Attention Deficit Hyperactivity Disorder: Advances in Epidemiology, Pathogenesis, and Neurobiology
DOI:
https://doi.org/10.56294/neuro2025189Keywords:
Attention-Deficit Hyperactivity Disorder, ADHD, depression, anxiety, autism spectrum disorderAbstract
Introduction. ADHD is a neurodevelopmental condition that affects approximately 5-7% of children and adolescents and persists in a significant number of cases into adulthood, with an estimated prevalence of 2.5% in adults globally. The impact goes far beyond school or work performance; it is associated with an increased risk of accidents, risky behaviors, comorbid disorders such as anxiety, depression, substance use disorders, and a significant reduction in quality of life. Methods. A search was conducted in the databases SciELO, Scopus, PubMed/MedLine, Google Scholar, Cochrane Library, as well as Clinical Keys services. The search terms for the search formulation were "ADHD", "Attention Deficit Disorder", "Hyperactivity", "depression", "autism spectrum", "anxiety", as well as their translations into English. Results. The reported prevalence of ADHD in children ranges from 2 to 18 percent depending on the diagnostic criteria and the population studied. The prevalence in school-aged children is estimated to be between 9 and 15 percent, making it one of the most common childhood disorders. Possible etiological factors include comorbid disorders, oppositional defiant disorder, conduct disorder, anxiety disorder, depression, developmental coordination disorder, autism spectrum disorder, and sleep disorders. Conclusion: ADHD constitutes a complex neurodevelopmental condition whose impact transcends clinical boundaries to become a multifaceted challenge for public health, neuroscience, and social justice.
References
American Psychiatric Association. Attention-deficit/hyperactivity disorder. In: Diagnostic and statistical manual of mental disorders (DSM-5 (R)). 5th ed. Washington, DC: American Psychiatric Association Publishing; 2013. p. 68.
Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics [Internet]. 2015;135(4):e994-1001. Available at: http://dx.doi.org/10.1542/peds.2014-3482
Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord [Internet]. 2014;16(3). Available at: http://dx.doi.org/10.4088/PCC.13r01596
Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS. Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med [Internet]. 2007;161(9):857–64. Available at: http://dx.doi.org/10.1001/archpedi.161.9.857
Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers [Internet]. 2015 Aug 6;1(15020):15020. Available at: https://www.nature.com/articles/nrdp201520
Rubia K. Cognitive neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and its clinical translation. Front Hum Neurosci [Internet]. 2018;12:100. Available at: http://dx.doi.org/10.3389/fnhum.2018.00100
Barkley RA, Murphy KR, Fischer M. ADHD in adults: What the science says. New York, NY: Guilford Publications; 2007.
Doshi JA, Hodgkins P, Kahle J, Sikirica V, Cangelosi MJ, Setyawan J, et al. Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. J Am Acad Child Adolesc Psychiatry [Internet]. 2012;51(10):990-1002.e2. Available at: http://dx.doi.org/10.1016/j.jaac.2012.07.008
Grimm O, Kranz TM, Reif A. Genetics of ADHD: What should the clinician know? Curr Psychiatry Rep [Internet]. 2020;22(4):18. Available at: http://dx.doi.org/10.1007/s11920-020-1141-x
Arns M, Conners CK, Kraemer HC. A decade of EEG Theta/Beta Ratio Research in ADHD: a meta-analysis: A meta-analysis. J Atten Disord [Internet]. 2013;17(5):374–83. Available at: http://dx.doi.org/10.1177/1087054712460087
Kollins SH, DeLoss DJ, Cañadas E, Lutz J, Findling RL, Keefe RSE, et al. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. Lancet Digit Health [Internet]. 2020;2(4):e168–78. Available at: http://dx.doi.org/10.1016/S2589-7500(20)30017-0
Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS. Prevalence and Treatment of Mental Disorders Among US Children in the 2001-2004 NHANES. PEDIATRICS [Internet]. 2010 Dec 14;125(1):75–81. Available at: https://doi.org/10.1542/peds.2008-2598
Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child & Adolescent Psychology [Internet]. 2018 Jan 24;47(2):199–212. Available at: https://doi.org/10.1080/15374416.2017.1417860
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics [Internet]. 2019;144(4):1–25. Available at: https://doi.org/10.1542/peds.2019-2528
Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, et al. Mental health surveillance among children--United States, 2005-2011. MMWR Suppl. 2013;62(2):1–35.
