Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. ADHD also affects many adults. Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought).
An estimated 8.4% of children and 2.5% of adults have ADHD.1,2 ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It is more common among boys than girls.
Symptoms and Diagnosis
Many ADHD symptoms, such as high activity levels, difficulty remaining still for long periods of time and limited attention spans, are common to young children in general. The difference in children with ADHD is that their hyperactivity and inattention are noticeably greater than expected for their age and cause distress and/or problems functioning at home, at school or with friends.
ADHD is diagnosed as one of three types: inattentive type, hyperactive/impulsive type or combined type. A diagnosis is based on the symptoms that have occurred over the past six months.
Inattentive type – six (or five for people over 17 years) of the following symptoms occur frequently:
- Doesn't pay close attention to details or makes careless mistakes in school or job tasks.
- Has problems staying focused on tasks or activities, such as during lectures, conversations or long reading.
- Does not seem to listen when spoken to (i.e., seems to be elsewhere).
- Does not follow through on instructions and doesn't complete schoolwork, chores or job duties (may start tasks but quickly loses focus).
- Has problems organizing tasks and work (for instance, does not manage time well; has messy, disorganized work; misses deadlines).
- Avoids or dislikes tasks that require sustained mental effort, such as preparing reports and completing forms.
- Often loses things needed for tasks or daily life, such as school papers, books, keys, wallet, cell phone and eyeglasses.
- Is easily distracted.
- Forgets daily tasks, such as doing chores and running errands. Older teens and adults may forget to return phone calls, pay bills and keep appointments.
Hyperactive/impulsive type – six (or five for people over 17 years) of the following symptoms occur frequently:
- Fidgets with or taps hands or feet, or squirms in seat.
- Not able to stay seated (in classroom, workplace).
- Runs about or climbs where it is inappropriate.
- Unable to play or do leisure activities quietly.
- Always "on the go," as if driven by a motor.
- Talks too much.
- Blurts out an answer before a question has been finished (for instance may finish people's sentences, can't wait to speak in conversations).
- Has difficulty waiting his or her turn, such as while waiting in line.
- Interrupts or intrudes on others (for instance, cuts into conversations, games or activities, or starts using other people's things without permission). Older teens and adults may take over what others are doing.
There is no lab test to diagnose ADHD. Diagnosis involves gathering information from parents, teachers and others, filling out checklists and having a medical evaluation (including vision and hearing screening) to rule out other medical problems. The symptoms are not the result of person being defiant or hostile or unable to understand a task or instructions.
The Causes of ADHD
Scientists have not yet identified the specific causes of ADHD. There is evidence that genetics contribute to ADHD. For example, three out of four children with ADHD have a relative with the disorder. Other factors that may contribute to the development of ADHD include being born prematurely, brain injury and the mother smoking, using alcohol or having extreme stress during pregnancy.
Behavioral therapy and medication can improve the symptoms of ADHD. Studies have found that a combination of behavioral therapy and medication works best for most people, particularly those with moderate to severe ADHD.
Behavioral therapy focuses on managing the symptoms of ADHD. For children, treatment usually consists of teaching parents and teachers how to provide positive feedback for desired behaviors and consequences for negative ones. Although behavioral therapy requires careful coordination, it can help children learn how to control their behavior and make good choices. Adults with ADHD may benefit from psychotherapy and from behavioral strategies that improve structure and organization.
There are two main types of medication for ADHD: stimulants and non-stimulants.
Stimulant medications are highly effective treatments that have been safely used for decades. They include methylphenidate and amphetamines. As with all medicines, children taking these drugs must be carefully monitored by their parents and doctors. Two non-stimulant medications, atomoxetine and guanfacine, have also been shown to be effective in treating ADHD symptoms. These medications are alternatives for those who do not respond well to stimulants or if a non-stimulant is preferred.
Some children experience dramatic relief of symptoms with medication and this relief continues with ongoing treatment. Other children may experience only partial relief or the medication may seem to stop working. A change in medication or adjustment in dose may improve the response. Other children and families may benefit from additional therapy specific to problem behaviors.
The national organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) notes that many adults report that medication helps them gain more control and organization in their lives.
Children who have ADHD tend to benefit from structure, routines and clear expectations. The following may be helpful:
- Make clear schedules.
- Maintain routines.
- Make sure instructions are understood – use simple words and demonstrate.
- Focus on your child when talking to him/her. Avoid multitasking.
- Supervise. Children with ADHD may require more supervision than their peers.
- Maintain communication with the child's teacher.
- Model calm behavior.
- Focus on effort and reward good behavior.
ADHD and the School-Aged Child
Teachers and school staff can provide parents and doctors with information to help evaluate behavior and learning problems, and can assist with behavioral training. However, school staff cannot diagnose ADHD, make decisions about treatment or require that a student take medication to attend school. Only parents and guardians can make those decisions with the child’s physician.
Students whose ADHD impairs their learning may qualify for special education under the Individuals with Disabilities Education Act or for a Section 504 plan (for children who do not require special education) under the Rehabilitation Act of 1973. Children with ADHD can benefit from study skills instruction, changes to the classroom setup, alternative teaching techniques and a modified curriculum.
ADHD and Adults
Many adults with ADHD do not realize they have the disorder. A comprehensive evaluation typically includes a review of past and current symptoms, a medical exam and history, and use of adult rating scales or checklists. Adults with ADHD are treated with medication, psychotherapy or a combination. Behavior management strategies, such as ways to minimize distractions and increase structure and organization, and involving immediate family members can also be helpful.
- Autism spectrum disorder
- Disruptive, impulse control and conduct disorders
- Social communication disorder
- Specific learning disorder
- Danielson, ML, et al. Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, Volume 47, 2018 - Issue 2
- Simon V, Czobor P, Bálint S, et al. Prevalence and correlates of adult attention-deficit hyperactivity disorder: a meta-analysis. Br J Psychiatry 194(3): 204–211, 2009
Physician Review By:
Ranna Parekh, M.D., M.P.H.