Introduction
The concept of hyperactivity in children has been documented in the medical literature since the 18th Century. In 1798, physician and author Sir Alexander Crichton described a mental state much like ADHD, referring to individuals with a ‘disease of attention,’ who refer to themselves as having ‘the fidgets,’ and have ‘the incapacity of attending with a necessary degree of constancy to any one obj
The concept of hyperactivity in children has been documented in the medical literature since the 18th Century. In 1798, physician and author Sir Alexander Crichton described a mental state much like ADHD, referring to individuals with a ‘disease of attention,’ who refer to themselves as having ‘the fidgets,’ and have ‘the incapacity of attending with a necessary degree of constancy to any one object,’ hallmark symptoms of what we now call ADHD. He was also accurate in other aspects of his portrayal of the condition, such as its early onset and the possibility of improvement with maturity.1 The notion that ADHD is a disorder of childhood prevailed until the turn of the century, but rigorous research, including longitudinal studies, has now documented the persistence of symptoms into adulthood in around 65% of individuals.2
Attention-deficit/hyperactivity disorder is the most common psychiatric disorder in children, affecting around 5%–7% of the school-going population,3 with the prevalence in 3–12-year-olds slightly higher than in 12–18-year-olds (7.6% vs. 5.6%, respectively).4 While in childhood there is a clear male preponderance of ADHD, in adult samples, sex differences are more modest or absent.5 The prevalence of ADHD does not significantly differ between Africa and the rest of the world.6 A local study found the prevalence of ADHD among primary school children of all ethnic populations in the Limpopo province to be 5.5%. 7 However, in another community-based sample (N = 12447), the prevalence of ADHD was 2.7% – which may be an underestimation as children with predominantly inattentive symptoms were less likely to be referred for screening and assessment.8
It is well recognised that ADHD is highly heritable, in fact among the most heritable of all psychiatric conditions. Family studies have identified a 2 to 8-fold increase in the risk for ADHD in parents and siblings of children with ADHD. Various twin and adoption studies have also highlighted the highly genetic nature of ADHD.9 Genetic studies suggest that a plethora of genes, each one with a small but significant effect, interact with environmental factors to increase the susceptibility to ADHD.10 Some of these environmental factors include prematurity and low birth weight, early deprivation, maternal obesity, childhood exposure to second-hand cigarette smoke and lead contamination.11
Attention-deficit/hyperactivity disorder is a costly, chronic disorder with a significant impact on the quality of life of individuals with ADHD and their families. Comorbidity in children with ADHD is prevalent and can range from poor self-esteem and academic difficulties to clinically relevant mental health disorder diagnoses. This contributes to the burden of disease and reduced quality of life of children with ADHD and their families.12 Up to 50% of children have at least one additional psychiatric disorder, while 25% have two or more comorbid disorders.13
Belsham B, Kelly L, Schoeman R_The SASOP/PsychMg child and adolescent attention-deficit/hyperactivity disorder guidelines_South African Journal of Psychiatry; 25 February 2025