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Attention-deficit/hyperactivity disorder is a high-burden condition
Attention-deficit/hyperactivity disorder (ADHD) is a debilitating mental health disorder that, although most frequently diagnosed in school years, is now acknowledged to affect individuals across the lifespan, from the preschool period through to adulthood [1]. It is marked by symptoms of inattention, overactivity and impulsiveness that have an early onset, are age-inappropriate, persistent and pervasive [2]. The UK NICE estimated that approximately 210,000 children aged 5-18 years are affected by ADHD in England and Wales [3]. In the long-term, childhood ADHD is associated with risk of delinquency, criminality, educational failure and mental illness, thus creating a substantial burden to healthcare, social welfare and criminal justice systems [4]. The presence of comorbid diagnoses, such as conduct disorder, increase the risk for a poor outcome. For instance, children with a comorbid conduct disorder diagnosis are at risk for greater and more diverse substance abuse [1] and delinquency [5] in adolescence. The associated costs are growing in many countries. The burden associated with ADHD on pediatric clinics and social/education services is increasing as the numbers of children attending services grows year on year, with preschoolers also being increasingly referred [3,6]. The estimated annual cost associated with childhood and adolescent ADHD in the USA in 2005 was approximately US$14,600 per individual [7,8]. There are also substantial indirect costs associated with ADHD. For instance, family members of children with ADHD are more likely to use medical services [9] and no account has been taken of the costs due to family member stress [10]. Furthermore, children with ADHD suffer a wide range of impairments that impinge on social and healthcare systems at a number of levels (e.g., education, criminal justice, mental health and social services) [ADDISS. A report based on research amongst children and parents illustrating the impact of ADHD on the school day. School report: Perspectives on ADHD -A New Source of Information (2004). Unpublished Data]. It has been estimated that 45% of the young male prison population have ADHD [11] (see also [12,13]). In addition, adolescents with ADHD have been shown to have more driving accidents [13].
Current ADHD treatment strategies are valuable but have drawbacks
Treatment for ADHD generally begins during the school years once the condition and its complications have been...