What Is ADHD?

Attention deficit hyperactivity disorder, or ADHD, is a behavioral condition that includes challenges relating to overactivity and difficulty paying attention to the point that it interferes with everyday life. ADHD is one of the most common childhood neurodevelopmental disorders, or a condition that impacts how the brain works. It affects around 11% of school-aged children.

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

There are three presentations, or types, of ADHD:

• Predominantly inattentive presentation, or difficulty paying attention and focusing
• Predominantly hyperactive-impulsive presentation, or difficulty controlling their behavior and sitting still
• Combined presentation, or symptoms from the inattentive and the hyperactive-impulsive presentations

ADHD symptoms arise from differences in the brain and neurological system or nervous system.

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

What Are Signs and Symptoms of ADHD?

Children with ADHD have more trouble than others sitting still, focusing, and paying attention. This can lead to difficulty getting along with other children and learning in certain school settings.

AHDH that persists into adulthood can interfere with relationships, work performance, and overall quality of life. In adults, the hyperactivity seen in childhood may be described 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 often
• Trouble getting along with other kids
• Difficulty taking turns

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 It Diagnosed?

ADHD is diagnosed based on symptoms and an interview. 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
• Had a formal evaluation, ruling out other primary underlying causes of the symptoms

Types

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

Predominantly Inattentive Presentation

A child must have at least six of the following symptoms; an adolescent or adult must have five:

• 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

A child up to age 16 must have six symptoms; older adolescents and adults must have five:

• Often fidgeting, or tapping hands or feet
• Often gets up or leaves when expected to stay seated
• Often runs or climbs inappropriately
• May feel 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
• Has difficulty taking turns
• Often interrupts conversations when others are speaking

Combined Presentation

Has symptoms from both presentations of hyperactive-impulsive and inattentive:

• 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

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, or a group of mental health conditions that tend to involve excessive fear and worry
• Depression, or mental health conditions that tend to involve feeling sad, lonely, low, and empty
• Learning difficulties
• Vision and hearing problems 

How Is It 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 behavior-based with parental involvement.

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

Medication

The two types of ADHD 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. 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 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:

• 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

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, which is a movement program that claims to increase the brain's performance
• Luminosity, which is a program that involves games that claim to improve memory and focus
• Cogmed, which is 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, which is 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
• Movement therapy, an intervention often used as part of sensory integration training, which aims at helping with bodily 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 techniques. Studies suggest that biofeedback, movement therapy, and eye movement training have evidence that supports their use as adjunct therapies.

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

What Are Some Tips for Coping With 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 any uncomfortable or unwanted symptoms of 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.