What Is ADHD (Attention Deficit Hyperactivity Disorder)?

Attention deficit hyperactivity disorder, or ADHD, is a mental health condition that includes challenges relating to inattention, hyperactivity, and impulsivity to the point that it interferes with everyday life. ADHD is one of the most common childhood neurodevelopmental disorders—a condition that has its onset in the developmental period and impacts how the brain works. It affects around 5% of school-aged children.

Adults also can be diagnosed with ADHD. Around two-thirds of children with ADHD continue to experience symptoms as adults.

ADHD symptoms arise from differences in the brain.

This article explains the symptoms associated with ADHD. It also discusses causes, diagnosis, and treatment options for this condition.

What Are the Signs and Symptoms of ADHD?

Children with ADHD have more trouble than others paying attention and sustaining focus. They may have difficulties sitting still and may act impulsively. This can lead to difficulty getting along with other children and learning in certain school settings.

ADHD that persists into adulthood can interfere with relationships, work performance, and overall quality of life. In adults, the hyperactivity seen in childhood may present as restlessness. The typical stresses of adulthood can also worsen ADHD symptoms.

Symptoms of attention deficit hyperactivity disorder depend on the type, but, in general, children and teens with ADHD may exhibit:

• Frequent forgetfulness
• Daydreaming and the appearance of not listening
• Trouble staying on task
• Disorganization
• Avoidance of tasks that require focus
• Trouble sitting still, fidgeting, and squirming
• Excessive talking
• Risky behavior
• Carelessness, or lack of attention to details
• A pattern of making mistakes
• Trouble getting along with other kids
• Difficulty taking turns

Adults may experience different presentations of ADHD: inattentive, impulsive/hyperactive, or a combination of both. Symptoms of ADHD may present differently in adulthood, with less hyperactivity being common.

Types of ADHD

There are three different presentations of ADHD as defined by the DSM-5.

Predominantly Inattentive Presentation

People who have a predominantly inattentive presentation of ADHD struggle with attention and concentration. This might result in a tendency to overlook details or follow through on tasks.

A child must have at least six (five for adolescents 17 and older and adults) of the following symptoms:

• Trouble paying attention while performing tasks or engaging in play activities
• Makes careless mistakes frequently
• Frequently forgetting the details of daily tasks
• Often easily distracted
• Often appears not to be listening when talked to directly
• Frequently forgetful in performing daily tasks
• Fails to finish homework or other tasks, or has problems following through

Predominantly Hyperactive-Impulsive Presentation

People with this presentation of ADHD might seem to have an excess of energy, be excitable, impulsive, or have trouble sitting still. Common tendencies are fidgeting, interrupting conversations or lessons, or being impatient.

A child must have had at least six of several symptoms (five for adolescents 17 and older and adults). These include:

• Often fidgeting, or tapping hands or feet
• Often gets up or leaves when expected to stay seated
• Often runs or climbs inappropriately
• Feeling restless or agitated
• Often unable to be involved in quiet or relaxing activities
• Often talks non-stop
• Often blurts out responses before the question has been completely asked in conversations
• Difficulty taking turns
• Often interrupts conversations when others are speaking

Combined Presentation

People whose ADHD has aspects of both presentations are said to have a combined presentation. They may exhibit inattentiveness in addition to hyperactivity.

To make a diagnosis of a combined presentation, both sets of criteria must be met. In addition:

• Symptoms must be present for at least six months
• Symptoms must be considered disruptive in either work, school, or social settings
• Symptoms are considered inappropriate for the person’s developmental level
  

What Causes ADHD?

What causes ADHD is not well understood, although there is research that suggests that genetics likely play an important role.

Other factors that may be linked to having ADHD include:

• Brain injury
• Environmental conditions during fetal development or in early life, such as exposure to lead
• Use of alcohol or tobacco during pregnancy
• Premature delivery or low birth weight

There are many myths about the potential causes of ADHD that have been proven false. These include eating large amounts of sugar, watching too much television, as well as experiencing poverty or turmoil in the family. Such factors may worsen symptoms of ADHD, but don't cause it.

