Attention-deficit/hyperactivity disorder, or ADHD, is a medical condition that causes symptoms of inattention, hyperactivity and impulsivity. ADHD is more often diagnosed in children, but adolescents and adults may also have it. Treatment includes medication, psychotherapy and complementary treatments.
It is normal to be distracted, unfocused or impulsive sometimes. But for people with ADHD, these traits occur more often and are more severe. ADHD can interfere with their daily activities, school or work, and social lives.
According to the Centers for Disease Control and Prevention, more than 6 million children in the United States have ADHD. Boys are more likely to have the disorder than girls are.
While most people are diagnosed as children, adults can also be diagnosed with ADHD. The National Institute for Mental Health estimates about 4.4 percent of American adults has ADHD.
People sometimes use ADD and ADHD interchangeably. ADHD was formerly known as ADD, or attention deficit disorder, and focused primarily on symptoms of inattention. The term is outdated, and the most up-to-date medical literature no longer recognizes it.
People with ADHD may also have other mental health conditions, including bipolar disorder, learning disorders, anxiety disorders and depression.
There is no cure for ADHD, though some symptoms change or lessen with adulthood. Several effective treatments exist and can help manage symptoms.
Symptoms and Diagnosis
Someone with ADHD has two key types of behavioral symptoms: inattention and hyperactivity/impulsivity.
Each behavior has its own list of symptoms. Some people may only have issues with one type of behavior, but most children show signs of both.
Preschool-aged children most commonly show signs of hyperactivity. Symptoms may present differently in adults. For example, hyperactivity in adults may manifest as restlessness.
Symptoms may appear as early as age 3 and continue into adulthood as inattention, impulsivity and antisocial behaviors. Some signs an adult may have undiagnosed ADHD include problems at work, history of poor academic performance and difficult or failed relationships.
In order to diagnose ADHD, health care providers consult the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), a book by the American Psychiatric Association, according to the Centers for Disease Control and Prevention.
Health care providers screen people for persistent symptoms related to inattention and hyperactivity/impulsivity. This information is only for reference. People should talk to a licensed health care provider for a proper diagnosis.
Symptoms of ADHD* include:
- Dislikes doing tasks that require focus or attention for a long period, and often avoids these tasks (homework, schoolwork)
- Distracted easily
- Easily loses things needed for activities or tasks such as cell phone, wallet, keys, paperwork, schoolbooks, etc.
- Forgetful in daily tasks and activities
- Loses focus or gets side tracked when performing workplace duties, chores or schoolwork
- Problems with attention to details, makes careless mistakes at work, school or with other activities
- Trouble keeping attention on play activities or other tasks
- Trouble organizing activities and tasks and may forget the proper sequence of tasks
- When spoken to directly, seems to not be paying attention or listening
- Adults may feel restless, children may climb objects or run around in inappropriate situations
- Blurts out an answer before a question is completed
- Difficulty being patient or waiting for their turn
- Frequently “on the go”
- Gets up when expected to remain seated
- Interrupts or intrudes on the games or conversations of others
- Squirms in seat, fidgets or taps with feet or hands
- Talks excessively
- Unable to participate in leisure activities or play quietly
*This list is only for reference purposes. Only a qualified health care professional can diagnose ADHD.
In order to receive an ADHD diagnosis, children up to 16 years of age must have six or more symptoms of inattention and/or six or more symptoms of hyperactivity/impulsivity, according to the CDC. For people ages 17 and older, a diagnosis requires five or more symptoms.
- Symptoms present before age 12
- Symptoms present in two or more settings, such as home, school, work or with friends
- Evidence that the symptoms interfere with daily activities and functioning at home, school or work
- Symptoms are not attributable to another mental disorder, such as anxiety, mood disorder, schizophrenia or another psychotic disorder
Other mental disorders frequently occur in people with ADHD. Six in 10 children with ADHD had at least one other disorder, according to a 2016 parent survey published in Journal of Clinical Child and Adolescent Psychology by M.L. Danielson and colleagues at the CDC.
About 52 percent of the children had a behavior or conduct problem. Others had anxiety (33 percent), depression (17 percent), autism spectrum disorder (14 percent) or Tourette syndrome (1 percent).
Causes and Risk Factors
Much like mental disorders such as depression or anxiety, researchers aren’t sure what causes ADHD. Several environmental and genetic factors could increase a person’s risk of having ADHD.
More males than females have ADHD, and symptoms manifest differently in females and males. Females are more likely to have inattention symptoms.
Mothers who smoke, drink or use drugs during pregnancy have an increased risk of having a child with ADHD, according to the National Institutes of Mental Health. For example, a study in Pediatrics found that children born to mothers who smoked during pregnancy have a 60 percent increased risk of having a child with ADHD.
Genetics and family history are also risk factors. For example, 25 percent of parents of children with ADHD also have it, according to the American Academy of Child & Adolescent Psychiatry.
Other developmental risks include low birth weight, brain injuries and exposure to toxins during pregnancy.
Taking some medications while pregnant may also increase the risk of having a child who develops ADHD. A 2017 study by Eivind Ystrom and colleagues in Pediatrics found that taking acetaminophen while pregnant was associated with a greater risk of ADHD in children.
