The Variations of ADHD



Theresa Cerulli, MD: Welcome to this HCPLive® Peers & Perspectives® presentation titled “Advances in the Management of Attention-Deficit/Hyperactivity Disorder.”

I am Dr Theresa Cerulli, from Beth Israel Deaconess Medical Center in Boston. I'm joined today by Dr Frank Lopez, from the Children's Developmental Center in Winter Park, Florida. We are here to discuss currently available and novel drugs in the pipeline to treat ADHD [attention-deficit/hyperactivity disorder] as well as management of ADHD during this COVID-19 [coronavirus disease 2019] pandemic.

Welcome, let’s begin.

Frank Lopez, MD: Thank you, Dr Cerulli.

Theresa Cerulli, MD: Such a pleasure to see you, Frank.

Frank Lopez, MD: We’re here and working together to improve outcomes for patients and their families.

Theresa Cerulli, MD: Absolutely. I know ADHD is a topic near and dear to your heart as it is mine, so I look forward to this discussion, particularly in light of the fact that you are both involved in clinical treatment of children and adolescents with ADHD, but also the clinical studies for a lot of pipeline medications over the years. I know you’ll have a lot to weigh in on with our discussion today. So, welcome.

Frank Lopez, MD: Thank you.

Theresa Cerulli, MD: All right, if we could get started with some background overview information about ADHD that would be fantastic. Frank, tell us, in your clinical experience is ADHD a uniform disorder?

Frank Lopez, MD: Absolutely not. ADHD is an incredibly heterogenous disorder, and it varies from person to person, family to family. There are a lot of influences go into this—environmental, genetic, structural, or lack thereof. There’s no one size fits all.

Back when I started in my career, it was 9:1 boys to girls being identified, especially depending on high reference clinics. And then over the last 25 years what we have seen is more girls being identified, more variability being identified. So now we’re looking at about 3:1. And I would expect that before the end of this decade it may actually be closer to 1:1.

Theresa Cerulli, MD: You’re talking about the ratio of boys to girls.

Frank Lopez, MD: Absolutely. If you look at that, what are we looking at incidence-wise? Again, it depends on the series that you read, but what has been accepted early and as late as 2019, is that there are about 9.4% of children, ages 6 to 17, that have been diagnosed as having ADHD.

Now that’s for the US. When you look at worldwide rates, that’s a little bit different. It ranges from 2.2% to 2.8%, depending what you’re reading and what countries you’re looking at. But the range overall between children and adults across the world is anywhere from 0.1% to as high as 8.1%. It is not limited to 1 particular country, 1 particular race or ethnicity, it is a very heterogeneous disorder with high incidence, and morbidity, when it’s left untreated.

Theresa Cerulli, MD: In what other ways would you say this is a heterogeneous condition? I know when I’m talking to parents I say it’s as unique in each individual as a thumbprint is, right?

Frank Lopez, MD: That is absolutely correct. It’s a great analogy. If you think about it, if you look at incidence of heritability, it’s around 74%. And that is probably the third leading heritable disease in general. Height and IQ [intelligence quotient] are the 2 that take precedence over that primarily, but there are many other things. But at the end of the day what we’re looking at here is a very penetrating disorder in families. We don’t have a specific gene that we can identify as the cause. We’re still in the process of trying to identify that. And hopefully in the next few years we’ll have a better picture of that particular lineage.

Again, it really varies, but it is highly heritable. And typically when I see a child coming in and parents are both there, I feel, I know, there’s about a 57% chance that 1 of those 2 parents has the disorder. The problem is having them self-identified and then get their own help.

Transcript Edited for Clarity

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