Attention Deficit Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness.
Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child’s circumstances change, such as when they start school. Most cases are diagnosed when children are 6 to 12 years old.
The symptoms of ADHD usually improve with age, but many adults who were diagnosed with the condition at a young age continue to experience problems.
People with ADHD may also have additional problems, such as sleep and anxiety disorders.
Attention deficit hyperactivity disorder (ADHD) affects children and teens and can continue into adulthood. ADHD is the most commonly diagnosed mental disorder of children. Children with ADHD may be hyperactive and unable control their impulses. Or they may have trouble paying attention. These behaviors interfere with school and home life.
It’s more common in boys than in girls. It’s usually discovered during the early school years, when a child begins to have problems paying attention.
Adults with ADHD may have trouble managing time, being organized, setting goals, and holding down a job. They may also have problems with relationships, self-esteem, and addiction.
Symptoms in Children
Symptoms are grouped into three categories:
Inattention. A child with ADHD:
Is easily distracted
Doesn’t follow directions or finish tasks
Doesn’t appear to be listening
Doesn’t pay attention and makes careless mistakes
Forgets about daily activities
Has problems organizing daily tasks
Doesn’t like to do things that require sitting still
Often loses things
Tends to daydream
Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:
anxiety disorder – which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
oppositional defiant disorder (ODD) – this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
conduct disorder – this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
autistic spectrum disorder (ASD) – this affects social interaction, communication, interests and behaviour
epilepsy – a condition that affects the brain and causes repeated fits or seizures
Tourette’s syndrome – a condition of the nervous system, characterised by a combination of involuntary noises and movements (tics)
learning difficulties – such as dyslexia
Symptoms in adults
In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.
As ADHD is a developmental disorder, it’s believed it cannot develop in adults without it first appearing during childhood. But it’s known that symptoms of ADHD often persist from childhood into a person’s teenage years and then adulthood.
Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood.
By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.
The symptoms in children and teenagers are sometimes also applied to adults with possible ADHD. But some specialists say the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children.
For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressures of adult life increase. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.
Some specialists have suggested the following as a list of symptoms associated with ADHD in adults:
carelessness and lack of attention to detail
continually starting new tasks before finishing old ones
poor organisational skills
inability to focus or prioritise
continually losing or misplacing things
restlessness and edginess
difficulty keeping quiet, and speaking out of turn
blurting out responses and often interrupting others
mood swings, irritability and a quick temper
inability to deal with stress
taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously
Causes of ADHD
The cause of ADHD isn’t known. Researchers say several things may lead to it, including:
Heredity. ADHD tends to run in families.
Chemical imbalance. Brain chemicals in people with ADHD may be out of balance.
Brain changes. Areas of the brain that control attention are less active in children with ADHD.
Poor nutrition, infections, smoking, drinking, and substance abuse during pregnancy. These things can affect a baby’s brain development.
Toxins, such as lead. They may affect a child’s brain development.
A brain injury or a brain disorder. Damage to the front of the brain, called the frontal lobe, can cause problems with controlling impulses and emotions.
Sugar doesn’t cause ADHD. ADHD also isn’t caused by watching too much TV, a poor home life, poor schools, or food allergies.
ADHD can’t be prevented or cured. But spotting it early, plus having a good treatment and education plan, can help a child or adult with ADHD manage their symptoms.
Groups at risk
Certain groups are also believed to be more at risk of ADHD, including people:
who were born prematurely (before the 37th week of pregnancy) or with a low birthweight
with brain damage – which happened either in the womb or after a severe head injury later in life
If you think you or your child may have attention deficit hyperactivity disorder (ADHD), you might want to consider speaking to your GP about it.
If you’re worried about your child, it may help to speak to their teachers, before seeing your GP, to find out if they have any concerns about your child’s behaviour.
Your GP cannot formally diagnose ADHD, but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.
When you see your GP, they may ask you:
about your symptoms or those of your child
when these symptoms started
where the symptoms occur – for example, at home or in school
whether the symptoms affect your or your child’s day-to-day life – for example, if they make socialising difficult
if there have been any recent significant events in your or your child’s life, such as a death or divorce in the family
if there’s a family history of ADHD
about any other problems or symptoms of different health conditions you or your child may have
If your GP thinks your child may have ADHD, they may first suggest a period of “watchful waiting” – lasting around 10 weeks – to see if your child’s symptoms improve, stay the same or get worse.
They may also suggest starting a group-based, ADHD-focused parent training or education programme. Being offered a parent training and education programme does not mean you have been a bad parent – it aims to teach you ways of helping yourself and your child.
Treatment and Therapies
While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.
For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.
Stimulants. The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works because it increases the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.
Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose.For example, stimulants can raise blood pressure and heart rate and increase anxiety. Therefore, a person with other health problems, including high blood pressure, seizures, heart disease, glaucoma, liver or kidney disease, or an anxiety disorder should tell their doctor before taking a stimulant.
Talk with a doctor if you see any of these side effects while taking stimulants:
tics (sudden, repetitive movements or sounds);
increased anxiety and irritability
Non-stimulants. A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant: when a person has bothersome side effects from stimulants; when a stimulant was not effective; or in combination with a stimulant to increase effectiveness.
Although not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, some antidepressants are sometimes used alone or in combination with a stimulant to treat ADHD. Antidepressants may help all of the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.
Doctors and patients can work together to find the best medication, dose, or medication combination. Learn the basics about stimulants and other mental health medications on the NIMH Mental Health Medications webpage and check the FDAwebsite (http://www.fda.gov/), for the latest information on warnings, patient medication guides, or newly approved medications.
Adding psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.
Behavioral therapy is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:
monitor his or her own behavior
give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting
Parents, teachers, and family members also can give positive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.
For more information on psychotherapy, see the Psychotherapies webpage on the NIMH website.
Education and Training
Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need special help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors that they want to discourage. They may also learn to structure situations in ways that support desired behavior.
Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.
Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Tips to Help Kids and Adults with ADHD Stay Organized
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:
Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
Organizing everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:
Making lists for different tasks and activities
Using a calendar for scheduling events
Using reminder notes
Assigning a special place for keys, bills, and paperwork
Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.