How Is ADHD Diagnosed?

ADHD is diagnosed based on the presence of certain required symptoms. A diagnosis is generally made through a diagnostic interview and may also involve other screens and psychological tests. The evaluation may be done by a primary care provider or a mental health professional such as a psychologist, psychiatrist, or a brain specialist called a neurologist.

When diagnosing a child, the practitioner may interview parents, teachers, and other adults who provide care for the child. This allows them to consider the child's behavior in different settings. The child may also be interviewed, depending on their age.

A diagnosis of ADHD will depend on whether specific criteria listed in the Diagnostic and Statistical Manual (DSM-5) are met. Mental health professionals and healthcare providers use this manual to help evaluate an individual's symptoms. 

The criteria differ based on the type of ADHD, but, for a diagnosis of any type of ADHD to be made, the person being evaluated must have:

• Several hyperactive-impulsive or inattentive symptoms before age 12
• Several symptoms present in at least two settings, such as at school and at home
• Demonstrated that the symptoms interfere with their ability to function in a social, school, or work setting
• Have had other psychiatric disorders ruled out that may be the cause

Differential Diagnosis

There are a number of conditions that may be mistaken for ADHD and have to be ruled out in order to make a diagnosis, including:

• Sleep disorders, or conditions that impact your quality of sleep
• Anxiety disorders, or a group of mental health conditions that tend to involve excessive fear and worry
• Mood disorders or mental health conditions that involve disruptions in emotions and other accompanying symptoms
• Learning disorders
• Vision and hearing problems 

ADHD in Adults

ADHD is commonly associated with children since a lot of times symptoms are noticed in childhood and in school in particular. However, ADHD is a disorder that affects people of all ages. In adults, the inattentive presentation is most prevalent. The same treatments are effective in adults and children but are individualized in both populations.

Co-Existing Conditions

People with ADHD often have co-existing conditions, such as autism spectrum disorder, depression, anxiety, oppositional defiant disorder, and learning disorders. More than half of people with ADHD also have another mental health condition.

How Is ADHD Treated?

ADHD is typically treated with behavioral therapy, medication, or both. For children ages 4 and 5 years old, the first line of treatment is usually behavior-based with parental involvement before medication is tried.

ADHD Medication

There are two types of ADHD medications, stimulant and non-stimulant. Stimulant medications are available in short-acting, intermediate-acting, and long-acting forms:

• Psychostimulants, like Ritalin (methylphenidate) and Adderall (dextroamphetamine), improve or reduce ADHD-related symptoms. Some studies show that stimulants improve ADHD symptoms in approximately 70% of adults and 70% to 80% of children.
• Non-stimulant medicines, like Strattera (atomextine), Intuniv (guanfacine), and Kapvay (clonidine), may be used as stand-alone medications to treat ADHD or they may be prescribed in addition to other medications.

Most common side effects of medications for ADHD are mild; some subside after the medication has been taken for a while. If side effects are not short-lived, the prescribing physician may lower the dosage or possibly prescribe a different drug. 

Side effects of stimulant ADHD medication include:

• Insomnia, or difficulty sleeping
• Loss of appetite
• Weight loss
• Nervousness or irritability
• Mood swings
• Headaches and stomachaches

Less common side effects of stimulant medications may include:

• A rebound effect, in which hyperactivity or moodiness increases as the medication wears off
• Tics, or repetitive muscle movements such as eye blinking
• Minor delay in normal growth pattern

Lifestyle Changes

There are several lifestyle behaviors that can have a positive impact on ADHD symptoms. They include:

Limit Screen Time: Researchers are learning more about how screen time affects ADHD. There is new evidence that excessive screen time in young children changes the brain, making screen time a risk factor for developing ADHD. For those living with ADHD, limiting use of screens can help improve symptoms of ADHD.

