31.6 Attention Deficit/Hyperactivity Disorder
1169
Canitano R, Scandurra V. Psychopharmacology in autism: An update.
Prog Neuro-
psychopharmacol Biol Psychiatry.
2011;35:18–28.
Carminati GG, Deriaz N, Bertschy G. Low-dose venlafaxine in three adolescents
and young adults with autistic disorder improves self-injurious behavior and
attention deficit/hyperactivity disorder (ADHD)-like symptoms.
Prog Neuro-
psychopharmacol Biol Psychiatry.
2006;30:312.
Constantino JN, Lajonchere C, Lutz M, Gray T, Abbacchi A, McKenna K, Singh
D, Todd RD. Autistic social impairment in the siblings of children with perva-
sive developmental disorders.
Am J Psychiatry.
2006;163:294–296.
Danfors T, von Knorring AL, Hartvig P, Langstrom B, Moulder R, Stromberg B,
Tortenson R, Wester U, WatanabeY, Eeg-Olofsson O. Tetrahydrobiopterin in the
treatment of children with autistic disorder: A double-blind placebo-controlled
crossover study.
J Clin Psychopharmacol.
2005;25:485.
Gadow KD, DeVincent CJ, Pomeroy J. ADHD symptom subtypes in children
with pervasive developmental disorder.
J Autism Dev Disord.
2006;36(2):
271–223.
Gardener H, Spiegelman D, Buka SL. Perinatal and neonatal risk factors for
autism: A comprehensive meta-analysis.
Pediatrics.
2011;128:344–355.
Hazlett HC, Poe, M, Gerig C, Smith RG, Provenzale J, Ross A, Gilmore J, Piven
J. Magnetic resonance imaging and head circumference study of brain size in
autism: Birth through age 2 years.
Arch Gen Psychiatry.
2005;62:1366.
Huffman LC, Sutcliffe TL, Tanner ISD, Feldman HM. Management of symptoms
in children with autism spectrum disorders: A comprehensive review of phar-
macologic and complementary-alternative medicine treatments.
J Dev Behav
Pediatr.
2011;32:56–68.
Kasari C, Lawton K. New directions in behavioral treatment of autism spectrum
disorders.
Curr Opin Neurol.
2010;23:137–143.
Ke JY, Chen CL, Chen YJ, Chen CH, Lee LF, Chiang TM. Features of devel-
opmental functions and autistic profiles in children with fragile X syndrome.
Chang Gung Med J.
2005;28:551.
Koyama T, Tachimori H, Osada H, Kurita H. Cognitive and symptom profiles
in high-functioning pervasive developmental disorder not otherwise specified
and attention-deficit/hyperactivity disorder.
J Autism Dev Disord.
2006;36(3):
373–380.
Lehmkuhl, HD, Storch E, Bodfish JW, Geffken GR. Brief Report: Exposure and
response prevention for obsessive compulsive disorder in a 12-year-old with
autism.
J Autism Dev Disord.
2008;38:977–981.
Mandell DS, Novak MM, Zubritsky CD. Factors associated with age of diagnosis
among children with autism spectrum disorders.
Pediatrics.
2005;116:1480.
Miano S, Ferri Raffaele. Epidemiology and management of insomnia in children
with autistic spectrum disorder.
Pediatr Drugs.
2010;12:75–84.
Nazeer A. Psychopharmacology of autistic spectrum disorders in children and
adolescents.
Pediatr Clin N Am.
2011;58:85–97.
Owley T, Walton L, Salt J, Guter SJ, Winnega M, Leventhal BL, Cook EH. An
open–label trial of escitalopram in pervasive developmental disorders.
J Am
Acad Child Adolesc Psychiatry.
2005;44:343.
Research Units on Pediatric Psychopharmacology Autism Network. Randomized,
controlled crossover trial of methylphenidate in pervasive developmental disor-
ders with hyperactivity.
Arch Gen Psychiatry.
2005;62:1266.
Robinson EB, Koenen KC, McCormick MC, Munir K, Hallet V, Happe F, Plomin
R, Ronald A. Evidence that autistic traits show the same etiology in the general
population an at the quantitative extremes (5 percent, 2.5 percent, and 1 per-
cent).
Arch Gen Psychiatry.
2011;68:1113–1121.
Rogers SJ, Vismara LA. Evidence-based comprehensive treatments for early
autism.
J Clin Child Adolesc Psychol.
2008;37:8–38.
Ronald A, Hoekstra RA. Autism spectrum disorders and autistic traits: A decade
of new twin studies.
Am J Med Genet Part B.
2011;156:255–274.
Research Units on Pediatric Psychopharmacology Autism Network (RUPPAN).
Risperidone treatment of autistic disorder: Longer-term benefits and blinded
discontinuation after 6 months.
