Attention deficit disorder

Attention deficit disorder (ADD) also called attention deficit hyperactivity disorder (ADHD), is a neurobehavioral disorder that affects mostly children but also some adults. Attention deficit disorder (ADD), is an older term for the disorder doctors now call ADHD or attention-deficit hyperactivity disorder. Attention deficit disorder was called ADD up until 1987, when the word “hyperactivity” was added. Some people still use the old term, attention deficit disorder or ADD, out of habit, or because it’s a more familiar term than ADHD. Some use it to refer to kids with ADHD who aren’t hyperactive.

Attention deficit disorder affects 6.1 million (9.4%) of all American children:

• The estimated number of children ever diagnosed with attention deficit hyperactivity disorder, according to a national 2016 parent survey, is 6.1 million (9.4%). This number includes ¹:
  • 388,000 children aged 2–5 years
  • 4 million children aged 6–11 years
  • 3 million children aged 12–17 years
• Boys are more likely to be diagnosed with attention deficit hyperactivity disorder than girls (12.9% compared to 5.6%) ¹

Studies show that the number of children being diagnosed with attention deficit hyperactivity disorder continues to increase, according to the Centers for Disease Control and Prevention (CDC). Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with attention deficit hyperactivity disorder. Boys also are more likely to have the hyperactive-impulsive type, which is easier to spot than the quieter child who is inattentive.

Studies suggest that about 4% of adults may have attention deficit hyperactivity disorder. For adults, the symptoms are the same as those in children but might show up somewhat differently. Adults with attention deficit hyperactivity disorder may have poor time management skills and trouble with multitasking, become restless with downtime, and avoid activities that require sustained concentration. A diagnosis of attention deficit hyperactivity disorder in an adult is given only when it’s known that some of the symptoms were present early in childhood, usually under the age of seven.

Attention deficit disorder is usually diagnosed in childhood, although the condition can continue into the adult years. Attention deficit hyperactivity disorder or ADHD involves symptoms including inattention, hyperactivity and impulsive behavior. These symptoms are associated with learning, behavioral and emotional problems. Attention deficit hyperactivity disorder interferes with a person’s ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral). Some of the warning signs of attention deficit hyperactivity disorder include failure to listen to instructions, inability to organize oneself and school work, fidgeting with hands and feet, talking too much, leaving projects, chores and homework unfinished, and having trouble paying attention to and responding to details. Everyone gets restless and distracted from time to time. But for people with attention deficit hyperactivity disorder it can be extremely hard to stay focused on a task.

The main features of attention deficit hyperactivity disorder are:

• Difficulty paying attention or inattention (for example to workplace tasks, conversations, or personal belongings)
• Being overactive or hyperactivity (for example fidgeting or being unable to sit still, talking a lot)
• Acting without thinking or impulsivity (for example interrupting conversations, being unable to wait in line)

Signs of hyperactivity and impulsivity may include:

• Fidgeting and squirming while seated
• Getting up and moving around in situations when staying seated is expected, such as in the classroom or in the office
• Running or dashing around or climbing in situations where it is inappropriate, or, in teens and adults, often feeling restless
• Being unable to play or engage in hobbies quietly
• Being constantly in motion or “on the go,” or acting as if “driven by a motor”
• Talking nonstop
• Blurting out an answer before a question has been completed, finishing other people’s sentences, or speaking without waiting for a turn in conversation
• Having trouble waiting his or her turn
• Interrupting or intruding on others, for example in conversations, games, or activities

Showing these signs and symptoms does not necessarily mean a person has attention deficit hyperactivity disorder. Many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. Symptoms of attention deficit hyperactivity disorder 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. If you are concerned about whether you or your child might have attention deficit hyperactivity disorder, the first step is to talk with a health care professional to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychiatrist or clinical psychologist, primary care provider, or pediatrician.

There are 3 types of attention deficit hyperactivity disorder:

1. A predominantly inattentive subtype. Inattentive means a person is easily distractible or inattentive but isn’t hyperactive or impulsive.
2. A predominantly hyperactive-impulsive subtype. Hyperactive-Impulsive occurs when a person has symptoms of impulsivity and hyperactivity.
3. A combined subtype. Combined attention deficit hyperactivity disorder is where a person has a mixture of symptoms including hyperactivity, inattention, and impulsivity.

People with attention deficit hyperactivity disorder may also have additional problems, such as sleep and anxiety disorders.

There is no “cure” for attention deficit hyperactivity disorder. The good news is that attention deficit hyperactivity disorder is treatable. Psychological and behavior therapies and medicine can all be effective. For children, positive parenting techniques are also recommended. Children with attention deficit hyperactivity disorder seldom outgrow it; however, some may find adaptive ways to accommodate the attention deficit hyperactivity disorder as they mature.

