress the reuptake,

or removal, of dopamine (Wilkins, 2023).

In recent years, according to Abdelnour et al. (2022), the number of people diagnosed

with ADHD has been increasing (Abdelnour et al., 2022). This trend has sparked a debate about

the reasons behind it. Some people are concerned that there may be over-diagnosis and over-

prescription of stimulant medications. Others have raised the issue of diagnostic disparities,

particularly among underrepresented populations (Abdelnour et al., 2022). In 2020, the Centers

for Disease Control and Prevention (CDC) reported that between 2016 and 2019, seven percent

of Washingtonians aged 3-17 years were diagnosed by providers with ADHD. These figures were

reported by parents and obtained through the National Survey of Children’s Health. The CDC

theorizes that ADHDs increased prevalence is likely due to changing diagnostic criteria and

greater awareness of the disorder among marginalized groups, including people of color and

females. The media and social media have also played a role in raising public awareness of

ADHD, which in turn has led more people to bring up their concerns with physicians (Abdelnour

et al.,2022)

Childhood ADHD is associated with numerous negative outcomes, including poor

academic performance, increased healthcare costs, and caregiver burdens. These negative

outcomes may continue into adulthood and manifest in similar ways, such as poor performance

at work and difficulties with social relationships. According to Schein et al. (2022) Tthe total

societal costs associated with ADHD in the United States in 2018 were $19.4 billion among

children and $13.8 billion among adolescents (Schein et al., 2022). Education costs accounted

for roughly half of the total burden in both populations, followed by direct healthcare costs and

caregiving costs. The main driver of education costs was special education, which resulted in
ADHD: A CLINICAL REVIEW 4

additional days spent on education and expenses related to tutoring and special education

services.

ADHD is more frequently diagnosed in males than females; however, a higher ratio of

males to females is found in clinical samples as opposed to population samples, suggesting that

clinical diagnoses of ADHD are subject to sex bias. A study by Mowlem et al. (2019)

investigated sex differences concerning ADHD symptoms, conduct problems, and learning

difficulties in a large Swedish population-based sample. The findings indicated that females have

a stronger predictive association with hyperactive/impulsive and conduct symptoms on ADHD

diagnosis and treatment status and that clinically diagnosed males and females show comparable

symptom severity.

Similarly, ADHD was previously believed to affect children of all social classes equally,

but recent evidence suggests that it is more common among the poor. Rowland et al. (2018)

conducted a joint analysis of family income and parental history of ADHD diagnosis and

discovered both were strong predictors of ADHD prevalence, with low-income children having a

6.2-fold higher risk than those from high-income families without a parental history. The

interaction between family income and parental history of ADHD diagnosis was statistically

significant, indicating that the relationship between family income and childhood ADHD was

weaker among children with a parental history of ADHD diagnosis.

ADHD: A CLINICAL REVIEW 5

References

Abdelnour, E., Jansen, M. O., & Gold, J. A. (2022). ADHD diagnostic trends: Increased

recognition or overdiagnosis?. Missouri Journal of Medicine, 119(5), 467–473.

https://pubmed.ncbi.nlm.nih.gov/36337990/

Centers for Disease Control and Prevention. (2023). State-based prevalence of ADHD diagnosis

and treatment 2016-2019. https://www.cdc.gov/ncbddd/adhd/data/diagnosis-treatment-

data.html

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A.,

Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese,

S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J.,

Asherson, P., Atwoli, L., … Wang, Y. (2021). The world federation of ADHD

international consensus statement: 208 evidence-based conclusions about the

disorder. Journal of Neuroscience and Biobehavioral Reviews, 128, 789–818.

https://doi.org/10.1016/j.neubiorev.2021.01.022

Mowlem, F. D., Rosenqvist, M. A., Martin, J., Lichtenstein, P., Asherson, P., & Larsson, H.

(2019). Sex differences in predicting ADHD clinical diagnosis and pharmacological

treatment. Journal of European Child & Adolescent Psychiatry, 28(4), 481–489.

https://doi.org/10.1007/s00787-018-1211-3
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National Institute of Mental Health. (2023). Attention-deficit/hyperactivity

disorder. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-

adhd

Rowland, A. S., Skipper, B. J., Rabiner, D. L., Qeadan, F., Campbell, R. A., Naftel, A. J., &

Umbach, D. M. (2018). Attention-deficit/hyperactivity disorder (ADHD): Interaction

between socioeconomic status and parental history of ADHD determines

prevalence. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 59(3),

213–222. https://eds-p-ebscohost-com.proxy.pnwu.org/eds/pdfviewer/pdfviewer?

vid=1&sid=bf118351-cfe5-4e96-830d-e9f4cb5897f1%40redis

Schein, J., Adler, L. A., Childress, A., Cloutier, M., Gagnon-Sanschagrin, P., Davidson, M.,

Kinkead, F., Guerin, A., & Lefebvre, P. (2022). Economic burden of

attention-deficit/hyperactivity disorder among children and adolescents in the United

States: A societal perspective. Journal of Medical Economics, 25(1), 193–205.

https://doi.org/10.1080/13696998.2022.2032097

Thomas, L. (2022). How does ADHD affect the brain? News Medical Life

Sciences. http://www.news-medical.net/health/How-does-ADHD-Affect-the-Brain.aspx

Wilkins, F. (2023). How is the ADHD brain different? An in-depth look at the underlying causes

of ADHD symptoms in children. Child Mind Institute. https://childmind.org/article/how-

is-the-adhd-brain-different/
ADHD: A CLINICAL REVIEW 7

Part 1: Overview of the Condition

Criteria Score
General Description
1. Provides a clear and concise broad description of the condition. 5/5
2. Includes potential causes of the condition (e.g., genetics, lifestyle, 5/5
environment)
3. Identifies major structures of the central nervous system that are affected, 10/10
including neurotransmitters
Subtotal 20/20
Global Burden of Disease
4. Identifies incidence of the condition 5/5
5. Identifies prevalence of the condition 5/5
6. Identifies medical costs associated with treating the condition 15/15
7. Identifies non-medical costs associated with the condition 5/5
Subtotal 30/30
Health Disparities
8. Summarizes the impact on disadvantaged communities 20/20
Subtotal 20/20
Composition
9. Includes title page that is formatted according to instructor guidelines 5/5
10. Writing style and grammar follow APA (7th ed.) guidelines 4/5
th
11. Uses bias-free language according to APA (7 ed.) guidelines 5/5
12. Mechanics of style follows APA (7th ed.) guidelines 5/5
th
13. In-text citations follow APA (7 ed.) guidelines 4/5
th
14. Reference list follows APA (7 ed.) guidelines 4/5
Subtotal 27/30
SUMMATIVE TOTAL 97/100
Feedback: Ruby and Annie, very well-written paper. A very strong start to your clinical
review. Minor points off for APA. In general, try to avoid writing things like “a study by
Author stated…” Instead, just report what the author stated with an in-text citation.