Introduction Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral childhood disorders with 5% of school children being affected by the disorder (Czamara, Tiesler, Kohbock et al., 2013). According to the DSM-V (2013), ADHD is characterized by inattention, hyperactivity and impulsivity, all of which interfere with the child’s ability to engage in quality “social, academic, or occupational functioning” (p. 2) for an extended period of time—at least 6 months or more. This paper will discuss the symptoms that a child with ADHD may exhibit, age of onset and gender differences, etiology, course, prognosis and current treatment and a differential diagnosis for the disorder as well.

Symptom Picture

Prevalence rates in the world for ADHD stands at 5.29% (Smith, 2017). This is roughly consistent with rates in the U.S. where one out of every twenty children are affected by ADHD (Faraone, Sergeant, Gillbert & Biederman, 2003).

A child who has ADHD typically experiences a range of emotions and impulses that often prevent the child from limiting his or her train of thought to a single idea or subject. In many cases, a child with ADHD will see numerous corollaries to a single idea and feel compelled to explore them. At the same time, the child may experience the underlying problem of engaging in so many tangential sequences, but—feeling frustrated by his or her inability to prevent the mind from exploring these tangents—the child can easily become upset, distracted, and annoyed. These feelings may be directed inward or outward.

At the same time, the child may want to focus on a single activity while wanting to do several others too. This produces tension and conflict within the body, mind and will of the child. The challenge for the child is to understand these conflicting impulses and develop the ability to control them, which can in all fairness be at times beyond the child’s grasp (Caye, Swanson, Thapar et al., 2016).

Children are also faced with the challenge of developing relationships with peers, which is a task that can be quite difficult for children with ADHD (McQuade & Hoza, 2015). Misbehavior often stems from the child’s inability to control impulses, which can upset other children and cause the child with ADHD to feel isolated, feel cut off, disliked, unloved and even despised. It is difficult for children with ADHD to comprehend why they marginalized and their responses to feelings of marginalization can increase the distance between them and their peers even more—especially if those feelings are represented confrontationally. This can easily carry over into school performance where the child with ADHD may perform poorly.

Cultural Variables

When it comes to variations among different cultures, there is basically no variance as Davis, Cheung, Takahashi, Shinoda & Lindstrom (2011)...

Whether it is among children in the UK, children in Japan, children in Ukraine, or children in Central America, the findings show that ADHD is a universal disorder that affects all children of all cultures and is not more prevalent in any one culture or among any one ethnicity. According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD, 2018), prevalence among children ages 2-17 in the U.S. is:
· 8.4 percent White 

· 10.7 percent Black 

· 6.6 percent Other 

· 6.0 percent Hispanic/Latino 

· 9.1 percent Non-Hispanic/Latino

There is wide disparity among states in the U.S., however. For example, Nevada has the lowest rate of ADHD prevalence at 4.2% while Kentucky has the highest rate at 14.8% (CHADD, 2018).

Age of Onset and Gender Features

The average age of when symptoms start is anywhere between 2-17 years of age, with most children being diagnosed between ages 6 and 11 and most children demonstrating signs of it between the ages of 11 and 14, with symptoms dwindling the older they get if appropriately treated (CHADD, 2018). The majority of children with ADHD are also boys, with 13.3% of boys having ADHD and only 5.6% of girls having ADHD (CHADD, 2018). Onset is typically gradual and can range in severity from mild to moderate to severe. 5.1 million children currently are diagnosed with ADHD in the U.S., and the average age of the child when diagnosis is made is 6 years old. Mild ADHD is most commonly diagnosed at 7, Moderate ADHD at age 6, and Severe ADHD most commonly at age 4.5 (CHADD, 2018).

Etiology

Voeller (2004) notes that ADHD can be both inherited and acquired and that it is not possible for physicians to distinguish between inherited ADHD and acquired ADHD. It is considered to be “a disorder of neurotransmitter function, with particular focus on the neurotransmitters dopamine and norepinephrine” (Voeller, 2004, p. 799). Research indicates that dopamine plays a major role in the regulation of the impulses that the child reacts to and has an impact on the learning process, behavior, and motivation. It also factors into memory-related tasks and dopamine can modulate neuronal activity that is related to motor processes as well. As Voeller (2004) states, “dopamine plays an important role in the function of the prefrontal-subcortical system” (p. 800). Norepinephrine is also a major player in the impact of the child’s ability to be alert and maintain focus or to maintain attention with tasks. Environmental factors can also play a part in the onset of the disorder: for example, children who grow up or come of age in environments or family situations that are chaotic tend to show signs of ADHD more than children who grow up in stable environments. Voeller (2004) states that “the risk of ADHD is proportional to the number…