Am J Psychiatry.
2005;162:1361–1369.
Stigler KA, McDonald BC, Anand A, Saykin AJ, McDougle CJ. Structural and
functional magnetic resonance imaging of autism spectrum disorders.
Brain
Res.
2011;1380:146–161.
Sugie Y, Sugie H, Fukuda T, Ito M. Neonatal factors in infants with autistic disor-
der and typically developing infants.
Autism.
2005;5:487–494.
Tanaka JW, Wolf JM, Klaiman C, Koenig K, Cockburn J, Herlihy L, Brown C,
Stahl S, Kaiser MD, Schultz RT. Using computerized games to teach face rec-
ognition skills to children with autism spectrum disorder: the Let’s Face it! Pro-
gram.
J Child Psychol Psychiatry.
2010;51:944–952.
Vanderbuilt Evidence-based Practice Center, Nashville TN. Therapies for chil-
dren with autism spectrum disorders.
Comparative Effectiveness Review
2011;
26;1–13.
Veenstra-VanderWeele J, Blakely RD. Networking in Autism: Leveraging genetic,
biomarker and model system findings in the search for new treatments.
Neuro-
psychopharmacology.
2012;37:196–212.
Volkmar FR, Klin A, Schultz RT, State M. Pervasive developmental disorders.
In: Sadock BJ, Sadock VA, Ruiz P. eds.
Kaplan & Sadock’s Comprehensive
Textbook of Psychiatry.
9
th
ed. Vol. 2. Philadelphia: Lippincott Williams &
Wilkins; 2009:540.
Wang M, Reid D. Virtual reality in pediatric neurorehabilitation: Attention
deficit hyperactivity disorder, autism and cerebral palsy.
Neuroepidemiology.
2011;36:2–18.
Wink LK, Erickson CA, McDougle CJ. Pharmacologic treatment of behavioral
symptoms associated with autism and other pervasive developmental disorders.
Curr Treat Options Neurol.
2010;12:529–538.
Zuddas A, Zanni R, Usala T. Second generation antipsychotics (SGAs) for non-
psychotic disorders in children and adolescents: A review of the randomized
controlled trials.
Eur Neuropsychopharmacol.
2011;21:600–620.
▲▲
31.6 Attention Deficit/
Hyperactivity Disorder
Attention-Deficit/
Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is a neuro-
psychiatric condition affecting preschoolers, children, adoles-
cents, and adults around the world, characterized by a pattern
of diminished sustained attention, and increased impulsivity or
hyperactivity. Based on family history, genotyping, and neuro-
imaging studies, there is clear evidence to support a biological
basis for ADHD. Although multiple regions of the brain and sev-
eral neurotransmitters have been implicated in the emergence of
symptoms, dopamine continues to be a focus of investigation
regarding ADHD symptoms. The prefrontal cortex of the brain
has been implicated because of its high utilization of dopamine
and its reciprocal connections with other brain regions involved
in attention, inhibition, decision-making, response inhibition,
working memory, and vigilance. ADHD affects up to 5 to 8
percent of school-aged children, with 60 to 85 percent of those
diagnosed as children continuing to meet criteria for the disor-
der in adolescence, and up to 60 percent continuing to be symp-
tomatic into adulthood. Children, adolescents, and adults with
ADHD often have significant impairment in academic function-
ing as well as in social and interpersonal situations. ADHD is
frequently associated with comorbid disorders including learn-
ing disorders, anxiety disorders, mood disorders, and disruptive
behavior disorders.
The Fifth Edition of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) has
made several changes to the diagnostic criteria of ADHD in youth
and in adults. Whereas in the past, ADHD symptoms had to be pres-
ent by age 7 years, in DSM-5, “several inattentive or hyperactive-
impulsive symptoms” must be present by age 12 years. Previously,
there were two subtypes: Inattentive and Hyperactive/Impulsive type.
In DSM-5, however, subtypes have been replaced by the following
three specifiers, which essentially denote the same groups: (1) com-
bined presentation, (2) predominantly inattentive presentation, and
(3) predominantly hyperactive/impulsive presentation. Additional
changes in DSM-5 include permitting a comorbid ADHD and autism
spectrum diagnosis to be made. Finally, in DSM-5, for adolescents
17 years and older and for adults, only five symptoms, rather than
six symptoms of either inattention or hyperactivity and impulsivity
are required. In addition, to reflect the developmental differences in
ADHD across the life span, examples of symptoms have been added
to the DSM-5 criteria for ADHD. To confirm a diagnosis of ADHD,
impairment from inattention and/or hyperactivity and impulsivity
must be present in at least two settings and interfere with develop-
mentally appropriate social or academic functioning. For current
DSM-5 changes see Table 31.6-1.