The usual course of treatment may include medications such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine), which are stimulants that decrease impulsivity and hyperactivity and increase attention. The U.S. Food and Drug Administration (FDA) has approved the generic versions of Strattera (atomoxetine) to treat attention deficit hyperactivity disorder in pediatric and adult individuals. Most experts agree that treatment for attention deficit hyperactivity disorder should address multiple aspects of the individual’s functioning and should not be limited to the use of medications alone. Treatment should include structured classroom management, parent education (to address discipline and limit-setting), and tutoring and/or behavioral therapy for the child.

Do video games cause attention deficit hyperactivity disorder?

Why is it that my child, who finds it almost impossible to stay in his chair and focus on the lesson at school, can nonetheless sit in front of a video screen, transfixed, for hours? He fits all the criteria for attention deficit hyperactivity disorder (ADHD) — except when he’s playing video games.

There is no evidence whatsoever that TV or video games cause attention deficit hyperactivity disorder. Super-fast-paced TV shows and video games do have a special appeal for kids who have attention deficit hyperactivity disorder. If you’re playing a video game, you have to immediately respond; otherwise you lose. You don’t have time to think. So kids with attention deficit hyperactivity disorder are very drawn to that — here are no gaps for them to start thinking about something else.

Video games effectively hold the attention of kids who find it very challenging to concentrate in the rest of their lives. But what’s happening when kids are absorbed in video games isn’t the same kind of paying attention that other tasks require.

Continuous activity doesn’t mean sustained attention. The task is changing so rapidly, short bursts of attention are all that’s involved. These games are constantly shifting focus, and there is instant gratification and reward.

It makes sense the kids with attention deficit hyperactivity disorder would find games more compelling than the average person. Nothing else in life moves that quickly and rewards that spontaneously.

An Iowa State University study ² of some 3,000 children and adolescents from Singapore, measured over 3 years, found that children who spent more time playing video games were more impulsive and had more attention problems. Researchers interpreted the findings to suggest that video game playing can “compound kids’ existing attention problems.” But the study results don’t offer supporting evidence that the games cause or worsen the attention problems — they just suggest that kids who play the most have more severe attention deficit hyperactivity disorder symptoms. It could be that kids who have the most severe attention deficit hyperactivity disorder symptoms are the most drawn to video games.

Can you grow out of attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder symptoms change as children get older, and it’s estimated that about a third of children who are diagnosed with the attention-deficit hyperactivity disorder will no longer meet the criteria by the time they reach young adulthood.

In general, hyperactivity declines as kids move through elementary school, and inattention becomes the primary problem for them as the schoolwork they are expected to do becomes more demanding and their parents and teachers are not so closely supervising their activities. In adolescence, impulsivity also becomes a big concern, as it leads to car accidents, unsafe sex, and other risky behavior.

Children who are most likely to have attention deficit hyperactivity disorder that continues into adulthood are those whose symptoms are very severe in childhood, and those who also have another psychiatric disorder, like depression or anxiety.

What is attention deficit hyperactivity disorder hyperfocus?

While attention deficit hyperactivity disorder is called an attention deficit disorder, experts say what’s really disordered is the child’s ability to control and direct what he’s paying attention to. So many kids with attention deficit hyperactivity disorder are perfectly capable of intense focus on things that are very exciting to them, like video games, but they can’t maintain that kind of focus on things that aren’t immediately rewarding, like schoolwork or putting on their shoes or going to bed.

That intense concentration, sometimes called hyperfocus, is also the reason kids with attention deficit hyperactivity disorder often get upset when asked to stop doing something they are engaged in, like a favorite activity at school or playing a video game. They have what experts call an inability to “attention switch,” which can cause a lot of conflicts with adults.

And speaking of video games: Because they are constantly stimulating and rewarding, experts say they can induce a kind of trance state in a child who has trouble regulating her attention. In that case, it’s less a matter of hyperfocus than what one calls “screen suck.”

What is executive functioning?

Executive functions are the self-regulating skills that we all use to accomplish tasks, from getting dressed to doing homework. They include:

• Planning
• Organizing time and materials
• Making decisions
• Shifting from one situation to another
• Controlling emotions
• Learning from past mistakes

Most kids with attention deficit hyperactivity disorder have deficits in some executive functions, though not all children with executive function issues have attention deficit hyperactivity disorder.

Attention deficit disorder in children

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder that begins in early childhood. Children with attention deficit hyperactivity disorder may find it hard to concentrate and may become hyperactive — to the point where the condition can interfere with their schooling, friendships or family life.

All children show the symptoms of attention deficit hyperactivity disorder to some degree. It is normal for children to get restless and distracted from time to time, and to be active and have lots of energy.

A lot of children who have behavior problems and difficulty concentrating do not have attention deficit hyperactivity disorder or they may be suffering from only a mild form of attention deficit hyperactivity disorder. The challenge for parents and health professionals is to recognize the difference between normal behavior problems and attention deficit hyperactivity disorder symptoms, which require early treatment.

The number of diagnoses of attention deficit hyperactivity disorder is increasing, and the reasons for this are unknown. The increase may, however, be at least partly explained by better recognition. There are a lot of behavioral and developmental disorders that can cause symptoms of attention deficit hyperactivity disorder in young children, so it’s important to have a proper assessment. Other reasons for children being inattentive, impulsive or hyperactive are health or emotional problems, learning difficulties or lack of sleep.

