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Key Features

  • Common neurodevelopmental disorder that may affect about 7–8% of children and 2.5% of adults

  • Associated with a triad of symptoms: impulsivity, inattention, and hyperactivity

  • Most children have a combined type with symptoms of inattention as well as hyperactivity and impulsivity

  • Girls have a higher prevalence of the inattentive subtype; boys have a higher prevalence of the hyperactive subtype

  • Although symptoms begin in early childhood, they can diminish between ages 10 and 25 years

    • Hyperactivity declines more quickly

    • Impulsivity and inattentiveness often persist into adolescence and adulthood

Clinical Findings

  • May be combined with other psychiatric conditions, such as

    • Mood disorder in approximately 20% of patients

    • Conduct disorders in 20%

    • Oppositional defiant disorder in up to 40%

  • Up to 25% of children with ADHD have tics or Tourette syndrome; conversely, well over 50% of individuals with Tourette syndrome also have ADHD

  • ADHD is also associated with a variety of genetic disorders including

    • Fragile X syndrome

    • Williams syndrome

    • Angelman syndrome

    • XXY syndrome (Klinefelter syndrome)

    • Turner syndrome

  • Fetal alcohol syndrome (FAS) is also strongly associated with ADHD

  • CNS trauma, CNS infections, prematurity, and a difficult neonatal course with brain injury can also be associated with later ADHD

  • Metabolic problems such as hyperthyroidism can sometimes cause ADHD


  • Significant challenges in academic functioning and social interactions are present

  • DSM-5 describes three ADHD subtypes: hyperactive-impulsive, inattentive, and combined

  • To be classified according to one or another of these subtypes, the child must exhibit six or more of the symptoms listed in Table 3–3

  • DSM-5 continues to include the same 18 symptoms, 2 symptom domains, and require 6 symptoms from each domain for children younger than 17

  • DSM-5 includes the following changes:

    • Criteria will address symptoms across the life span

    • Symptoms causing the impairment will need to be present prior to age 12 instead of age 7

    • Some symptoms need to be present across more than one setting

Table 3–2.1Revised Cardiac Risk Index.
Table 3–3.1Indications for prophylactic perioperative beta-blockade.1

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