Abstract and Keywords
In this chapter I review the literature on attention-deficit/hyperactivity disorder (ADHD) with the aim of providing a developmental synthesis. In the first section I ask: What is ADHD? I conclude that it is a relatively broad construct that, although having validity as a mental disorder dimension and utility as diagnostic category, is frequently comorbid with, but can be distinguished from, other disorders, and is highly heterogeneous. In the second section I ask: What causes ADHD? I conclude that ADHD has a complex set of causes implicating multiple genetic and environmental risks (and their interaction) reflected in alterations in diverse brain systems. The causal structure of ADHD is heterogeneous, with different children displaying different etiological and pathophysiological profiles. In the third section I reflect on developmental considerations. I conclude that ADHD-type problems present in different forms throughout the lifespan from the preschool period to adulthood and that existing data suggest patterns of continuity and discontinuity that support a lifespan perspective both at the level of clinical phenotype and underlying pathophysiology. In the light of this I argue for a developmental reconceptualization of the disorder, grounded in a biopsychosocial framework that would allow the complexity and heterogeneity of the condition to be understood in terms of risk, resilience, and protective factors, as well as mediating and moderating processes. I review the implications of the developmental perspective for nosological and diagnostic formulations of the condition. In the last section I set out priorities for future research in the genetics, imaging, neuropsychology, and treatment of the condition.
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