There are strict criteria used to diagnose attention deficit hyperactivity disorder. If your child has 6 or more symptoms for at least 6 months to a degree that it interferes with their everyday life, they may be diagnosed with attention deficit hyperactivity disorder.

Around 1 in every 20 children has symptoms of attention deficit hyperactivity disorder. It is more common in boys. Most children eventually grow out of it, but some continue to have attention deficit hyperactivity disorder symptoms into their adult lives.

The good news is that attention deficit hyperactivity disorder is treatable. Psychological and behavioral therapies, positive parenting techniques and medicine can all be effective. The right treatment plan, including support from parents, schools and health professionals, can help children with attention deficit hyperactivity disorder to improve their attention and behavior. Many children with attention deficit hyperactivity disorder go on to do well, both at school and socially.

Can a child who’s not hyperactive have attention deficit hyperactivity disorder?

Yes. Kids who have trouble focusing but are not unusually restless or impulsive have a more inattentive type attention deficit hyperactivity disorder. They tend to be diagnosed later because they are less prone to disruptive or problematic behavior that comes to the attention of teachers and parents. But kids who have inattentive symptoms may start to struggle in the middle of elementary school, when it becomes increasingly difficult for them to keep up.

Does attention deficit hyperactivity disorder affect kids outside of school?

Yes. Their inattention and impulsivity also affects their friendships, extra-curricular activities, and family life. They may have trouble making and keeping friends because they interrupt constantly, and are prone to blowing up when they don’t get their way. It’s not uncommon for children with severe attention deficit hyperactivity disorder to be blackballed from playdates because they can’t be counted on to behave. Kids with attention deficit hyperactivity disorder may have trouble playing on teams because they find it hard to focus and follow the rules.

At home, they may find themselves on a collision course with parents and siblings because they don’t follow instruction, are impulsive, and melt down when they are asked to transition from some activity they enjoy to mealtime, homework time, or bedtime.

By the time kids with attention deficit hyperactivity disorder reach adolescence, their impulsivity can be dangerous, making them prone to car accidents, unsafe sex, and other risky behaviors.

Why are kids with attention deficit hyperactivity disorder often defiant or demonstrate disruptive behavior?

Defiance and emotional outbursts are very common in kids with attention deficit hyperactivity disorder, though they are not, themselves, symptoms of attention deficit hyperactivity disorder.

Kids who have attention deficit hyperactivity disorder tend to become defiant when they are expected to do things that are hard for them, especially when it means stopping something that’s pleasurable—like playing a video game. So things like homework, going to bed, getting dressed, and coming to dinner can become battlegrounds. These situations are difficult for them to tolerate because of inherit deficits in paying attention, tolerating a boring situation, reining in impulses, transitioning from a fun activity, and controlling their activity level. Since these situations are really challenging for them, they may try to avoid them. Unfortunately when it comes to attention deficit hyperactivity disorder parenting, the avoidance strategies that these kids typically use are disruptive behavior, tantrums, arguing, defiance, and power struggles.

Attention deficit disorder in adults

Most children with attention deficit hyperactivity disorder (ADHD) find their attention and behavior improves with age and the symptoms of attention deficit hyperactivity disorder resolve by the time they reach their teenage or adult years. A minority of people continue to have attention deficit hyperactivity disorder symptoms into adulthood.

About half of children with attention deficit hyperactivity disorder continue to have problems into adulthood. Sometimes attention deficit hyperactivity disorder is missed in childhood and only gets noticed later in life.

In order to diagnose attention deficit hyperactivity disorder in adulthood, it needs to be established that the symptoms began in childhood.

Adult attention deficit hyperactivity disorder can affect people’s employment, ability to study and capacity to manage their lives. Because the diagnosis in adulthood can be very complicated, it usually involves seeing a specialist doctor or psychiatrist.

Adult attention deficit hyperactivity disorder symptoms

Some people with attention deficit hyperactivity disorder have fewer symptoms as they age, but some adults continue to have major symptoms that interfere with daily functioning. In adults, the main features of attention deficit hyperactivity disorder may include difficulty paying attention, impulsiveness and restlessness. Symptoms can range from mild to severe.

Inattention (problems with paying attention) and hyperactivity (being unusually active) and impulsivity are the key symptoms of attention deficit hyperactivity disorder.

Many adults with attention deficit hyperactivity disorder aren’t aware they have it — they just know that everyday tasks can be a challenge. Adults with attention deficit hyperactivity disorder may find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social plans. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings and outbursts of anger.

