Attention Deficit Hyperactivity Disorder

Introduction

Psychiatric medical experts, especially nurses, have come across many patients with disorders. A common disorder that has been on the rise in the contemporary world is Attention Deficit Hyperactivity Disorder (ADHD), in most cases, diagnosed among children. According to Mayo Clinic, this condition is chronic and is affecting millions of children. Additionally, this disorder is a combination of many challenges ranging from impulsive behavior, little sustenance on attention, and hyperactivity. The clinic also reports that individuals diagnosed with ADHD disorder are likely to struggle with low self-esteem, sometimes with troubled relationships, students experience low performance at schools. Although, the prevalence of ADHD is much on young children and adolescence, the condition has been noticed in adult patients. The disorder targets the brain, making the patients challenged in controlling their behaviors, and how they pay attention. Similarly, according to WebMD, ADHD disorder is commonly diagnosed in patients with pre-existing mental disorders, and in most cases, boys over girls.

ADHD stands out second as a chronic illness in children affecting their behavioral condition. The diagnostic of this disorder has been the use of observable specific behavior in multiple settings. In the United States, national survey report of 2016, 9.4 percent of children ADHD diagnosis and 8.4 percent had this disorder (Wolraich et al., 2019). This disorder has a long history, despite the change in name over time. In the middle years of the 19^th century, its characteristics were described by a German physician Heinrich Hoffman, and his discussion was presented in the children’s book. The significant characteristics of this disorder, as discussed in a meeting held in Roya College of Physicians, in 1902, ADHD was found a defect in moral character. A few years later, it was observed that the disorder would appear in patterns of restless, inattentive, easily aroused, and hyperactivity. It was also noted that children might suffer from minimal brain damage or dysfunction, which could be passed across a generation or caused by environmental factors.

Additionally, after brain damage was found to contribute to ADHD minimally, this disorder was revised and became behaviorally descriptive. Then followed its reflection in the psychiatric classification system DSM-II, and its name became hyperkinetic reaction of childhood disorder. The research and changes were continual that in 1980, studies also revealed that the primary impairment had shifted from hyperactivity to inattention, thus changing the name to attention-deficit disorder in DSM-III. Further, it was categorized into three sub-types, inattention, hyperactive, and combined, in DSM-IV, which stands to date in DSM-5. In the latter edition, the subtypes have become presentations, including people across all the lifespans. Across ages of advancement and evolution since its discovery, the diagnostic criteria for ADHD remains almost the same, which involves the clinicians (Steinau, 2013). In the 1960s use of teacher- or parent-reported behavior–rating scales have been deployed to determine significant impairment as described in the DSM-5

WebMD also confirms that it is prominent among children and teens, and in some situations, can continue to adult ages (Bélanger et al., 2018). It is always advisable that before the condition of the disorder worsens, the patient seeks a pediatrician for evaluation, treatments, and therapy. Although the exact cause of ADHD is not clearly defined, the specialist attributes its development to genetic, environmental, or problems associated with the nervous system. Research is still underway to get the exact cause of this disorder and make them administer the right medication and therapy. This essay presents a comprehensive review of diagnostic criteria and influencers that can be used when considering ADHD symptoms; it will also include a discussion of neurobiological and other influences. Besides, this essay incorporates the cultural and genetic issues that need to be considered in treatment and professional-based guidelines, including views related to ADHD, APRN practice issues, and areas associated with this disorder that need to be addressed in the future.

Diagnostic Criteria and Influences to Include When Considering Diagnoses with ADHD Symptoms

There is a need to carry out diagnoses and find out the symptoms that are associated with ADHD. This will ensure that the type of treatment and therapy administered to the patients are the right ones. Additionally, carrying out the diagnosis would help the health providers identify ADHD symptom criteria, come up with alternative causes to these symptoms, and other related conditions such as anxiety and other forms of depression that might be responsible for these symptoms. It is important to note that a profound means to carry out this diagnosis is still underway, although much effort has been put into research ADHD. However, before carrying out any evaluation, some set conditions need to be followed carefully. Among these conditions include identifying the symptoms behaviors that must be present in two or more settings; secondly, the nature of the symptoms must be impairing; thirdly, the symptoms' behavior has been present in the child before 12 years (Cabral et al., 2020). Lastly, the symptoms should not be a result of another disorder that is not ADHD.

