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Agrowing body of evidence indicates that attention deficit–­hyperactivity disorder (ADHD) is being diagnosed and treated in an increasing number of countries around the world. Recent research suggests that ADHD is now the most common developmental or psychiatric diagnosis among school-­age ­children and adolescents, with worldwide prevalence estimates of 5% and 7.2% (Polanczyk et al. 2014; Thomas et al. 2015). ADHD is being increasingly recognized as a lifespan disorder in many countries (see, e.g., Fayyad et al. 2007; NICE 2009; Nakamura et al. 2013), although far less research has focused on adult ADHD. Data show that the global consumption of psychostimulant medi­ cations—­ the most frequently prescribed treatment for ADHD—is growing as well (Scheffler et al. 2007; INCB 2015). Findings such as ­ these mark a notable shift in the worldwide picture of ADHD, which ­ until roughly 25 years ago was far less global in scope. Prior to the 1990s, most of the reported diagnosis, treatment, and research related to ADHD occurred in the United States, where the diagnosis was originally devised and institutionalized. The diagnosis of ADHD emerged from the related diagnostic categories of “hyperactivity” and “minimal brain dysfunction.” The most recent antecedent of ADHD is the diagnostic category of “attention deficit disorder (ADD: with or without hyperactivity)” from the 1980 American Psychiatric Association’s 1 ADHD in Global Context An Introduction Meredith R. Bergey Angela M. Filipe 2   Global Perspectives on ADHD (APA) Diagnostic and Statistical Manual of Disorders (DSM-­III), which described a disorder characterized by hyperactivity, impulsivity, and inattention (see chapter 2 for details.) The 1987 revision of this manual (DSM-­III-­R) renamed the condition “Attention Deficit/Hyperactivity Disorder,” or “ADHD.” This term has been used in subsequent revisions and has become the popu­ lar designation. Given this heritage, it is perhaps not surprising that the prevalence of the ADHD diagnosis is highest in the United States, where 11% of school-­age ­children (Visser et al. 2014) and 4% of adults (Kessler et al. 2006) have been diagnosed. The United States is also the country where psychostimulant medi­ cation was first widely used to treat symptoms that are associated with ADHD, and it continues to be the largest consumer of the world’s supply of methylphenidate (Ritalin; INCB 2015). ­ Until the early 1990s, ­ there ­ were few studies concerning the diagnosis and treatment of ADHD-­ related be­ hav­ iors and its antecedents outside the United States, prompting some suggestions that ADHD might be a “culture-­ bound syndrome ” (Canino and Alegria 2008). Given the changes in recent de­ cades and the current dynamics and complexities surrounding ADHD, this is no longer a­viable proposition. A growing body of evidence points to an established and much more international interest in be­hav­iors that constitute ADHD than has often been previously considered. Reports from a few countries outside the United States pres­ ent historical accounts of troublesome be­ hav­ iors, restlessness, and inattention that have been deemed not only as prob­ lems of childhood but also as objects of medical attention and intervention (e.g., the work of Frederic Still in the United Kingdom and Franz Kramer and Hans Pollnow in Germany). Regardless of ­ whether such manifestations would align exactly with the current ADHD diagnosis, it is evident that increased attention is being paid in vari­ ous countries to the diagnosis and treatment of what are considered the core symptoms of ADHD in ­children and adults: inattention, impulsivity, and hyperactivity. In addition, ­ these be­ hav­ iors have increasingly been diagnosed as ADHD on the basis of the APA’s DSM criteria (Conrad and Bergey 2014). Contributing to this increase is a shift in some Eu­ ro­ pean countries away from the use of the diagnostic criteria of the World Health Organ­ ization’s (WHO) International Classification of Diseases (ICD, now in its tenth edition; WHO 2010). As ­ table 1.1 illustrates, the ICD describes a similar diagnostic category called “hyperkinetic disorder.” The ICD category pres­ents a narrower diagnostic threshold than that described in the DSM (Conrad and Bergey 2014), meaning the DSM­ will define a larger number of ­ children and adults as having ADHD. ADHD in Global Context   3­Table 1.1. Key Differences in Diagnostic Criteria for ADHD and HKD DSM: ADHD Diagnosisa ICD: HKD Diagnosis No ­ later than 7 years No ­ later than 7 years Symptoms in 1 or more dimensionb Symptoms in all dimensionsb Some impairment in at least 2 settings Full criteria met in at least 2 settings Comorbid conditions...


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