Adult attention deficit hyperactivity disorder symptoms may include:

• Impulsiveness
• Disorganization and problems prioritizing
• Poor time management skills
• Problems focusing on a task
• Trouble multitasking
• Excessive activity or restlessness
• Poor planning
• Low frustration tolerance
• Frequent mood swings
• Problems following through and completing tasks
• Hot temper
• Trouble coping with stress

Adults with symptoms of hyperactivity may:

• seem agitated or nervous
• be unable to sit still and concentrate
• talk non-stop without being aware of their surroundings
• have rapid thoughts or be unable to stop thinking
• have sleep problems.

Some adults with attention deficit hyperactivity disorder may have symptoms of impulsivity.

They might:

• start things and not finish them
• not consider the consequences of their actions
• interrupt other people
• take over what someone else is doing
• have problems with money
• change jobs frequently
• use drugs or alcohol
• have a hot temper or be irritable.

Some people with attention deficit hyperactivity disorder can concentrate when they really enjoy something, but lose track when they get bored.

You don’t need to have all these symptoms to be diagnosed with attention deficit hyperactivity disorder. Often, adults with attention deficit hyperactivity disorder feel quite frustrated and can become anxious or depressed at not being able to achieve their full potential.

Sleep problems and relationship issues can be the reason that people initially seek treatment.

If any of the symptoms listed above continually disrupt your life, work or relationships, you should talk to your doctor about whether you might have attention deficit hyperactivity disorder.

Different types of health care professionals may diagnose and supervise treatment for attention deficit hyperactivity disorder. Seek a provider who has training and experience in caring for adults with attention deficit hyperactivity disorder.

Diagnosis of attention deficit hyperactivity disorder in adults can be difficult because certain attention deficit hyperactivity disorder symptoms are similar to those caused by other conditions, such as anxiety or mood disorders. And many adults with attention deficit hyperactivity disorder also have at least one other mental health condition, such as depression or anxiety.

Almost everyone has some symptoms similar to attention deficit hyperactivity disorder at some point in their lives. If your difficulties are recent or occurred only occasionally in the past, you probably don’t have attention deficit hyperactivity disorder. Attention deficit hyperactivity disorder is diagnosed only when symptoms are severe enough to cause ongoing problems in more than one area of your life. These persistent and disruptive symptoms can be traced back to early childhood.

Adult attention deficit hyperactivity disorder diagnosis

A diagnosis of attention deficit hyperactivity disorder in an adult is usually made by a psychiatrist who is experienced in the field.

Psychiatrists are the best-placed specialists to diagnose and treat adults with attention deficit hyperactivity disorder.

A psychiatrist can:

• make a diagnosis of attention deficit hyperactivity disorder
• devise a management plan for attention deficit hyperactivity disorder
• diagnose and treat any other mental health issues, including depression or alcohol and drug use
• prescribe medication
• keep track of any medication side effects and your physical health
• link you to counseling and mentoring for people with attention deficit hyperactivity disorder
• provide referrals to other health professionals.

Some psychiatrists are more experienced in diagnosing and treating attention deficit hyperactivity disorder than others.

Diagnosis might involve:

• tests of your thinking (psychological tests)
• a physical check-up that might involve testing your heart, blood tests or a brain scan (if needed)
• questions about your childhood
• an interview with a partner, parent or close friend about your behaviour
• review of documents like old school reports.

Generally, adults are only diagnosed with attention deficit hyperactivity disorder if there is evidence that they had symptoms as a child.

Symptoms also have to be present in more than one situation (for example at work and at home) and affect daily life.

Attention deficit disorder causes

The exact cause of attention deficit hyperactivity disorder is unknown, but the condition has been shown to run in families.

Current research suggests attention deficit hyperactivity disorder may be caused by interactions between genes and environmental or non-genetic factors. Like many other illnesses, a number of factors may contribute to attention deficit hyperactivity disorder such as ³:

• Genes
• Cigarette smoking, alcohol use, or drug use during pregnancy
• Exposure to environmental toxins during pregnancy
• Exposure to environmental toxins, such as high levels of lead, at a young age
• Low birth weight
• Brain injuries

Research has shown that, in children with attention deficit hyperactivity disorder, the chemical messenger dopamine is transported differently between the nerve cells of the brain, especially in the regions that are used for memory and learning. And there are other physical differences that may be involved in the development of attention deficit hyperactivity disorder. Genes play an important role.

Some experts disagree with the view that attention deficit hyperactivity disorder is only linked to physical or genetic factors. Instead, they consider changes in our society to be just as important. They believe that attention deficit hyperactivity disorder symptoms also result from overstimulation coupled with lack of exercise, modern society’s emphasis on achievement, and changes in a child’s family situation. Hardly any good-quality studies have tested these theories, though.

It is also not clear what factors might play a role in the risk of developing attention deficit hyperactivity disorder. Individual studies have shown that children are at greater risk if their mothers smoked, drank alcohol or consumed other drugs while pregnant. There is also a possible link between attention deficit hyperactivity disorder and very low birth weight or other childbirth-related problems like a lack of oxygen at birth.

Certain foods are often associated with attention deficit hyperactivity disorder too ⁴. Some research actually suggests that children who often eat foods containing artificial colors and preservatives are more likely to develop abnormal behavior ⁴. But nutrition appears to play a very small role at most. If you think it may be a factor, you can test whether changing a child’s diet helps.

