Guidelines & Protocols


Attention Deficit Hyperactivity Disorder (ADHD) is one of the most frequently encountered childhood-onset neuro-behavioural disorders in primary care settings. It has defining features of inattention, over-activity and impulsivity. The core symptoms co-exist with other emotional, behavioural and learning disorders.1, 2

Often primary care physicians, paediatricians, psychiatrists, clinical psychologists and others are asked to evaluate and treat a child who has disruptive relationships with peers, defies parental discipline and does poorly in school. ADHD could account for some of these symptoms. Early recognition, assessment, and management of this condition can improve the educational and psychosocial difficulties faced by the child and adolescent. 1-3

Screening for hyperactivity and inattention (the hallmark symptoms of ADHD) in a community survey amongst Malaysian children and adolescents between the ages of 5 – 15 years showed a prevalence rate of 3.9 %. It is more common in males compared to females. 3, 4


Several risk factors have been identified in the causation of ADHD. These factors may be biological or non-biological in nature. ADHD is three times more likely to occur in males 5, Level 7 and is more common in first born children. 6, Level 8

Genetic factors are important in the causation of ADHD. Children with ADHD are two to eight times more likely to have a parent with ADHD.7, Level 7; 8, Level 7; 9, Level 9 Mean heritability estimate of ADHD from twenty twin studies is 76%. There are at least seven genes that have been found to be significantly associated with ADHD i.e. DRD4, DRD5, DAT, DBH, 5-HTT, HTR1B, and SNAP-25.9Level 9

Preterm birth is associated with more than twice the risk of developing ADHD, 10, Level 1; 11, Level 7 while children with low birth weight have two to three fold increased risk.7, Level 7; 11, Level 7

Children with ADHD have significantly higher rates of neonatal complications compared with their unaffected siblings. 12, Level 7

CPG – Management of Attention Deficit Hyperactivity Disorder in Children And Adolescents