Pathophysiology

The exact pathologic cause of ADHD has not been identified. ADHD is generally thought of as a disorder of self-regulation or response inhibition. Patients who meet the criteria for ADHD have difficulty maintaining self-control, resisting distractions, and concentrating on ideas.4,6 Further, children with ADHD often alternate between inattentiveness to monotonous tasks and overexcitement. Multiple brain studies have failed to elucidate any pathophysiologic basis for ADHD.

Dysfunction of the neurotransmitters norepinephrine and dopamine is thought to be key in the pathology of ADHD. Norepinephrine is responsible for maintaining alertness and attention, whereas dopamine is responsible for regulating learning, motivation, goal setting, and memory. Both these neurotransmitters predominate in the frontal subcortical system, an area of the brain responsible for maintaining attention and memory. Genetics appears to play a role with a 50% chance of developing ADHD in a child who has a parent who is also affected. An association has been made between the development of ADHD and fetal alcohol syndrome, lead poisoning, maternal smoking, and hypoxia.4,6

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