Research has also identified a number of possible differences in the brains of people with attention deficit hyperactivity disorder when compared with those without the condition.

Other factors suggested as potentially having a role in attention deficit hyperactivity disorder include:

• being born prematurely (before the 37th week of pregnancy)
• having a low birth weight
• smoking or alcohol or drug abuse during pregnancy

Attention deficit hyperactivity disorder can occur in people of any intellectual ability, although it’s more common in people with learning difficulties.

Risk factors for attention deficit hyperactivity disorder

Risk of attention deficit hyperactivity disorder may increase if:

• You have blood relatives, such as a parent or sibling, with attention deficit hyperactivity disorder or another mental health disorder
• Your mother smoked, drank alcohol or used drugs during pregnancy
• As a child, you were exposed to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• You were born prematurely

Attention deficit disorder signs and symptoms

Attention-deficit hyperactivity disorder or ADHD, is a condition that makes it unusually difficult for children to concentrate, to pay attention, to sit still, to follow directions, and to control impulsive behavior. While all young children are at times distractible, restless, and oblivious to parents’ and teachers’ instructions, kids with attention-deficit hyperactivity disorder behave this way much more often than other children their age. And their inability to settle down, focus, and follow through on tasks in age-appropriate ways makes it very hard for them to do what’s expected of them at school. It can also lead to conflict at home and difficulty getting along with peers.

Symptoms of attention deficit hyperactivity disorder are divided into three groups: inattentive behaviors and hyperactive and impulsive behaviors.

Symptoms of impulsivity include:

• Nonstop talking
• Having trouble waiting for a turn in games or activities
• Interrupting others in conversations or games
• Taking unnecessary risks
• Excessive talking or interrupting, blurting out answers

Symptoms of hyperactivity include:

• Frequent fidgeting with hands
• Squirming when seated
• Trouble staying seated for long periods of time
• An urge to keep in constant motion
• Difficulty doing quiet activities
• Trouble completing tasks
• Forgetfulness
• Excessive running and climbing
• Trouble playing quietly
• Extreme impatience
• Always seems to be “on the go” or “driven by a motor”

Symptoms of inattention include:

• Short attention span
• Trouble listening to others
• Being easily distracted
• Trouble staying focused on tasks
• Poor organizational skills
• Trouble attending to details
• Forgetfulness
• Makes careless mistakes
• Doesn’t seem to be listening when spoken to directly
• Has difficulty following instructions
• Has trouble organizing
• Avoids or dislikes sustained effort
• Is forgetful, always losing things

Avoidance of tasks that require a lot of mental effort, such as schoolwork, or for adults, working on complicated reports and forms.

Adults with attention deficit hyperactivity disorder may have additional symptoms, including mood swings and difficulty maintaining relationships.

Having one or more of these symptoms doesn’t necessarily mean you or your child has attention deficit hyperactivity disorder. Everybody gets restless and distracted at times. Most children are naturally full of energy and often have trouble sitting still. This is not the same as attention deficit hyperactivity disorder.

Some children exhibit only the first group attention deficit hyperactivity disorder of symptoms, and some exhibit only the latter. But the majority of those with an attention deficit hyperactivity disorder diagnosis have a combination of all three, which can make it very difficult for them to function in school, and in other activities, and can create a lot of conflict at home.

People who have attention deficit hyperactivity disorder have combinations of these symptoms:

• Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
• Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
• Seem to not listen when spoken to directly
• Fail to not follow through on instructions, fail to finish schoolwork, chores, or duties in the workplace, or start tasks but quickly lose focus and get easily sidetracked
• Have problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, keeping work organized, managing time, and meeting deadlines
• Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
• Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
• Become easily distracted by unrelated thoughts or stimuli
• Forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments.

Attention deficit hyperactivity disorder is a long-lasting condition that can affect many aspects of your life. Symptoms may cause problems in school or work, home life, and relationships. In children, attention deficit hyperactivity disorder can delay normal development.

Effects of attention deficit hyperactivity disorder

Children and teenagers with attention deficit hyperactivity disorder have more accidents, hurt themselves more often, and have more problems at school ⁵. They tend to have more conflicts with their peers and go against the rules, or behave defiantly and even aggressively. Teenagers with attention deficit hyperactivity disorder are more likely to smoke, drink alcohol or use other drugs, which may make other problems worse. They are also more frequently involved in crimes than other people their age who do not have attention deficit hyperactivity disorder. Developmental problems may arise too, such as difficulties with language development or reading and writing.

Children with attention deficit hyperactivity disorder may also have other emotional problems or disorders, including things like depression or anxiety disorders. Some children with attention deficit hyperactivity disorder have a tic disorder as well.

When adults have attention deficit hyperactivity disorder it usually causes problems in relationships or at work. Especially adults who were very hyperactive and impulsive as children are sometimes inconsiderate of others: They find it difficult to attend to their responsibilities, tell the truth, or respect their partner.

