Attention Deficit/Hyperactivity Disorder

Published in: Cesk Slov Neurol N 2011; 74/107(4): 408-418
Category: Minimonography


Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder first appearing in early childhood and persisting at a rate of 60% until adulthood. Underlying it are structural and functional aberrations in a number of areas of the brain, especially the frontal cortex and basal ganglia, compounded by dysbalance of some neurotransmitters (dopamine and noradrenaline). ADHD etiology appears to be multifactorial as the coresponsible

factors include genetic predisposition and external environment effects. Disorder in the fronto-striato-thalamo-cortical circuit leads to executive (self-regulating) functions impairment and to basic clinical symptoms – inattention, hyperactivity and impulsiveness. In addition, ADHD also involves emotional changes, social maladaptation, and motor-perception problems. There are frequent comorbidities (oppositional defiant disorder, anxiety, depression, developmental learning disorders, tics) in what are further impediments to the ADHD patients´ progress at school, social assertion and emotional development. Diagnosis is based on clinical symptoms (Diagnostic and Statistical Manual of Mental Disorders – DSM-IV or International Classification of Diseases – ICD-10). Treatment makes use of psychostimulants and atomoxetin in combination with psychotherapeutic methods. Since paediatric neurologists are often the first medical specialists to examine children with ADHD, knowledge of the symptoms, diagnostic and therapeutic procedures can only upgrade correct care of those patients.

Key words:
attention deficit/hyperactivity disorder – executive functions – neurodevelopmental disorder


1. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007; 164(6): 942–948.

2. Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet 2005; 366(9481): 237–248.

3. Bradley C. The behavior of children receiving benzedrine. Am J Psychiatry 1937; 94: 577–585.

4. Clements SD, Peters JE. Minimal brain dysfunctions in the school-age children. Diagnosis and treatment. Arch Gen Psychiatry 1962; 6: 185–197.

5. Třesohlavá Z et al. Lehká mozková dysfunkce v dětském věku. 2nd ed. Praha: Avicenum 1983.

6. Lesný I. Malá mozková postižení. In: Lesný I (ed). Dětská neurologie. Praha: Avicenum 1980: 234–238.

7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington: American Psychiatric Association 1994.

8. Mezinárodní klasifikace nemocí, 10. revize. Duševní poruchy a poruchy chování. Diagnostická kritéria pro výzkum. Praha: Psychiatrické centrum 1996.

9. Paclt I, Florian J. Deficit pozornosti u hyperaktivních dětí. Čes Slov Psychiatr 1996; 1: 23–40.

10. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36(2): 159–165.

11. Barkley RA. Behavioral inhibition, sustained attention, and executive function: constructing a unifying theory of ADHD. Psychol Bull 1997; 121(1): 65–94.

12. Drtílková I. Současné názory na biologické příčiny hyperkinetické poruchy. In: Drtílková I (ed). Hyperkinetická porucha: ADHD. Praha: Galén 2007: 41–54.

13. Todd RD, Botteron KN. Is attention-deficit/hyperactivity disorder and energy deficiency syndrome? Biol Psychiatr 2001; 50(3): 151–158.

14. Pliszka SR. The neuropsychopharmacology of attention-deficit hyperactivity disorder. Biol Psychiatry 2005; 57(11): 1385–1390.

15. Castellanos FX, Elia J, Kruesi MJ, Gulotta CS, Mefford IN, Potter WZ et al. Cerebrospinal fluid monoamine metabolites in boys with attention-deficit hyperactivity disorder. Psychiatry Res 1994; 52(3): 305–316.

16. Krause KH, Dresel SH, Krause J, Kung HF, Tatsch K. Increased striatal dopamine transporter in adult patients with attention deficit hyperactivity disorder: effects of methylphenidate as measured by single photon emission computed tomography. Neurosci Lett 2000; 285(2): 107–110.

17. Feron FJ, Hendriksen JG, van Kroonenburgh MJ, Blom-Coenjaerts C, Kessels AG, Jolles J et al. Dopamine transporter in attention-deficit hyperactivity disorder normalizes after cessation of methylphenidate. Pediatr Neurol 2005; 33(3): 179–183.