Increase Physical Activity: Increasing the amount of physical activity can help improve symptoms of ADHD, including inattention, executive functioning, and reduced hyperactivity.

Improve Sleep: Trouble sleeping can be a symptom of ADHD itself, or a side effect of certain medications to treat ADHD. Using evidence-based lifestyle changes to maximize sleep can help ADHD symptoms. Some evidence-based measures to improve sleep include using melatonin supplements, weighted blankets, and light therapy.

Eat well: Eating nutritious meals on a regular schedule can help you manage symptoms of ADHD. Meal planning and meal prepping can help ensure you have nutritious foods at the ready. Although more research is needed, some small studies show that ensuring adequate levels of Vitamin D, iron, zinc, and polyunsaturated fat may help reduce symptoms of ADHD.

Work on Time Management: Managing time can be a challenge for some people with ADHD, but it's an important skill. Studies show students with ADHD work longer and harder than their peers. Thus, it is important to find a good time management system with a behavioral health care provider.

Behavioral Therapy

There are several behavioral treatment modalities recommended for ADHD, including:

• Behavior modification: Strategies based on the child's symptoms that aim at increasing wanted behaviors and decreasing unwanted behaviors
• Behavioral parent training: Training parents to respond in a way that will promote the child’s healthy growth and development and strengthen the parent/child relationship
• Social skills training: Provides a safe environment for a child to learn positive social skills, including how to interact well with other kids at school and with family members at home
• School interventions: Involves a trained professional who can work with the child’s teachers and school counselors to formulate a plan of action aimed at implementing classroom interventions as necessary
• Organizational skills training: Aimed at teaching older kids organizational and time management skills at school and at home

Alternative and Complimentary Treatments

There are many alternative and complementary treatments that tout effectiveness for treating ADHD. However, the Centers for Disease Control and Prevention (CDC) warns many of these have been proven neither safe nor effective.

Examples of alternative or complementary treatments for ADHD that need more research include:

• Brain gym, a movement program that claims to increase the brain's performance
• Luminosity, a program that involves games that claim to improve memory and focus
• Cogmed, a program said to be effective in training the working memory in children with ADHD
• Omega-3 supplements, or fish oil supplements, that some studies show may be helpful in the treatment of those with mild symptoms of ADHD, as well as those who do not respond well to stimulant drugs
• Massage therapy
• Mindfulness training, the practice of being present and tuning into yourself
• Biofeedback, or neurofeedback, which shows brain activity in real-time and uses interventions to activate other parts of the brain
• Sensory-motor integration therapy, an intervention, which aims at helping increase bodily and sensory awareness, balance, and coordination
• Eye movement training, or eye tracking training, which aims to improve self-control

Some alternative treatments do have research that backs up their effectiveness when used as part of a multimodal approach, which is a treatment that combines several treatment modalities.

Prior to beginning any new therapy, be sure to check with your healthcare provider.

What's the Difference Between ADD and ADHD?

ADD, short for attention-deficit disorder, is a term that is now outdated, and now the term ADHD is officially used. What many people think about when they hear the term ADD is typically the inattentive presentation of ADHD.

What Are Some Tips for Coping for ADHD?

Living with a child or adolescent who has ADHD can come with unique challenges. As a parent, it’s important to learn about ways to help your child manage their ADHD. It's also important to get support for yourself if needed. You can learn more about parenting tips on helpguide.org.

Seeking professional help for you and your child as soon as possible can help you feel supported and better understand the unique challenges and strengths that having ADHD comes with.

Summary

ADHD is a neurodevelopmental disorder that can impact children, teens, and adults. The three types of ADHD include inattentive, hyperactive-impulsive, and combined presentation.

Signs and symptoms of ADHD will vary depending on the type and can change over time. While the cause of ADHD is not known, genetics may play a role.

ADHD is diagnosed based on certain criteria found in the DSM-5 and treatment will vary depending on the individual's specific needs.