Coexisting conditions

Although attention deficit hyperactivity disorder doesn’t cause other psychological or developmental problems, other disorders often occur along with attention deficit hyperactivity disorder and make treatment more challenging. These include:

• Mood disorders. Many adults with attention deficit hyperactivity disorder also have depression, bipolar disorder or another mood disorder. While mood problems aren’t necessarily due directly to attention deficit hyperactivity disorder, a repeated pattern of failures and frustrations due to attention deficit hyperactivity disorder can worsen depression.
• Anxiety disorders. Anxiety disorders occur fairly often in adults with attention deficit hyperactivity disorder. Anxiety disorders may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by attention deficit hyperactivity disorder.
• Other psychiatric disorders. Adults with attention deficit hyperactivity disorder are at increased risk of other psychiatric disorders, such as personality disorders, intermittent explosive disorder and substance abuse.
• Learning disabilities. Adults with attention deficit hyperactivity disorder may score lower on academic testing than would be expected for their age, intelligence and education. Learning disabilities can include problems with understanding and communicating.

Attention deficit disorder complications

Attention deficit hyperactivity disorder can make life difficult for you. attention deficit hyperactivity disorder has been linked to:

• Poor school or work performance
• Unemployment
• Trouble with the law
• Alcohol or other substance abuse
• Frequent car accidents or other accidents
• Unstable relationships
• Poor physical and mental health
• Poor self-image
• Suicide attempts.

Attention deficit disorder diagnosis

It is best to have attention deficit hyperactivity disorder diagnosed by specialists who are very familiar with the disorder. These may include doctors, psychiatrists or psychotherapists who specialize in treating children and teenagers.

An in-depth talk and physical examination are important for ruling out other possible causes of the abnormal behavior. Things like sleep disorders, problems with vision or hearing, or an overactive thyroid gland might also lead to concentration problems, problems at school or hyperactivity.

The talk can also help to rule out other mental disorders as possible causes, and to diagnose any additional medical conditions. Your doctor or therapist may ask you questions like these:

• Is your child forgetful, easily distracted or unfocused?
• Does your child frequently climb up on things, disrupt others, or have rage attacks?
• Does the behavior occur both at school and at home?
• How long have you observed this kind of behavior in your child?
• Does your child’s performance at school suffer as a result, or does your child have difficulty findings friends because of their behavior, and are they unhappy about it?

Psychological tests and questionnaires are used to approach the diagnosis in a structured way. The child’s teachers or preschool teachers may also be asked to describe the child’s behavior in school or preschool.

There is no specific attention deficit hyperactivity disorder test. Attention deficit hyperactivity disorder screening usually involves several steps, including:

• A physical exam to find out if a different type of disorder is causing symptoms.
• An interview. You or your child will be asked about behavior and activity level.

The following tests are designed specifically for children:

• Interviews or questionnaires with people who interact regularly with your child. These may include family members, teachers, coaches, and babysitters.
• Behavioral tests. These are written tests designed to measure a child’s behavior compared with the behavior of other children the same age.
• Psychological tests. These tests measure thinking and intelligence.

DSM-5 Criteria for attention deficit hyperactivity disorder

People with attention deficit hyperactivity disorder show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development ⁶:

1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
   • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
   • Often has trouble holding attention on tasks or play activities.
   • Often does not seem to listen when spoken to directly.
   • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
   • Often has trouble organizing tasks and activities.
   • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
   • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
   • Is often easily distracted
   • Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
   • Often fidgets with or taps hands or feet, or squirms in seat.
   • Often leaves seat in situations when remaining seated is expected.
   • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
   • Often unable to play or take part in leisure activities quietly.
   • Is often “on the go” acting as if “driven by a motor”.
   • Often talks excessively.
   • Often blurts out an answer before a question has been completed.
   • Often has trouble waiting their turn.
   • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of attention deficit hyperactivity disorder can occur:

• Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
• Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
• Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

Diagnosing attention deficit hyperactivity disorder in adults

Attention deficit hyperactivity disorder often lasts into adulthood. To diagnose attention deficit hyperactivity disorder in adults and adolescents age 17 years or older, only 5 symptoms are needed instead of the 6 needed for younger children. Symptoms might look different at older ages. For example, in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.

Attention deficit disorder treatment

Although there’s no cure for attention deficit hyperactivity disorder, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medication, if necessary.

Types of treatment for attention deficit hyperactivity disorder include

• Behavior therapy, including training for parents; and
• Medications.

Medicine is often the first treatment offered to adults with attention deficit hyperactivity disorder, although psychological therapies such as cognitive behavioral therapy (CBT) may also help.

There are many treatment options, and what works best can depend on the individual child and family. To find the best options, it is recommended that parents work closely with others involved in their child’s life—healthcare providers, therapists, teachers, coaches, and other family members.