Some common characteristics of ADHD include anxiety, learning disabilities, depressions, undetected seizures, sleep problems, medical disorders affecting brain functionality. Most of these symptoms are associated with sudden life changes, such as deaths, family break-ups, relocation to new homes, and other weird behaviors, depending on the patients' age. According to Cleveland Clinic, adults have been found capable of recognizing the behaviors caused by ADHD within themselves, when their children are diagnosed. However, some patients have been found incapable of seeking professional aid to help them find anxieties and depression caused by ADHD. Additionally, the American Psychological Association (APA) provides guidelines that help psychiatrists in diagnosis.  According to APA, to be diagnosed with ADHD, a child must have more than six symptoms belonging to the inattention or hyperactivity category over the last six months. For adults, one should portray more than five established ADHD behaviors belonging to the same categories, for the same period as children.

Moreover, for ADHD symptoms or behavior, the patients, either child, adolescents, or adults, must meet some criteria, which is as follows: the patient must portray symptoms that interfere with school, home, or work life. Also, they should be present in two or more settings and, lastly, present before the age of 12 years (Cabral et al., 2020). Through these symptoms, healthcare officials will be in a position to decide whether the patient has ADHD or not. However, for the overall diagnosis process, there must be a strategic procedure that needs to be followed. According to the Centers for Disease and Control and Prevention, so far, there is no single test to diagnose ADHD, and many other problems, anxiety, depression, like sleep disorder, as well as other learning disabilities. A common practice with ADHD diagnoses among children is that the healthcare providers are to identify whether the patient's symptoms are worth diagnosis (Bélanger et al., 2018). More importantly, the American Academy of Pediatrics (APP) prompts that the health experts seek information from the teachers, parents, and other adults who have interacted with the children at different places. Through these strategies, the healthcare provider is capable of explaining whether the symptoms belong to another condition or occur at the same time as ADHD.

In order to ensure that ADHD diagnosis proceeds successfully, “the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5),” is used. This standard is used across communities to determine the number of children with ADHD and its impact on public health. DSM-5 criteria for ADHD use persistent patterns of inattention or hyperactivity to show its interference with functioning (Pacchiarotti et al., 2020). When addressing inattention, some of the common characteristics present include easily distracted, often troubled, seems not to listen when talked to directly, loses necessary things, fails to give close attention, and often trouble when organizing personal tasks, and so on. For the hyperactive case, one fidget with or taps hands or feet, might leave seats before time, runs about situations, unable to play during leisure, often talks excessively, troubled waiting their turn, and intrudes others, among many others.

Precisely, the DSM-5 criteria for ADHD include some fundamental approaches. The first criteria are the inattentive type diagnosis, which helps identify the listening skills, lost or misplaced items, forgetting of daily activities. This criteria also identifies the diminished daily activities, fall of focus, and in-school children's inability to complete homework and school assignments. The second criteria are the hyperactive or impulsive diagnosis criteria. The patient portrays over-talkative behavior, restlessness, incapable of staying sited in class, difficulties in waiting for a turn, and generally interruptive. Other diagnosis requirements include symptoms that are evident before 12 years, symptoms found not exclusive and oppositional behavior, and other mood disorders (American Psychiatric Association, 2013). Lastly, children need to carry out a classification to identify patients who meet both inattentive and hyperactive criteria for the last six months. Besides, those that meet the inattentive criterion, but not hyperactive criteria for the same period, and finally, those that meet the hyperactivity criterion, but not inattentive for the stated period of the past six months.

Conversely, for DSM-5 criteria on adults, the diagnosis criteria are different. For adults, all the requirements must be met for a diagnosis of ADHD. The criteria include five or more inattentive or hyperactive symptoms, which must be persistent for more than six months. The latter symptoms should adversely have impacted development levels either socially, academically, or occupationally. The second criteria are that inattentive or impulsive symptoms should have been present before 12 years (American Psychiatric Association, 2013). Thirdly, symptoms should be portrayed in at least two settings: school, workplace, or at home. The fourth is clear evidence that the symptoms show the reduced quality of overall functioning of the individual. Lastly, the symptoms should not occur exclusively during schizophrenia or other psychotic disorders.