Auza-Santivañez JC, Apaza Huanca B, Paz Roman CA, Cardozo Gil P, Antezana-Muñoz JB, Bautista-Vanegas FE, et al. Current perspectives in the diagnosis and management of bacterial meningitis. Literature review and update. Multidisciplinar (Montevideo) [Internet]. 2025 Feb. 9 [cited 2025 Aug. 7];3:191. Available from: https://doi.org/10.62486/agmu2025191
Wolraich ML, McKeown RE, Visser SN, Bard D, Cuffe S, Neas B, et al. The prevalence of ADHD: its diagnosis and treatment in four school districts across two states. Journal of Attention Disorders [Internet]. 2014 Oct 1;18(7):563–75. Available at: https://doi.org/10.1177/1087054712453169
Salvatierra-Rocha CJ, Auza-Santivañez JC, Peralta Landívar A, Lá Fuente Zerain C, Kubatz La Madrid ME, Cruz Cruz Y, et al. Neurological complications in patients with Human Immunodeficiency Virus infection at the Japanese Hospital in Santa Cruz, Bolivia. Rehabilitation and Sports Medicine [Internet]. 2025 Jan. 1 [cited 2025 Aug. 7];5:25. Available at: https://doi.org/10.56294/ri202525
Zablotsky B, Black LI, Maenner MJ, Schieve LA, Danielson ML, Bitsko RH, et al. Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009-2017. Pediatrics [Internet]. 2019;144(4):e20190811. Available at: https://doi.org/10.1542/peds.2019-0811
Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Network Open [Internet]. 2018 Aug 31;1(4):e181471. Available at: https://doi.org/10.1001/jamanetworkopen.2018.1471
Centers for Disease Control and Prevention (CDC). QuickStats: Percentage of Children and Adolescents Aged 5–17 Years Who Had Ever Received a Diagnosis of Attention-Deficit/Hyperactivity Disorder, by Urbanization Level and Age Group — National Health Interview Survey, United States, 2020–2022. MMWR Morbidity and Mortality Weekly Report [Internet]. 2024 Feb 8;73(5). Available at: https://doi.org/10.15585/mmwr.mm7305a6
Bitsko RH, Claussen AH, Lichstein J, Black LI, Jones SE, Danielson ML, et al. Mental Health Surveillance Among Children — United States, 2013–2019. MMWR Supplements [Internet]. 2022 Feb 25;71(2):1–42. Available at: https://doi.org/10.15585/mmwr.su7102a1
Green M, Wong M, Atkins D, Taylor J, Feinleib M. Diagnosis of attention-deficit/hyperactivity disorder. Rockville (MD): Agency for Health Care Policy and Research (US); 1999.
Larson K, Russ SA, Kahn RS, Halfon N. Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007. Pediatrics [Internet]. 2011 Mar 1;127(3):462–70. Available at: https://doi.org/10.1542/peds.2010-0165
Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry [Internet]. 2001;40(2):147–58. Available at: http://dx.doi.org/10.1097/00004583-200102000-00009
Levy F, Hay DA, Bennett KS, McStephen M. Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry [Internet]. 2005;44(4):368–76. Available at: http://dx.doi.org/10.1097/01.chi.0000153232.64968.c1
Auza-Santivañez JC, Bautista-Vanegas FE, Carías A, Apaza Huanca B, Sosa Remón A, Condo-Gutierrez AR, et al. Bibliographic review on the application of biomaterials in neurological disorders. eVitroKhem [Internet]. 2025 Jun. 20 [cited 2025 Aug. 7];4:169. Available at: https://doi.org/10.56294/evk2025169
Koolwijk I, Stein DS, Chan E, Powell C, Driscoll K, Barbaresi WJ. “Complex” Attention-Deficit Hyperactivity Disorder, More Norm Than Exception? Diagnoses and Comorbidities in a Developmental Clinic. Journal of Developmental & Behavioral Pediatrics [Internet]. 2014 Nov;35(9):591–7. Available at: https://doi.org/10.1097/dbp.0000000000000109
Tung I, Li JJ, Meza JI, Jezior KL, Kianmahd JSV, Hentschel PG, et al. Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis. PEDIATRICS [Internet]. 2016 Sep 21;138(4):e20160430–0. Available at: https://doi.org/10.1542/peds.2016-0430
Bélanger SA, Andrews D, Gray C, Korczak D. ADHD in children and youth: Part 1—Etiology, diagnosis, and comorbidity. Paediatrics & Child Health [Internet]. 2018 Oct 24;23(7):447–53. Available at: https://doi.org/10.1093/pch/pxy109
Barbaresi WJ, Campbell L, Diekroger EA, Froehlich TE, Liu YH, O’Malley E, et al. Society for developmental and behavioral pediatrics clinical practice guideline for the assessment and treatment of children and adolescents with complex attention-deficit/hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics [Internet]. 2020;41(2):S35. Available at: https://doi.org/10.1097/dbp.0000000000000770
Barbaresi WJ, Campbell L, Diekroger EA, Froehlich TE, Liu YH, O’Malley E, et al. The Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder: Process of Care Algorithms. Journal of Developmental & Behavioral Pediatrics [Internet]. 2020 Jan 27;41(2S):S58–74. Available at: https://doi.org/10.1097/dbp.0000000000000781D
Pliszka S. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry [Internet]. 2017 Jul;46(7):894–921. Available at: https://doi.org/10.1097/chi.0b013e318054e724
Wolraich ML, Hannah JN, Pinnock TY, Baumgaertel A, Brown J. Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample. J Am Acad Child Adolesc Psychiatry [Internet]. 1996;35(3):319–24. Available at: http://dx.doi.org/10.1097/00004583-199603000-00013
Wolraich ML, Hannah JN, Baumgaertel A, Feurer ID. Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a county-wide sample. J Dev Behav Pediatr [Internet]. 1998;19(3):162–8. Available at: http://dx.doi.org/10.1097/00004703-199806000-00003
Pliszka SR. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview. J Clin Psychiatry. 1998;59 Suppl 7:50–8.