18. Castellanos FX, Giedd JN, Marsh WL, Hamburger SD, Vaituzis AC, Dickstein DP et al. Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder. Arch Gen Psychiatry 1996; 53(7): 607–616.

19. Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA 2002; 288(14): 1740–1748.

20. Hill DE, Yeo RA, Campbell RA, Hart B, Vigil J, Brooks W. Magnetic resonance imaging correlates of attention-deficit/hyperactivity disorder in children. Neuropsychology 2003; 17(3): 496–506.

21. Shaw P, Lerch J, Greenstein D, Sharp W, Clasen L, Evans A et al. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2006; 63(5): 540–549.

22. Rubia K, Overmeyer S, Taylor E, Brammer M, Williams SC, Simmons A et al. Hypofrontality in attention deficit hyperactivity disorder during higherorder motor control: a study with functional MRI. Am J Psychiatry 1999; 156(6): 891–896.

23. Silk T, Vance A, Rinehart N, Egan G, O‘Boyle M, Bradshaw JL et al. Fronto-parietal activation in attention-deficit hyperactivity disorder, combined type: functional magnetic resonance imaging study. Br J Psychiatry 2005; 187(3): 282–283.

24. Konrad K, Neufang S, Hanisch C, Fink GR, Herpertz-Dahlmann B. Dysfunctional attentional networks in children with attention deficit/hyperactivity

disorder: evidence from an event-related functional magnetic resonance imaging study. Biol Psychiatry 2006; 59(7): 643–651.

25. Vance A, Silk TJ, Casey M, Rinehart NJ, Bradshaw JL, Bellgrove MA et al. Right parietal dysfunction in children with attention deficit hyperactivity disorder, combined type: a functional MRI study. Mol Psychiatry 2007; 12(9): 826–832.

26. Tian L, Jiang T, Wang Y, Zang Y, He Y, Liang M et al. Altered resting-state functional connectivity patterns of anterior cingulate cortex in adolescents with attention deficit hyperactivity disorder. Neurosci Lett 2006; 400(1–2): 39–43.

27. Bush G, Frazier JA, Rauch SL, Seidman LJ, Whalen PJ, Jenike MA et al. Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the Counting Stroop. Biol Psychiatry 1999; 45(12): 1542–1552.

28. Berquin PC, Giedd JN, Jacobsen LK, Hamburger SD, Krain AL, Rapoport JL et al. Cerebellum in attention-deficit hyperactivity disorder: a morphometric MRI study. Neurology 1998; 50(4): 1087–1093.

29. Anderson CM, Polcari A, Lowen SB, Renshaw PF, Teicher MH. Effects of methylphenidate on functional magnetic resonance relaxometry of the cerebellar vermis in boys with ADHD. Am J Psychiatry 2002; 159(8): 1322–1328.

30. Bush G, Valera EM, Seidman IJ. Functional neuroimaging of ADHD: a review and suggested future directions. Biol Psychiatr 2005; 57(11): 1273–1284.

31. Faraone SV, Doyle AE. The nature and heritability of attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2001; 10(2): 299–316.

32. Malá E. Hyperkinetické poruchy. Pediatr pro Praxi 2002; 3(1): 14–17.

33. Curatolo P, Paloscia C, D´Agati E, Moavero R, Pasini A. The neurobiology of attention deficit/hyperactivity disorder. Eur J Pediatr Neurol 2009; 13(4): 299–304.

34. Paclt I, Koudelová J, Krepelová A, Uhlíková P, Gazdíková M, Bauer P. Biochemical markers and genetic research of ADHD. Neuro Endocrinol Lett 2005; 26(4): 423–430.

35. Maher BS, Marazita ML, Ferrell RE, Vanyukov MM. Dopamine system genes and attention deficit hyperactivity disorder: a meta-analysis. Psychiatr Genet 2002; 12(4): 207–215.