Neurobiological and Other Influences of ADHD

Attention, Deficit Hyperactivity Disorder, cannot be attributed to one cause but intertwined pathophysiological entities. These causes range from various genetic influences and environmental risk factors present in some individuals, thus creating a chance or a spectrum for neurobiological complications. Based on latter complications, ADHD and the symptoms of both inattention, hyperactivity, and impulsivity characteristics common with these children are neurological. Although much of the research had not been carried out over the last few decades, there has been some sense of evidence provided. In the previously stated evidence, neurological structures and systems play a significant part. Precisely focusing on genetics, neurobehavioral, biochemical, and neuroanatomical associates of ADHD, the motor-regulatory system involving both subcortical and frontal systems are closely intertwined with ADHD (Corral & Hernández, 2018). The same studies highlight the possibility of genetics to portray deficiencies in neurotransmitters. After carrying out a family study, it is discovered that parents and children might be affected by the same condition of disorder through the same transmitters. Although so far, there is no neurobiological marker for this disorder, thus demanding an appropriate diagnosis that should critically carry out a reliable behavioral assessment, and treatment, which is carefully monitored by medical specialists to bring about informed behavioral interventions.

Moreover, apart from the neurobiological influences, there are other factors responsible for ADHD. As we had stated earlier, this disorder has been discovered in recent days, mainly associated with boy children, which results from biological conditions instead of poor parenting. However, we cannot attribute its course purely to genetics as other pathophysiological entities are also present and capable of causing the same complications. These factors primarily can be categorized as environmental factors for ADHD, including prenatal factors, which are basically associated with the mother’s lifestyle during pregnancy. An excellent example is alcohol exposure, which has been attributed to hyperactive, impulsive, or increased risks of psychiatric disorders, due to pre-existing abnormalities induced in the brain structure before birth (Corral & Hernández, 2018). Apart from alcohol, smoking has a great fold and contribution to ADHD risks; maternal smoking has been reported to have a powerful relationship, the reason being that smoke affects the nicotinic receptors, thus resulting in dopaminergic activity, causing ADHD.

Additionally, malnutrition and dietary deficiency make part of the postnatal factors responsible for ADHD. Precisely the imbalance between omega-3 and omega-6 fatty acids in the body are potential causes of this disorder. Also, the deficiency of iron in the body, especially during the pregnancy period, has been highlighted by various psychiatric researchers, to cause this problem. More so, complex models, which is an interplay between genes and the environment, seek considerations. For this reason, recent scholars try to examine the joint association between these two factors and exposure to prenatal conditions; among these conditions, the research reveals a close interconnection between the genotypes and prenatal exposure responsible for ADHD.

Cultural and Genetic Issues to Consider in the Treatment of ADHD

Culture may sound lesser, but when it comes to mental health, it counts a lot. It has fundamental effects on mental health, mental illness as well as on mental health services. Similarly, ADHD can be attributed to cultural issues, which have been based on racial and ethnic minorities on most occasions. Also, genetic factors can be part of the social factors responsible for the cause of disorders, the reason being genes are shared across families, thus making part of the culture. Precisely, culture and social factors are fundamental contributors to the cause of mental disorders, of varying nature, ranging from depressions, anxiety to ADHD (Slobodin & Masalha, 2020). Although the mental disorder is caused by complex interactions between various psychological, biological, social, and cultural factors, each has a stronger or weaker influence depending on the type of disorder. For instance, it is because of the cultural and social factors that highly contribute to depressions and post-traumatic conditions, as opposed to other causal agents.

The cultural background drives that responses based on ADHD, bringing unsettled, concerns, and common reactions. Although most pediatrics neglect the aspect of race and ethnicity when diagnosing this disorder and its subsequent treatments, to some degree, it impacts these processes. The minority group of children has been found to have high risks of been diagnosed with ADHD, as opposed to high social class individuals, the whites. Similarly, when whites are diagnosed, they have higher access to medications. More so, the cultural beliefs and attitudes impact diagnosis and affect treatment-seeking behaviors, due to differences prescribed for the whites and the minorities (Fairman, Peckham & Sclar, 2020). Additionally, culture has some connection to ADHD treatment between African Americans and whites, even if they belong to the same socioeconomic status. Again, differences in ethno-cultures are genetically generated and also associated with a combination of other factors.