Lam LT. Attention deficit disorder and hospitalization owing to intra- and interpersonal violence among children and young adolescents. Journal of Adolescent Health [Internet]. 2005 Jan [cited 2019 Nov 12];36(1):19–24. Available at: https://doi.org/10.1016/j.jadohealth.2003.12.010
Brent DA, Perper JA, Goldstein CE, Kolko DJ, Allan MJ, Allman CJ, et al. Risk Factors for Adolescent Suicide. Archives of General Psychiatry [Internet]. 1988 Jun 1;45(6):581. Available at: https://doi.org/10.1001/archpsyc.1988.01800300079011
Nasser EH, Overholser JC. Assessing varying degrees of lethality in depressed adolescent suicide attempters. Acta Psychiatrica Scandinavica [Internet]. 1999 Jun [cited 2020 Oct 18];99(6):423–31. Available at: https://doi.org/10.1111/j.1600-0447.1999.tb00988.x
Pliszka SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am [Internet]. 2000;9(3):525–40, vii. Available at: http://dx.doi.org/10.1016/s1056-4993(18)30105-6
Yoshimasu K, Barbaresi WJ, Colligan RC, Killian JM, Voigt RG, Weaver AL, et al. Gender, attention-deficit/hyperactivity disorder, and reading disability in a population-based birth cohort. Pediatrics [Internet]. 2010;126(4):e788-95. Available at: http://dx.doi.org/10.1542/peds.2010-1187
Yoshimasu K, Barbaresi WJ, Colligan RC, Killian JM, Voigt RG, Weaver AL, et al. Written-language disorder among children with and without ADHD in a population-based birth cohort. Pediatrics [Internet]. 2011;128(3):e605-12. Available at: http://dx.doi.org/10.1542/peds.2010-2581
Shaywitz SE, Fletcher JM, Shaywitz BA. Issues in the definition and classification of attention deficit disorder. Top Lang Disord [Internet]. 1994;14(4):1–25. Available at: http://dx.doi.org/10.1097/00011363-199408000-00003
Brookman-Frazee L, Stadnick N, Chlebowski C, Baker-Ericzén M, Ganger W. Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. Autism [Internet]. 2018;22(8):938–52. Available at: http://dx.doi.org/10.1177/1362361317712650
Hollingdale J, Woodhouse E, Young S, Fridman A, Mandy W. Autistic spectrum disorder symptoms in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analytical review. Psychol Med [Internet]. 2020;50(13):2240–53. Available at: http://dx.doi.org/10.1017/S0033291719002368
Miodovnik A, Harstad E, Sideridis G, Huntington N. Timing of the diagnosis of attention-deficit/hyperactivity disorder and autism spectrum disorder. Pediatrics [Internet]. 2015;136(4):e830-7. Available at: http://dx.doi.org/10.1542/peds.2015-1502
Clark B, Bélanger SA. ADHD in children and youth: Part 3-Assessment and treatment with comorbid ASD, ID, or prematurity. Paediatr Child Health [Internet]. 2018;23(7):485–90. Available at: http://dx.doi.org/10.1093/pch/pxy111
Matson JL, Cervantes PE. Commonly studied comorbid psychopathologies among persons with autism spectrum disorder. Res Dev Disabil [Internet]. 2014;35(5):952–62. Available at: http://dx.doi.org/10.1016/j.ridd.2014.02.012
Rao PA, Landa RJ. Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders. Autism [Internet]. 2014;18(3):272–80. Available at: http://dx.doi.org/10.1177/1362361312470494
Antshel KM, Russo N. Autism spectrum disorders and ADHD: Overlapping phenomenology, diagnostic issues, and treatment considerations. Curr Psychiatry Rep [Internet]. 2019;21(5):34. Available at: http://dx.doi.org/10.1007/s11920-019-1020-5
Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry [Internet]. 2019;24(4):562–75. Available at: https://doi.org/10.1038/s41380-018-0070-0
