ADHD, ODD, CD

3 subtypes of ADHD

• Predominantly inattentive type

• Predominantly hyperactive-impulsive type

• Combined type (most common)

ADHD gender ratio

• ADHD is more commonly diagnosed in boys than girls (approx. 2:1 to 3:1 in childhood).

• Girls are more likely to present with the inattentive subtype, which may appear less disruptive and be underdiagnosed

what has driven the rise of prevalence in ADHD

• increased awareness and screening

• changes in diagnostic criteria

• socialcultural factors (pressure on academic performance)

• pharmaceutical influence

what is the harm of overdiagnosis of ADHD

• medication for normal behavior (which has side effects

• stigma and self identity issues

• longer waitlists for those who actually have ADHD

• neglect of other underlying issues

how should a step by step diagnosis of ADHD be approached?

begin with watchful waiting, behavioral supports, or screening tools before going straight into clinical diagnosis and medication

will prevent overdiagnosis for those who were suspected to have ADHD, but can also delay the diagnosis of those who really need support

ADHD severity levels

Mild	Few excess symptoms beyond diagnostic threshold, only minor impairment

Moderate

Clear functional impairment, but not extreme

Severe

Many excess symptoms, or significant social/occupational impairment

DHD medication choice based on

1. Severity of comorbid conditions

   • if a cormorbid condition is more severe, treat that one first

2. Patient preferences or contraindications

   • If a non-stimulant may help both ADHD and comorbidity → use:

     • Atomoxetine

     • α2-adrenergic agonists (e.g., guanfacine)

     • Viloxazine

• if no strong preference or contraindication use stimulants such as Amphetamine or methylphenidate, and choose based on the duration

1. Response to treatment

• depending of the reponse to the treatment, maintain the use, or change to a different treatment