How Does ADHD Affect Adults?
While many people with ADHD get a diagnosis as children, many adults who have ADHD might not realize it. Some children with ADHD continue to have the condition as adults.
About 60 percent of children with ADHD become adults with ADHD, according to Anxiety and Depression Association of America. Less than 20 percent get treated or diagnosed.
In adults, symptoms of ADHD are primarily inability to focus, restlessness and disorganization. Left untreated, an adult with ADHD can have problems with emotional health, relationships, employment, self-esteem and family situations.
For the majority of people with ADHD, medication is the first line of treatment. But people who don’t respond well to medication can try other therapies such as psychotherapy or behavior therapy. These therapies can also be combined with medication to improve symptom control.
About 80 percent of people respond to medication for ADHD, according to an article by Dr. Roy Boorady for Child Mind Institute.
Drugs called stimulants are usually the first choice of medication for ADHD, but the American Academy of Pediatrics recommends that children ages 4-5 try behavior therapy before medication.
Stimulants are habit-forming and may be misused. Athletes and students have used these drugs to improve performance. Having these medications without a prescription is illegal.
- Adderall, Adderall XR (amphetamine)
- Focalin XR, SR Focalin (dexmethylphenidate)
- Dexedrine, Dextrostat, Spansule (dextroamphetamine)
- Vyvanse (lisdexamfetemine or dimesylate)
- Methylin, Ritalin, Concerta (methylphenidate)
- Ritalin SR (methylphenidate SR)
Side effects of stimulants include increased blood pressure, anxious feelings, decreased appetite, personality changes, stomach aches, headaches and sleep problems. Talk to a health care provider if you experience these symptoms or notice them in a child.
Non-stimulants such as Strattera (atomoxetine) and Intuniv (guanfacine) may also help increase concentration and reduce impulsivity. But they take longer to work than stimulants.
Health care providers may also recommend antidepressants such as Wellbutrin (bupropion) or Effexor (venlafazine). The U.S. Food and Drug Administration does not approve antidepressants to treat ADHD. Make sure you ask your provider why they are recommending the drug and talk about risks and benefits.
Different types of psychotherapy have been shown to help people and their families deal with ADHD symptoms. But therapy isn’t only for children. Therapy can also help train parents to support their children, communicate and overcome negative feelings.
- Behavioral Therapy
- Behavioral therapy helps a person with ADHD learn how to change behaviors to control symptoms. It also teaches parents, teachers and family members to provide positive reinforcement for good behaviors. Therapists can also teach people how to improve social skills.
- Cognitive Behavior Therapy
- Cognitive behavior therapy helps a person learn how to accept their own thoughts and feelings to improve concentration and focus. It can also help teach people how to think before they act or resist impulsive, risky behavior.
- Parental Skills Training
- Parental skills training teaches parents how to enforce and reward positive behaviors in children. It can also teach them how to show their children the consequences of their behavior.
In addition to proven treatments such as medication and psychotherapy, there are theories that sensitivities to certain foods may contribute to ADHD symptoms, according to National Alliance on Mental Illness. But according to a 2016 article by Kathleen F. Holton and colleagues in Psychiatric Times, no laboratory tests have been able to show that eliminating foods is effective.
Article authors did find evidence that food colorings may exacerbate symptoms, so eliminating processed foods and drinks may have some benefit. They also found that omega-3 fatty acid supplementation has a small but positive effect on ADHD symptoms.
Tips for Managing ADHD
A few strategies can help children and adults with ADHD stay organized and focus. Parents and teachers can influence children by praising positive behaviors. Keeping routines and schedules are some of the best ways to stay organized for adults.
- Give praise and criticism as needed and be supportive and positive.
- Have a place for everyday things such as clothing, backpacks and toys.
- Keep rules clear and consistent.
- Keep school materials and supplies in organizers. Make sure the child knows the importance of bringing home anything necessary for homework and writes down all instructions and assignments.
- Set the same routine for children every day. Schedule time for homework, activities and playtime. Keep the schedule in a public place, such as on the refrigerator.
- Ask a therapist or other supportive person to help you think through decisions and learn how to think about the positive and negative consequences of decisions.
- Assign a special place for paperwork, bills, keys and other important items.
- Get a counselor, therapist or life coach to help you make changes and develop strategies for staying organized and modifying behaviors.
- Get emotional support to counteract negative comments, thoughts or harmful experiences.
- Make sure you have plenty of reminders. You can use your smartphone, computer or other system to keep track of important occasions and deadlines.
- Start and maintain a wellness routine like keeping a healthy diet, regular exercise and plenty of sleep.
- Take medication as directed and on time.
- Take things one step at a time, especially large tasks. Breaking down tasks into steps can help you accomplish more.
- Try to keep the same routine such as getting up at the same time and going to work. Do chores or errands on a schedule.
- Use lists and reminder notes to help you keep track of tasks.
- Minimize distractions by working in a quiet place in the office or ask to work from home on certain days.
- Ask your boss to help you keep track of deadlines and schedule different types of tasks at the same times each day.
- Take a break to walk, chat with a coworker or get a coffee if you are feeling restless.
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