TY - JOUR T1 - Attention deficit hyperactivity disorder: clinical update JF - British Journal of General Practice JO - Br J Gen Pract SP - e243 LP - e245 DO - 10.3399/bjgp14X679507 VL - 64 IS - 621 AU - Geoff Kewley AU - Natasha Halliwell Y1 - 2014/04/01 UR - http://bjgp.org/content/64/621/e243.abstract N2 - Attention deficit hyperactivity disorder (ADHD) is characterised by inappropriate levels of inattention, hyperactivity, and impulsivity: the core symptoms. It is the most common neurobehavioural childhood disorder affecting 5% of children and 2–4% of adults worldwide.1 The National Institute of Health and Care Excellence (NICE)1 acknowledges ADHD as a lifespan developmental disorder: up to 60% of children have difficulties in adulthood.2 Each GP has approximately 20 children and 20 adults with ADHD at one time. Many remain undiagnosed and often suffer unnecessarily with adverse long-term outcomes.ADHD is highly heritable, occurring more frequently in boys.1 Those without hyperactivity, particularly girls, tend to be overlooked. A positive family history is the biggest risk factor for ADHD.1 ADHD can affect mental health, behaviour, self-esteem, and emotional development in children and adolescents and causes significant dysfunction along with parental distress. Children with ADHD often underperform academically, with increased school truancy and expulsion.3Untreated ADHD places heavy demands on health, social, and educational resources. This group of patients should be considered when planning child mental health, educational services,1 and adult psychiatry services with seamless transition services for adolescents. Structural and functional differences exist in the brains of patients with ADHD, including slower electrical responses to certain stimuli and a reduction in dopamine receptors, correlating with inattention. First-line medications increase dopamine and noradrenaline release in the extraneuronal space. Others block neurotransmitter transport and reuptake. Some core symptoms may be absent; hyperactivity often reduces with age. Impulsivity causes less ability to think of behaviour … ER -