Additionally, based on the genetic perspectives, some factors existing in specific families might cause ADHD. The type of genes varies across ethnic groups as well as cultural and social groups. The presence of these groups is a challenge, too, as individuals need to understand how to cope with daily problems attributed to these adversities, failure to which might result in seeking mental health treatment, as they are less represented in the mental health services. However, this should not be the excuse as there is a need to seek early treatment for the disorder before its conditions get to the extreme ends. More importantly, when handling ADHD patients, it is essential to consider all the cultural and social factors responsible for the disorder; also, the genetic factors are worth addressing.  This is in the bid to address the cause of the disorder first, as it would enable the psychiatrists to give cause-related treatment as opposed to symptom-based treatment. The cause-related treatment helps address the challenge based on its origin and thus the best in medical practice.

ADHD Treatment Options and Guidelines

When addressing brain-related treatment and therapies, the psychiatrists need to be fully equipped with competent skills. Currently, ADHD has no cure, although some treatments help reduce its associated symptoms and improve overall functioning. In common practice, the specialist offers medication, education, psychotherapies, and sometimes combined treatments. According to the National Institute of Mental Health (NIH), ADHD in many people reduces hyperactivity and impulsivity; these medications aim to improve the patients' focus, work, and learning ability (Mattingly et al., 2017). Although, some medications need to be tested before they get administered to some patients, and patients should be keenly monitored and carefully follow the prescriptions. Precisely the medications are aimed at improving the individual’s physical coordination. The medications belong to various groups, the common ones being the stimulant; others are non-stimulants, including psychotherapy and psychosocial interventions.

Mental health specialists revealed that stimulants are the common medication used in treating ADHD. Although the latter disorder is a stimulant, it is treated with stimulants, which increase brain chemical dopamine and norepinephrine, which helps in thinking and attention. These stimulants work best if administered under strict medical supervision; however, they are associated with some side effects upon misuse (Mattingly et al., 2017). A common effect of overdose of these stimulants is high blood pressure, heart rate, and anxiety. Thus, it is advisable that if a patient has these pre-existing conditions of hypertension, liver, kidney disease, and anxiety disorders, make it known to the doctors before receiving these medications. The NIH department also informs the patients that in case they experience decreased appetite, personality change, stomach aches, increased anxiety, sleep problems, among other side effects, they should seek medical advice. Conversely, some non-stimulants take longer to start working as opposed to stimulants. However, they might improve focus, attention, and impulsivity in ADHD patients at the end of it all. The non-stimulants are prescribed for patients who have revealed the side effects on stimulants, or when stimulants were not effective; at times, both are administered to increase the overall effectiveness.

Further, some psychosocial interventions have been found helpful with some patients and their families to manage the ADHD conditions and improve daily functioning. Children and patients, may need guidance on ADHD to help them, understand their parents, families, and teachers, thus reach full potential and succeed. Starting with behavioral therapy, which is psychotherapy, has been found successful in changing individuals' behaviors. It incorporates all the involved people’s role to monitor and give a self-appraisal in behavior change. Secondly, cognitive therapy teaches the patients to get mindful techniques, which places them in a position to accept their thoughts and feelings, thus improving concentration. Other therapies include family and marital therapies to address couple interactions, parental skills training, specific behavioral classroom management interventions, stress management techniques, and support groups. All these strategies, therapies, medications, and interventions aim to help ADHD patients stay organized, and improve their overall daily functioning.

Recent Research Applicable to ADHD Aspects and Treatment

The ADHD problem has been discovered in the few recent decades; thus, not much has been done. It is because of this reason that many contemporary scholars have been at the forefront of research on this disorder. All these researches aim to advance the knowledge or the knowledge on this disorder and thus the know-how to treat it. This is after a continuous failure and ineffectiveness in addressing ADHD patients in terms of medication-based treatments that have been questioned. They have not discussed the broader clinical needs common with the majority of ADHD individuals appropriately. Another area that has raised concern is the less effectiveness in non-pharmacological approaches that have been employed to address ADHD as it was expected (Cortese & Coghill, 2018). Additionally, the present-day scientists and clinic studies have posed a challenge to the existing conceptions on ADHD as they seem to affect future clinical approaches.