36. Biederman J. ADHD, a selective overview. Biol Psychiatry 2005; 57(11): 1215–1220.

37. Drtílková I. Klinický obraz. In: Drtílková I (ed). Hyperkinetická porucha ADHD. Praha: Galén 2007: 73–78.

38. Barkley RA, Murphy KR, Kwasnik D. Increased traffic violations and motor vehicle accidents in adolescents and adults with ADHD. Pediatrics 1996; 98(6):1089–1095.

39. Paclt I. Hyperkinetický syndrom v dospělosti. Remedia 2001; 11(6): 401–411.

40. Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of ADHD into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol 2002; 111(2): 279–289.

41. Paclt I. Diagnostika hyperkinetického syndromu v dospělosti. Psychiatr pro praxi 2002; 3(3): 115–117

42. Faraone SV, Biederman J, Spencer T, Wilens T, Seidman LJ, Mick E et al. Attention-deficit/hyperactivity disorder in adults: an overview. Biological Psychiatry 2000; 48(1): 9–20.

43. Paclt I. Vývojové aspekty jednotlivých nosografických skupin a hyperkinetický syndrom. In: Paclt I (ed). Hyperkinetická porucha a poruchy chování. Praha: Grada 2007: 69–75.

44. MTA Cooperative group. A 14-month randomized clinical trial of treatment strategies for ADHD. The MTA cooperative group. Multimodal treatment study of children with ADHD. Arch Gen Psychiatry 1999; 5(12): 1073–1086.

45. Jensen PS, Hinshaw S, Kraemer H, Lenora NBS, Newcorn JH, Abikoff HB et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry 2001; 40(2): 147–158.

46. Sachs GS, Baldassano F, Truman C, Guille C. Comorbidity of ADHD with early and late onset bipolar disorder. Am J Psychiatry 2000; 157(3): 466–470.

47. Barkley RA. Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. J Clin Psychiatry 2002; 63 (Suppl 12): 10–15.

48. Drtílková I. Komorbidní poruchy u hyperkinetické poruchy (ADHD) a jejich léčba. In: Drtílková I (ed). Hyperkinetická porucha. Praha: Galén 2007: 183–199.

49. Příhodová I. Nevšímalová S. Spánek a porucha pozornosti s hyperaktivitou- souhrn současných poznatků. Ces Slov Psychiatr 2006; 102(2): 80–84.

50. Sadeh A, Pergamin L, Bar-Haim Y. Sleep in children with attention-deficit hyperactivity disorder: a meta-analysis of polysomnographic studies. Sleep Med Rev 2006; 10(6): 381–398.

51. Corkum P, Tannock R, Moldofsky H. Sleep disturbances in children with attention-deficit/hyperactivity disorder J Am Acad Child Adolesc Psychiatry 1998; 37(6): 637–646.

52. Owens J, Maxim R, Nobile C, McGuinn M, Msall M. Parental and self-report of sleep in children with attention deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2000; 154(6): 549–555.

53. Prihodova I, Paclt I, Kemlink D, Skibova J, Ptacek R, Nevsimalova S. Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactivity disorder: a two-night polysomnographic study with a multiple sleep latency test. Sleep Med 2010; 11(9): 922–928.

54. Gruber R, Sadeh A, Raviv A. Instability of sleep patterns in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2000; 39(4): 495–501.

55. van der Heijden KB, Smith MG, Van Someren EJ, Gunning WB. Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiol Int 2005; 22(3): 559–570.

56. Salpekar JA, Foster LF. Comorbid attention deficit hyperactivity disorder and epilepsy. US Pediatr Rev 2007: 27–28.

57. Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol 2003; 45(1): 50–54.

58. Hesdorffer DC, Ludvigsson P, Olafsson E, Gudmundsson G, Kjartansson O, Hauser WA. ADHD as a risk factor for incident unprovoked seizures and epilepsy in children. Arch Gen Psychaitry 2004; 61(7): 731–736.

59. Sherman EMS, Slick DJ, Connolly MB, Eyrl KL. ADHD, neurological correlates and quality of life in severe pediatric epilepsy. Epilepsia 2007; 48(6): 1083–1091.

