Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition associated with potential functional impairment across childhood and adolescence. Research over the past decade have refined our understanding of ADHD epidemiology, neurobiology, diagnosis, and treatment, with growing emphasis on evidence-based assessment, multimodal intervention, and shared decision-making with young people and families. Current evidence supports the effectiveness of pharmacological and non-pharmacological approaches when delivered within developmentally informed and well-organised care pathways.
ADHD across development: prevalence and clinical impact
ADHD is characterised by persistent patterns of inattention and/or hyperactivity-impulsivity can interfere with functioning or development. Prevalence estimates suggest that around 5% of children and adolescents meet diagnostic criteria, with symptoms/traits frequently persisting into adulthood (Cortese et al., 2021). In addition to core symptoms, ADHD is associated with academic difficulties, social challenges, emotional dysregulation, and elevated rates of mental health comorbidity, including anxiety, depression, and behavioural problems. Longitudinal studies demonstrate increased risks for adverse educational, occupational, and psychosocial outcomes, highlighting the importance of early identification and effective intervention.
Conceptualising ADHD: diagnosis and neurodiversity
Current discussions increasingly situate ADHD within broader debates about neurodiversity, while retaining its status as a diagnosable condition associated with impairment and distress. From a clinical perspective, diagnosis relies on careful evaluation of symptom persistence, pervasiveness across settings, and functional impact, interpreted within a developmental framework. Recent clinical reviews emphasise the importance of comprehensive, multi-informant assessment, including clinical interviews, standardised rating scales, and information from schools and caregivers. Evidence does not support the use of standalone neuropsychological or cognitive tests for diagnostic purposes, although such assessments may inform broader clinical formulation in complex cases (Cortese et al., 2020; NICE, 2023).
Accurate ADHD diagnosis relies on comprehensive, multi-informant clinical assessment.
Aetiology and neurobiological correlates
ADHD is a highly heritable neurodevelopmental condition. Genetic studies indicate substantial heritability, while neuroimaging research has identified group-level differences in brain networks supporting attention, executive functioning, and reward processing (Cortese & Castellanos, 2020). Environmental factors, including prenatal exposures and psychosocial adversity, are understood to interact with genetic vulnerability rather than act as primary causes. Contemporary models conceptualise ADHD as a dimensional condition with heterogeneous developmental trajectories and clinical presentations (Faraone et al., 2021).
Pharmacological interventions: efficacy and safety
Pharmacological treatment remains one of the most effective interventions for reducing core ADHD symptoms in children and adolescents. Large network meta-analyses highlight robust short-term efficacy of stimulant medications, particularly methylphenidate, alongside acceptable tolerability profiles when appropriately monitored (Cortese et al., 2023). Recent research has focused on longer-term outcomes and adverse effects, including impacts on appetite, sleep, growth, and cardiovascular parameters. Evidence currently does not support an increased long-term risk of substance use disorders associated with stimulant treatment; on the contrary, appropriate treatment may be protective (Boland et al., 2020; Cortese et al., 2020).
Non-pharmacological and multimodal approaches
Clinical guidelines consistently recommend multimodal treatment approaches, particularly for children and adolescents with moderate to severe impairment. Non-pharmacological interventions may include psychoeducation, behavioural parent training, school/classroom-based strategies, and skills-focused psychological interventions. Meta analytic evidence suggests that behavioural and psychosocial interventions yield smaller effects on core symptoms than medication but contribute meaningfully to functional outcomes, parenting confidence, and family functioning. Combining pharmacological and non-pharmacological approaches allows treatment to be tailored to individual needs and developmental stage (Daley et al., 2021; Cortese et al., 2021).
Multimodal approaches address both symptoms and functional impairment.
Shared decision-making and family involvement
Shared decision-making has increasingly become an important principle in contemporary ADHD care. This approach emphasises collaboration between clinicians, young people, and families, integrating the best available evidence with individual preferences, values, and contextual factors. Research suggests that transparent discussion of benefits, risks, and uncertainties associated with treatment options improves engagement, adherence, and satisfaction with care. For adolescents, active involvement in decision-making supports autonomy and longer-term self-management (Cortese et al., 2020).
Service organisation and clinical challenges
Service-level challenges in ADHD care include long waiting times, variability in assessment practices, and inequities in access to evidence-based interventions. Recent health-service research signals the importance of integrated care pathways linking health, education, and social systems (Cortese et al., 2021). There is increasing interest in stepped-care and task-sharing models to improve access while maintaining diagnostic accuracy and treatment quality. Ongoing evaluation of such approaches is required as services respond to rising demand.
Conclusion
ADHD is a common neurodevelopmental condition with a strong evidence base supporting both pharmacological and psychosocial interventions. Reagent research has refined understanding of diagnosis, neurobiology, and management, while reinforcing the importance of developmentally informed, multimodal care. Continued attention to shared decision-making and service-level innovation is central to improving outcomes for children and adolescents with ADHD.
Where next?
Join Professor Samuele Cortese, one of the world’s most influential researchers of the past decade, for a comprehensive 4-hour clinical expert session on ADHD, designed specifically for mental health professionals working with children, adolescents, and families. Full details can be found at Practical Updates in ADHD Diagnosis and Management with Professor Samuele Cortese
References
- Boland, F., et al. (2020). Attention-deficit/hyperactivity disorder medication and risk of substance use disorders: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 29(11), 1513–1524.
- Cortese, S., & Castellanos, F. X. (2020). Neuroimaging of attention-deficit/hyperactivity disorder: Current neuroscience-informed perspectives for clinicians. Current Psychiatry Reports, 22, 1–9.
- Cortese, S., et al. (2020). Practitioner review: Current best practice in the management of adverse effects during treatment with ADHD medications in children and adolescents. Journal of Child Psychology and Psychiatry, 61(3), 265–279.
- Cortese, S., et al. (2021). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 7, 1–23.
- Cortese, S., et al. (2023). Comparative efficacy and tolerability of medications for attention-deficit/hyperactivity disorder in children, adolescents, and adults: An updated network meta-analysis. The Lancet Psychiatry, 10(6), 403–414.
- Daley, D., et al. (2021). Behavioral interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials. American Journal of Psychiatry, 178(4), 325–338.
- Faraone, S. V., et al. (2021). The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818.
- National Institute for Health and Care Excellence (NICE). (2023). Attention deficit hyperactivity disorder: Diagnosis and management (NG87).