For children with attention deficit hyperactivity disorder younger than 6 years of age, the American Academy of Pediatrics ⁷ recommends parent training in behavior management as the first line of treatment, before medication is tried. For children 6 years of age and older, the recommendations include medication and behavior therapy together — parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents. Schools can be part of the treatment as well. The American Academy of Pediatrics recommendations also include adding behavioral classroom intervention and school supports.

Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, as well as making changes as needed along the way.

Children ages 4-6 years

• The first line of treatment should include:
  • Parent training in behavior management; and/or
  • Behavioral classroom interventions (if available).
• Methylphenidate may be used if behavioral interventions do not provide significant improvement and the child continues to have serious problems.

Children and adolescents 6-18 years

Recommended treatment for children and adolescents includes:

• FDA-approved medications along with
• Parent training in behavior management and/or
• Behavioral classroom interventions.

Treatments often work best when used together.

For all children attending school, the school is a necessary part of any treatment plan. These plans can include:

• Educational interventions; and
• Individual school supports, such as school environment and behavioral supports.

School treatment plans often include an Individualized Education Program (IEP) or a 504 plan that describes accommodations.

Any child or adolescent who is taking medication

The American Academy of Pediatrics guidelines for treatment of attention deficit hyperactivity disorder recommend that:

• The primary care provider adjusts the patient’s medication dose as needed to achieve the most benefit with the least amount of tolerable side effects.
• For adolescents, medications should be used with patient approval.

Medication

For many people, attention deficit hyperactivity disorder medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. The first line of treatment for attention deficit hyperactivity disorder is stimulants.

• Stimulants: Although it may seem unusual to treat attention deficit hyperactivity disorder with a medication that is considered a stimulant, it is effective. Many researchers think that stimulants are effective because the medication increases the brain chemical dopamine, which plays essential roles in thinking and attention. Between 70-80% of children with attention deficit hyperactivity disorder have fewer attention deficit hyperactivity disorder symptoms when taking these fast-acting medications.
• Non-Stimulants: These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with attention deficit hyperactivity disorder. Doctors may prescribe a non-stimulant if a person had bothersome side effects from stimulants, if a stimulant was not effective, or in combination with a stimulant to increase effectiveness. FDA has also approved three non-stimulants to treat the symptoms of attention deficit hyperactivity disorder: Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine). These provide a useful alternative for children who do not tolerate stimulants well. Non-stimulants do not work as quickly as stimulants, but their effect can last up to 24 hours. Talk with your health care professional about what medications may be best for your child.
• Antidepressants: Although antidepressants are not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of attention deficit hyperactivity disorder, antidepressants are sometimes used to treat adults with attention deficit hyperactivity disorder. Older antidepressants, called tricyclics, sometimes are used because they, like stimulants, affect the brain chemicals norepinephrine and dopamine.

There are many different types and brands of these medications—all with potential benefits and side effects. Sometimes several different medications or dosages must be tried before finding the one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.

Medications can affect children differently and can have side effects such as decreased appetite or sleep problems. One child may respond well to one medication, but not to another.

Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.

Healthcare providers who prescribe medication may need to try different medications and doses. The American Academy of Pediatrics recommends that healthcare providers observe and adjust the dose of medication to find the right balance between benefits and side effects. It is important for parents to work with their child’s healthcare providers to find the medication that works best for their child.

Behavior therapy, including training for parents

Attention deficit hyperactivity disorder affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and other children. Children with attention deficit hyperactivity disorder often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is made.

• For Children and Teens: Parents and teachers can help children and teens with attention deficit hyperactivity disorder stay organized and follow directions with tools such as keeping a routine and a schedule, organizing everyday items, using homework and notebook organizers, and giving praise or rewards when rules are followed.
• For Adults: A licensed mental health provider or therapist can help an adult with attention deficit hyperactivity disorder learn how to organize his or her life with tools such as keeping routines and breaking down large tasks into more manageable, smaller tasks.

Children younger than 6 years of age

For young children with attention deficit hyperactivity disorder, behavior therapy is an important first step before trying medication because:

• Parent training in behavior management gives parents the skills and strategies to help their child.
• Parent training in behavior management has been shown to work as well as medication for attention deficit hyperactivity disorder in young children.
• Young children have more side effects from attention deficit hyperactivity disorder medications than older children.
• The long-term effects of attention deficit hyperactivity disorder medications on young children have not been well-studied.

School-age children and adolescents

For children ages 6 years and older, the American Academy of Pediatrics recommends combining medication treatment with behavior therapy. Several types of behavior therapies are effective, including:

• Parent training in behavior management;
• Behavioral interventions in the classroom;
• Peer interventions that focus on behavior; and
• Organizational skills training.

These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.