60. Hermann B, Jones J, Dabbs K, Allen CA, Sheth R, Fine J et al. The frequency, complications and etiology of ADHD in new onset pediatric epilepsy. Brain 2007; 130(12): 3135–3148.

61. Cahová P, Pejčochová J, Ošlejšková H. Hyperkinetická porucha/“Attention Deficit Hyperactivity Disorder” u dětských pacientů s epilepsií. Cesk Slov Neurol N 2011; 74/107(2): 157–142.

62. Doose H, Brigger- Heuer B, Neubauer B. Children with focal sharp waves: clinical and genetic aspects. Epilepsia 1997; 38(7): 788–796.

63. Cortez MA, Perez Velazquez JL, Snead OC jr. Animal models of epilepsy and progressive effects of seizures. Adv Neurol 2006; 97: 293–204.

64. Cahová P, Pejčochová J, Ošlejšková H. Hyperkinetická porucha v klinické praxi dětského neurologa. Postgraduální medicína 2010; 12(1): 8–18

65. Gucuyener K, Erdemoglu AK, Senol S, Serdaroglu A, Soysal S, Kockar AI. Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities. Child Neurol 2003; 18(2): 109–112.

66. Tan M, Appleton R. Attention deficit and hyperactivity disorder, methylphenidate, and epilepsy. Arch Dis Child 2005; 90(1): 57–59.

67. Clarke AR, Barry RJ, Bond D, Mc Carthy R, Selikowitz M. Effects of stimulant medication on the EEG of children with attention-deficit/hyperactivity disorder. Psychopharmacology 2002; 164(3): 277–284.

68. Ptáček R. Psychodiagnostika hyperkinetického syndromu (ADHD) u dětí. In: Paclt I (ed). Hyperkinetická porucha a poruchy chování. Praha: Grada 2007: 59–68.

69. Stray LL, Stray T, Iversen S, Ruud A, Ellertsen B, Tønnessen FE. The Motor Function Neurological Assessment (MFNU) as an indicator of motor function problems in boys with ADHD. Behav Brain Funct 2009; 5: 22

70. Sagvolden T, Johansen EB, Aase H, Russell VA. A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behav Brain Sci 2005; 28(3): 397–419.

71. Drtílková I. EEG u hyperkinetické poruchy. In: Drtílková I (ed). Hyperkinetická porucha. Praha: Galén 2007: 125–130.

72. Holtman M, Becker K, Kentner-Figura B, Schmidt MH. Increased frequency of rolandic spikes in ADHD children. Epilepsia 2003; 44(9): 1241–1244.

73. Richer LP, Shevell MI, Rosenblatt BR. Epileptiform abnormalities in children with attention deficit-hyperactivity disorder. Pediatr Neurol 2002; 26(2): 125–129.

74. Hemmer SA, Pasternak JF, Zecker SG, Trommer BL. Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol 2001; 24(2): 99–102.

75. Hughes JR, DeLeo AJ, Mellyn MA. The electroencephalogram in attention deficit–hyperactivity disorder: emphasis on epileptiform discharges. Epilepsy Behavior 2000; 1(4): 271–277.

76. Silvestri R, Gagliano A, Calarese T, Aricò I, Cedro C, Condurso R et al. Ictal and interictal EEG abnormalities in ADHD children recorded over night by videopolysomnography. Epilepsy Research 2007; 75(2–3): 130–137.

77. Holtman M, Matei A, Hellman U, Becker K, Poustka F, Schmidt MH. Rolandic spikes increase impulsivity in ADHD - A neuropsychological pilot study. Bran Dev 2006; 28(10): 633–640.

78. Becker K, Holtmann M. Role of electroencephalography in attention-deficit hyperactivity disorder. Expert Rev Neurother 2006; 6(5): 731–739.

79. Binnie CD. Significance and management of transitory cognitive impairment due to subclinical EEG discharges in children. Brain Development 1993; 15(1): 23–30.

