Understanding Attention Deficit Hyperactivity Disorder (ADHD): A Review of Prevalence, Theoretical Perspectives, and Implications for Early Intervention Volume 62- Issue 5

Vinutha U Muktamath¹*, Shweta Biradar² and Pooja Patil³

• ¹Scientist, All India Co-Ordinatated Research Project, Department of Human Development & Family Studies, India
• ²Assistant Professor, Dept. of Human Development & Family Studies, India
• ³Assistant Professor, NCERT, India

Received: July 17, 2025; Published: July 29, 2025

*Corresponding author: Vinutha U Muktamath, Scientist, All India Co-Ordinatated Research Project, Dept. of Human Development & Family Studies, UAS, Dharwad, India

DOI: 10.26717/BJSTR.2025.62.009799

Abstract PDF

Attention Deficit Hyperactivity Disorder (ADHD) is a neuro-developmental disorder characterized by patterns of inattention, hyperactivity, and impulsivity. Affecting children across various contexts, it has far-reaching consequences on academic, social, and emotional development. This review summarizes current knowledge on the prevalence, etiology, subtypes, and theoretical frameworks of ADHD, with a focus on its developmental course and implications for early intervention. Emphasizing the importance of awareness and structured screening in schools, the article advocates for proactive school-based interventions and health measures to mitigate longterm effects.

Abbreviations: ADHD: Attention Deficit Hyperactivity Disorder; CCC: Cognitive Complexity and Control; ToM: Theory of Mind; ODD: Oppositional Defiant Disorder

ADHD is one of the most common neuro-developmental disorders that begins in childhood and frequently persists into adolescence and adulthood. It significantly impairs social, academic, and occupational functioning, with effects evident at individual, familial, and societal levels. According to the DSM-5, ADHD manifests through symptoms of inattention and/or hyperactivity-impulsivity in at least two settings (e.g., home and school) and is often associated with poor outcomes when left untreated. The worldwide prevalence of ADHD is estimated to range from 3% to 5% among school-aged children, with reports from India suggesting even higher rates (5%–10%). A meta-analysis by Popit, et al. [1] reported global prevalence between 1.6% and 5%, while Indian data from 2009 to 2019 indicate rates of 7.6%–15% among children aged 8 to 15, with a higher incidence in males.

ADHD arises from multifactorial interactions of genetic, environmental, and neuro-developmental factors. Twin studies suggest heritability up to 80% (Faraone, et al. [2]). Environmental contributors include poor SES, single –parent families, maternal behaviors such as smoking, alcohol use, or drug use during pregnancy, psychosocial adversity, low birth weight, male gender and birth order and exposure to toxins like lead. Perinatal complications such as cesarean delivery, birth trauma, epilepsy and early head injuries have also been implicated (APA [3,4]). These factors collectively suggest that ADHD is not merely a behavioral issue but reflects complex neurobiological mechanisms.

Recent cognitive theories, including the Cognitive Complexity and Control (CCC) model, emphasize that children with ADHD struggle with cognitive flexibility—the capacity to shift between rules and perspectives. This leads to challenges in regulating attention and behavior. The CCC theory also connects cognitive flexibility with Theory of Mind (ToM), the capacity to understand others’ mental states. Impaired ToM development in ADHD is thought to arise from difficulties in embedding and switching between mental perspectives, thereby affecting attention regulation and behavioral control (Marzocchi, et al. [4-6]). Neuro-imaging studies have revealed structural and functional anomalies in the prefrontal cortex, basal ganglia, and cerebellum among individuals with ADHD, reinforcing the biological basis of the disorder (Castellanos, et al. [7]).

The DSM-5 Identifies Three Subtypes:

1. Predominantly Inattentive (ADHD-I): Difficulty sustaining attention, poor organizational skills, distractibility, and slow information processing.

2. Predominantly Hyperactive-Impulsive (ADHD-HI): Excessive movement, restlessness, impatience, and difficulty with quiet activities.

3. Combined Type (ADHD-C): Features from both inattentive and hyperactive-impulsive subtypes

Recent global estimates (Willcutt [8]) indicate subtype-specific prevalence as ADHD-I type (36 %), ADHD-HI (9 %) and ADHD-C (55%). Subtypes may vary depending on age, gender, symptom severity, and co-occurring conditions. The estimated prevalence of ADHD was approximately double in boys (10%) compared to girls (5%). Among the three recognized subtypes, the inattentive subtype (ADHD-I) was reported as the most prevalent, followed by the hyperactive-impulsive (ADHD-HI) and combined (ADHD-C) types (Ayano, et.al. [9]). In Indian studies, the combined subtype is most prevalent, followed by inattentive type, particularly in older children. A meta-analysis by Sagar, et al. [10] reviewing 42 studies in South Asia found ADHD-C more prevalent in urban schoolchildren, with maleto- female ratios ranging from 2:1 to 3:1. Subtype presentation often changes with age—hyperactive symptoms decline in adolescence, while inattentive symptoms persist and may affect academic performance and self-esteem. Longitudinal data also show that individuals with ADHD-C in childhood are at higher risk for adult ADHD and associated mood disorders (Willcutt, et al. [8-10]).

ADHD is Frequently Comorbid with:

• Oppositional Defiant Disorder (ODD) (30–50%)
• Anxiety Disorders (20–30%)
• Learning Disabilities (25–40%)
• Depression and Mood Disorders (15–20%)

These co-morbidities contribute to increased risk for academic underachievement, poor peer relationships, emotional distress and low self-esteem, risk-taking and antisocial behaviors, school dropout, substance abuse, delinquency, and occupational dysfunction in adulthood. Research by Barkley, et al. [11] found that untreated ADHD in adolescence correlates with a threefold increased risk of academic failure and criminal involvement. Longitudinal studies indicate that 60–85% of children diagnosed with ADHD continue to show symptoms during adolescence, and about 40% into adulthood (Garg and Arun, 2013).

Despite the high burden of disease, ADHD remains under diagnosed and undertreated, especially in low- and middle-income countries. Early screening and structured interventions in schools are essential. Recent opinion papers emphasize:

• Implementing standard ADHD screening tools as part of school health programs

• Training educators and caregivers in behavioral management

• Mandatory counseling services in schools

• Training for teachers and caregivers to recognize and manage ADHD symptoms

• Public awareness campaigns to destigmatize the disorder

Digital tools and AI-assisted behavioral assessments are emerging as promising screening modalities (Doshi, et al. [12]).

ADHD continues to be a growing neuro-developmental concern globally, particularly in low- and middle-income countries like India. The disorder is multifaceted, with subtype-specific variations, significant co-morbidities, and developmental consequences. Recent research reinforces the importance of understanding ADHD not only through biological and cognitive lenses but also in its socio-educational context. Early detection, inclusive educational practices, and targeted behavioral interventions are critical to improving outcomes for affected children.

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