Demontis D, Walters RK, Martin J, Mattheisen M, Als TD, Agerbo E, et al. Discovery of the First Genome-Wide Significant Risk Loci for Attention deficit/hyperactivity Disorder. Nature Genetics [Internet]. 2018 Nov 26;51(1):63–75. Available at: https://doi.org/10.1038/s41588-018-0269-7
Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, Greenstein D, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences [Internet]. 2007 Nov 16;104(49):19649–54. Available at: https://doi.org/10.1073/pnas.0707741104
Sciberras E, Mulraney M, Silva D, Coghill D. Prenatal Risk Factors and the Etiology of ADHD—Review of Existing Evidence. Current Psychiatry Reports [Internet]. 2017 Jan;19(1). Available at: https://doi.org/10.1007/s11920-017-0753-2
Cortese S, Kelly C, Chabernaud C, Proal E, Di Martino A, Milham MP, et al. Toward Systems Neuroscience of ADHD: A Meta-Analysis of 55 fMRI Studies. American Journal of Psychiatry [Internet]. 2012 Oct;169(10):1038–55. Available at: https://doi.org/10.1176/appi.ajp.2012.11101521
Loo SK, Makeig S. Clinical Utility of EEG in Attention-Deficit/Hyperactivity Disorder: A Research Update. Neurotherapeutics [Internet]. 2012 Jul;9(3):569–87. Available at: https://doi.org/10.1007/s13311-012-0131-z
Pliszka SR. The Neuropsychopharmacology of Attention-Deficit/Hyperactivity Disorder. Biological Psychiatry [Internet]. 2005 Jun;57(11):1385–90. Available at: https://doi.org/10.1016/j.biopsych.2004.08.026
Burk JA, Blumenthal SA, Maness EB. Neuropharmacology of attention. Eur J Pharmacol [Internet]. 2018;835:162–8. Available at: http://dx.doi.org/10.1016/j.ejphar.2018.08.008
Huang X, Wang M, Zhang Q, Chen X, Wu J. The role of glutamate receptors in attention-deficit/hyperactivity disorder: From physiology to disease. Am J Med Genet B Neuropsychiatr Genet [Internet]. 2019;180(4):272–86. Available at: http://dx.doi.org/10.1002/ajmg.b.32726
Hou Y-W, Xiong P, Gu X, Huang X, Wang M, Wu J. Association of serotonin receptors with attention deficit hyperactivity disorder: A systematic review and meta-analysis. Curr Med Sci [Internet]. 2018;38(3):538–51. Available at: http://dx.doi.org/10.1007/s11596-018-1912-3
Potter AS, Schaubhut G, Shipman M. Targeting the nicotinic cholinergic system to treat attention-deficit/hyperactivity disorder: rationale and progress to date. CNS Drugs [Internet]. 2014;28(12):1103–13. Available at: http://dx.doi.org/10.1007/s40263-014-0208-9
Alba G, Pereda E, Mañas S, Méndez LD, González A, González JJ. Electroencephalography signatures of attention-deficit/hyperactivity disorder: clinical utility. Neuropsychiatr Dis Treat [Internet]. 2015;11:2755–69. Available at: http://dx.doi.org/10.2147/NDT.S51783
Lenartowicz A, Mazaheri A, Jensen O, Loo SK. Aberrant modulation of brain oscillatory activity and attentional impairment in attention-deficit/hyperactivity disorder. Biol Psychiatry Cogn Neurosci Neuroimaging [Internet]. 2018;3(1):19–29. Available at: http://dx.doi.org/10.1016/j.bpsc.2017.09.009
Kaiser A, Aggensteiner P-M, Baumeister S, Holz NE, Banaschewski T, Brandeis D. Earlier versus later cognitive event-related potentials (ERPs) in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis. Neurosci Biobehav Rev [Internet]. 2020;112:117–34. Available at: http://dx.doi.org/10.1016/j.neubiorev.2020.01.019
Kaboodvand N, Iravani B, Fransson P. Dynamic synergetic configurations of resting-state networks in ADHD. Neuroimage [Internet]. 2020;207(116347):116347. Available at: http://dx.doi.org/10.1016/j.neuroimage.2019.116347
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