80. Laporte N, Sebire G, Gillerot Y, Guerrini R, Ghariani S. Cognitive epilepsy: ADHD related to focal EEG discharges. Pediatr Neurol 2002; 27(4): 307–311.

81. Marston D, Besag F, Binnie CD, Fowler M. Effects of transitory cognitive impairment on psychosocial functioning in children with epilepsy: a therapeutic trial. Dev Med Child Neurol 1993; 35(7): 574–581.

82. Holmes GL, Lenck-Santini PP. Role of interictal epileptiform abnromalities in cognitive impairment. Epilepsy Behavior 2006; 8(3): 504–515.

83. Deonna T, Zesiger P, Davidoff V, Maeder M, Mayor C, Roulet E. Benign partial epilepsy of childhood: a longitudinal neuropsychological and EEG

study of cognitive function. Dev Med Child Neurol 2000; 42(9): 595–603.

84. Gunduz E, Demirbilek V, Korkmaz B. Benign rolandic epilepsy: neuropsychological findings. Seizure 1999; 8(4): 246–249.

85. Duane DD, Heimburger G, Duane DC: Cognitive, behavioral and EEG effects of levetiracetam in pediatric developmental disorders of attention/learning. J Neuropsychiatry Clin Neurosci 2004; 16(2): 218–241.

86. Engler F, Maeder-Ingvar M, Roulet E, Deonna T. Treatment with sulthiame (Ospolot) in benign partial epilepsy of childhood and related syndromes: an open clinical and EEG study. Neuropediatrics 2003; 34(2): 105–109.

87. Goetz M. Současný pohled na léčbu ADHD. Remedia 2009; 19(3): 190–196.

88. Paclt I. Současnost a perspektivy psychofarmakoterapie ADHD v České republice a v zahraničí. Psychiatr Prax 2006; 1(7): 30–33.

89. Drtílková I. Farmakologická léčba hyperkinetické poruchy. In: Drtílková I (ed). Hyperkinetická porucha. Praha: Galén 2007: 131–166.

90. Drtílková I, Hrdlička M, Paclt I. Hyperkinetické poruchy (ADHD) u dětí. In: Raboch J (ed). Psychiatrie: Doporučené postupy psychiatrické péče III. Brno: Tribun EU 2010: 208–213.

91. Taylor E, Dopfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J. European clinical guidelines for hyperkinetic disorder-first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): 7–30.

92. AACAP Official Action. Practice parameters for the use of stimulant medications in treatment of children, adolescents and adults. J Am Acad Child Adolesc psychiatry 2002; 41 (Suppl 2): 26–49.

93. Biederman J, Spenser T, Wilens T. Evidence based pharmacotheraphy for attention-deficit hyperactivity disorder. Int J Neuropsychopharmacol 2004; 7(1): 77–97.

94. Hrdlička M. Postavení atomoxetinu v léčbě hyperkinetické poruchy u dětí a adolescentů. Čes slov psychiatr 2007; 103(5): 230–239.

95. Roessner V, Robatzek M, Knapp G, Banaschewski T, Rothenberger A. First-onset tics in patients with attention-deficit-hyperactivity disorder: impact of stimulants. Developmental Medicine Child Neurology 2006; 48(7): 616–621.

96. Tourette Syndrome Study Group. Treatment of ADHD in children with tics: a randomized controlled trial. Neurology 2002; 58(4): 527–536.

97. Bymaster FP, Katner JS, Nelson DL, Hemrick-Luecke SK, Threlkeld PG, Heiligenstein JH et al. Atomoxetine increases extracellular levels of norepinephrine and dopamine in prefrontal cortex of rat: a potential mechanism for efficacy in attention deficit/hyperactivity disorder. Neuropsychopharmacology 2002; 27(5): 699–711.

98. Sangal RB, Owens J, Allen AJ, Sutton V, Schuh K, Kelsey D. Effects of atomoxetine and methylphenidate on sleep in children with ADHD. Sleep 2006; 29(12): 1573–1585.

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