In order to solve the challenge of inclusion in the contemporary world from the past approaches, sets of new clinical practices are deployed. Scholars have embarked on serious research to try to understand ADHD. The current study uses data from the national surveys from where they gather data to be used on policy research and community-based research. They can understand the number of individuals with ADHD, conditions they might experience, and the type of treatment administered to them. Before the treatment, the specialists need to provide an account of how they go about the diagnosis, epidemiology, and then present the treatment procedures, as presented in “the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases.” Additionally, the current researches focus on understanding the causes of pathophysiological aspects associated with ADHD as scientifically presented in the recent decades. Finally, we need to address the discoveries, and some key challenges applicable to current models and treatment of ADHD, and how these discoveries promote new perspectives.

Controversies Associated With Attention Deficit Hyperactivity Disorder

Based on the fact that attention deficit hyperactivity disorder is a discovery and that much research has not been done about it, there exist many public disagreements. The latter disputes are a result of the existence of unclear information. Most of this information relates to the causes of the disorder, diagnosis, and the methods of treatment used, precisely using stimulants on children. These controversies have resulted in debates around ADHD, where some individuals even go to the extent of the question of whether this is a mental illness or a neurological description of a normal condition. Another source for debate is its cause and the accuracy of the current prevalence rates (Mahone & Denckla, 2017). This has extended into queries on the methods used in diagnosis and treatment.

Addressing the question of whether ADHD is a mental illness or not has been on the forefront. There is a need to find out whether ADHD can be categorized as a mental illness. Some experts describe this as brain-based variations, with most people stating that ADHD is not a disorder, as normal individuals at times portray the same symptoms as those with the disorders. However, another group of individuals who are fully convinced that this is a disorder supports their stand as individuals with this disorder activity and abilities greatly vary from normal people. Additionally, they agree that ADHD is a neurological disorder, influenced by environmental factors; however, the detractors claim that this type of disorder is primarily caused by psychological factors (Timimi, 2018). The existence of these debates calls for psychiatrists to address these controversies and understand what exactly ADHD is and how it should be dealt with; more so, they should clearly highlight how this disorder should be treated, especially the young children.

Advanced Practice Registered Nurses (APRN) Practice

APRN is an abbreviation of Advanced Practice Registered Nurses. This is a category of registered nurses who have earned a graduate-level degree such as Masters of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) and has been trained in one of four a recognized APRN practice. The four major roles of APRN include certified nurse-midwife (CNM), certified registered nurse anesthetic (CRNA), clinical nurse specialist (CNS), and nurse practitioners (NP) (McCauley et al., 2020). For nurses to get registered, they must get to higher education institutions where they get many skills and thus in a position to address the issues and the controversies that are associated with ADHD. More importantly, these nurses are more critical in addressing vital health complications, especially in the United States. Their skills allow them to serve patients and provide additional aid needed by patients whose conditions require much more specialized attention. They are capable of recording ADHD patients’ medical histories and diagnostic tests, writing the correct medication prescriptions, and sometimes referring patients to further care.

When dealing with ADHD patients, advanced practice registered nurses (APRNs) uses advanced diagnostic methods to identify and diagnose this disorder. These methods used are highly understudies, thus promising high degrees of accuracy. Children suspected to have symptoms of this disorder in the face of the APRNs are sure of recognition and diagnosis methods which are perceived much accurate (Vlam, 2006). In most cases, these nurses use American Academy of Pediatrics diagnostic guidelines for diagnosing this disorder in children, which is closely related to other methods used by other care providers. Although, the APRNs feel much comfortable when handling APRNS disorders diagnosis and treatment.

Future Implications

Future researchers need to answer the questions that arise with ADHD issues. There is much work that current and future researchers need to do, majorly on gathering knowledge on this disease. First and foremost, the researchers need to agree on the definition of ADHD as it has been seen to vary from different conditions, thus affecting the past and the current studies (Pallanti & Salerno, 2020). There is a need to carry out a scientific study that should come up with a measure or a standardized treatment of this disorder, which should not raise questions on whether to be administered to children. Additionally, today’s researchers need to address how ADHD affects each subgroup are affected by ADHD and get exact models that can handle the challenge and thus get the appropriate medication for each sub-group, either cultural, racial, or family. Scholars also need to critically examine how genes and environment interaction effects, and other factors are associated with ADHD and how they can be delineated from other forms of normal activities.

