Abishek Poddar, PhD, a former postdoctoral fellow in the Department of Molecular Biology at Massachusetts General Hospital (MGH), is the first author of a recent review in the journal NeuroSci, Unraveling Attention-Deficit Disorder Etiology: Current Challenges and Future Directions in Treatment.
Poddar (who completed the review while at MGH) and co-authors looked at 161 articles published in peer-reviewed journals from 2000 to 2024 to identify key themes in the ongoing research and treatment of ADHD.
Here are five things to know:
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder that results from a variety of factors including genetic predisposition, epigenetic modifications (changes in gene expression over the course of a lifetime) and environmental exposures such as chemical and psychological stressors.
ADHD is one of the most common neurodevelopmental disorders, affecting millions of adults and children worldwide. While there are evidence-based medications that are effective for ADHD, it is a complex disorder with a variety of causes and presentations. There are significant gaps in diagnosis and treatment that additional research can help to fill.
While ADHD is increasingly recognized and diagnosed in childhood, it is a lifelong condition that can present in various ways depending on factors such as age, gender and cultural background. It impacts multiple areas of life, including academic achievement, job performance, relationships and mental health.
Stimulants are the most prescribed treatments for ADHD, although alternative non-pharmacological treatment are emerging such as cognitive behavioral therapy (CBT), digital therapeutics that assist with attention, focus and medication adherence, and therapies examining the gut-brain axis.
ADHD is highly heritable. Genetic factors contribute to 74% of the overall risk of developing ADHD, and genome-wide association studies have 7,300 variants associated with increased risk of this disease.
However, possessing these variants alone does not guarantee the onset of ADHD, which highlights the need to understand the impact of environmental factors such as exposure to chemical stressors (pesticides, plastics and metals), and non-chemical stressors (negative parenting, stressful life events) that can also play a role in the onset of ADHD.
Current challenges and gaps in ADHD diagnosis and treatment include access to healthcare providers (particularly in rural areas), stigma surrounding ADHD diagnosis and treatment that may prevent individuals from seeking help, a notable gap in evidence-based treatments tailored to adults with ADHD, and the need for new treatment strategies that include co-occurring conditions such as anxiety, depression and substance use.
Potential solutions to these challenges include the use of telemedicine and mobile health services to increase access to care in remote areas, as well as government subsidies and other efforts to reduce the cost of medications and therapies.
Public health campaigns and other educational efforts can be developed to promote the understanding of ADHD as a neurodevelopmental disorder, rather than a behavioral issue.
New research studies can be conducted to better understand the unique presentation of symptoms and treatment needs of adults with ADHD, as most research and treatment studies have been focused on pediatric populations.
Clinicians can develop collaborative care models that treat individuals for ADHD along with comorbid conditions such as anxiety, depression and substance use.
Future research into ADHD should seek to better define how the interplay of genetics and environment contribute to the onset of disease, learn how ADHD symptoms change over time, and work on the development of new diagnostic tools (such as neuroimaging) that can increase the objectivity, accuracy and specificity of ADHD diagnoses, the researchers write.
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