Conclusion

In general, ADHD is one of the common psychiatric disorders among children, especially in boys. Even though the condition might be present in girls and adults, portraying almost the same characteristics or symptoms across all genders. Most commonly, ADHD patients portray abnormal behavior, through the use of the following criteria: the patient must portray symptoms that interfere with school, home, or work life, present in two or more settings, and lastly, present before the age of 12 years, in diagnostic of this disorder. The neurobiological and environmental factors have also been profound in causing ADHD, thus requiring a systematic method to address how these factors affect the treatment guidelines. Culture and social factors have also been found significant in determining the type of mental illness and mental health institutions in a region. Most importantly, the treatment of ADHD revolves around stimulants, non-stimulants, and psychosocial interventions; although some of these methods have not been effective, they help in reducing inattention and hyperactivity and thus improving functioning. However, due to some interventions' failure, ADHD nurses need to get higher education to place them better in addressing this disorder and eliminate much of the current controversies.

 

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Bélanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: part 1—etiology, diagnosis, and comorbidity. Paediatrics & child health, 23(7), 447-453.

Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational pediatrics, 9(Suppl 1), S104.

Corral, M. D. R. G., & Hernández, P. S. (2018). ADHD: neurobiological Basis and Social Aspects. MERIDIeS: revista de investigación científica para alumnos de enseñanza secundaria, 17, 81-90.

Cortese, S., & Coghill, D. (2018). Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward. Evidence-based mental health, 21(4), 173-176.

Fairman, K. A., Peckham, A. M., & Sclar, D. A. (2020). Diagnosis and treatment of ADHD in the United States: Update by gender and race. Journal of attention disorders, 24(1), 10-19.

https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-table1.pdf

https://www.cdc.gov/ncbddd/adhd/diagnosis.html

https://www.qandadhd.com/diagnostic-criteria

https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889

https://www.webmd.com/add-adhd/childhood-adhd/attention-deficit-hyperactivity-disorder-adhd#1-1

Mahone, E. M., & Denckla, M. B. (2017). Attention-deficit/hyperactivity disorder: a historical neuropsychological perspective. Journal of the International Neuropsychological Society: JINS, 23(9-10), 916.

Mattingly, G. W., Wilson, J., & Rostain, A. L. (2017). A clinician’s guide to ADHD treatment options. Postgraduate medicine, 129(7), 657-666.

McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., ... & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track. Nursing outlook, 68(4), 494-503.

Mehta, T. R., Monegro, A., Nene, Y., Fayyaz, M., & Bollu, P. C. (2019). Neurobiology of ADHD: A Review. Current Developmental Disorders Reports, 6(4), 235-240.

Pacchiarotti, I., Kotzalidis, G. D., Murru, A., Mazzarini, L., Rapinesi, C., Valentí, M., ... & Verdolini, N. (2020). Mixed features in depression: the unmet needs of diagnostic and statistical manual of mental disorders fifth edition. Psychiatric Clinics, 43(1), 59-68.

Pallanti, S., & Salerno, L. (2020). Adult ADHD: Future Directions for Practice and Research. In The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders (pp. 347-371). Springer, Cham.

Slobodin, O., & Masalha, R. (2020). Challenges in ADHD care for ethnic minority children: a review of the current literature. Transcultural psychiatry, 57(3), 468-483.

Steinau, S. (2013). Diagnostic criteria in attention deficit hyperactivity disorder–changes in DSM 5. Frontiers in psychiatry, 4, 49.

Steinau, S. (2013). Diagnostic criteria in attention deficit hyperactivity disorder–changes in DSM 5. Frontiers in psychiatry, 4, 49.

Szeto, S. (2019). The etiology of ADHD (Doctoral dissertation, Boston University).

Timimi, S. (2018). Rebuttal to Foreman’s article ‘Attention-deficit hyperactivity disorder (ADHD): progress and controversy in diagnosis and treatment’. Irish Journal of Psychological Medicine, 35(3), 262-265.

Vlam, S. L. (2006). Attention-deficit/hyperactivity disorder: diagnostic assessment methods used by advanced practice registered nurses. Pediatric Nursing, 32(1).

Wolraich, M. L., Chan, E., Froehlich, T., Lynch, R. L., Bax, A., Redwine, S. T., ... & Hagan, J. F. (2019). ADHD diagnosis and treatment guidelines: a historical perspective. Pediatrics, 144(4).