Tips for Parents

The following are suggestions that may help with your child’s behavior:

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized. Encourage your child to put schoolbags, clothing, and toys in the same place every day so that they will be less likely to lose them.
• Manage distractions. Turn off the TV, limit noise, and provide a clean workspace when your child is doing homework. Some children with attention deficit hyperactivity disorder learn well if they are moving or listening to background music. Watch your child and see what works.
• Limit choices. To help your child not feel overwhelmed or overstimulated, offer choices with only a few options. For example, have them choose between this outfit or that one, this meal or that one, or this toy or that one.
• Be clear and specific when you talk with your child. Let your child know you are listening by describing what you heard them say. Use clear, brief directions when they need to do something.
• Help your child plan. Break down complicated tasks into simpler, shorter steps. For long tasks, starting early and taking breaks may help limit stress.
• Use goals and praise or other rewards. Use a chart to list goals and track positive behaviors, then let your child know they have done well by telling them or by rewarding their efforts in other ways. Be sure the goals are realistic—small steps are important!
• Discipline effectively. Instead of scolding, yelling, or spanking, use effective directions, time-outs or removal of privileges as consequences for inappropriate behavior.
• Create positive opportunities. Children with attention deficit hyperactivity disorder may find certain situations stressful. Finding out and encouraging what your child does well—whether it’s school, sports, art, music, or play—can help create positive experiences.
• Provide a healthy lifestyle. Nutritious food, lots of physical activity, and sufficient sleep are important; they can help keep attention deficit hyperactivity disorder symptoms from getting worse.

Education and training

Children and adults with attention deficit hyperactivity disorder need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. Mental health professionals can educate the parents of a child with attention deficit hyperactivity disorder about the condition and how it affects a family. They can also help the child and his or her parents develop new skills, attitudes, and ways of relating to each other. Examples include:

• Parenting skills training teaches parents the skills they need to encourage and reward positive behaviors in their children.
• Stress management techniques can benefit parents of children with attention deficit hyperactivity disorder 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.

Adding behavioral therapy, counseling, and practical support can help people with attention deficit hyperactivity disorder and their families to better cope with everyday problems.

School-based programs

Some schools offer special education services to children with attention deficit hyperactivity disorder who qualify. Educational specialists help the child, parents, and teachers make changes to classroom and homework assignments to help the child succeed. Public schools are required to offer these services for qualified children, which may be free for families living within the school district.

Adult attention deficit hyperactivity disorder treatments

Recommended treatment for adults with attention deficit hyperactivity disorder involves:

• medication
• behavioral training and coaching
• education about your condition.

Medication

Stimulant medication is known to help people with attention deficit hyperactivity disorder to focus and complete tasks. Medication is used to support other changes to your lifestyle and behaviour.

The two main stimulant medications used for attention deficit hyperactivity disorder are methylphenidate and dexamphetamine. These medications can be addictive, but in the doses used to treat attention deficit hyperactivity disorder they usually aren’t.

If you are unable to use stimulants, the non-stimulant medication used is atomoxetine.

You might be prescribed other medications to help with sleep problems or other symptoms.

Behavioral training and coaching

Behavior therapy, attention deficit hyperactivity disorder coaching and mentoring will help you to deal with the symptoms of attention deficit hyperactivity disorder.

This usually involves practical advice on organising your work or home, planning ahead, social skills and working to your strengths.

Psychologists with experience managing attention deficit hyperactivity disorder can be helpful. There are also a small number of accredited attention deficit hyperactivity disorder coaches.

Your doctor or psychiatrist can help you to find the right person to talk to.

Education

Learning about attention deficit hyperactivity disorder will help you to identify your own set of symptoms and ways to manage them.

Living with attention deficit hyperactivity disorder

Looking after a child with attention deficit hyperactivity disorder can be challenging, but it’s important to remember that they cannot help their behavior.

Some issues that may arise in day-to-day life include:

• getting your child to sleep at night
• getting ready for school on time
• listening to and carrying out instructions
• being organized
• social occasions
• shopping

Adults with attention deficit hyperactivity disorder may also find they have similar problems, and some may have issues with relationships or social interaction.

Attention deficit hyperactivity disorder prognosis

Attention deficit hyperactivity disorder usually first develops in childhood. In adulthood the symptoms are generally much less severe or may have disappeared completely.

About 50 out of 100 children who have attention deficit hyperactivity disorder show at least some symptoms as adults. About 15 out of 100 still fulfill all of the criteria for an attention deficit hyperactivity disorder diagnosis when they are adults.

But the symptoms often change as people age. For instance, teenagers and adults with attention deficit hyperactivity disorder are usually less hyperactive than they were as children, but often feel restless.

References

1. Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology. 2018, 47:2, 199-212.
2. Video game playing can compound kids’ existing attention problems says ISU study. https://archive.news.iastate.edu/news/2012/feb/VGattention
3. National Institute of Mental Health, National Institutes of Health. Attention-Deficit/Hyperactivity Disorder (ADHD): The Basics. https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml
4. National Center for Biotechnology Information, U.S. National Library of Medicine. Attention deficit hyperactivity disorder (ADHD): Overview. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079174/
5. National Center for Biotechnology Information, U.S. National Library of Medicine. Attention deficit hyperactivity disorder (attention deficit hyperactivity disorder): Overview. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079174/
6. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
7. American Academy of Pediatrics, Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of children and adolescents with attention‐deficit/hyperactivity disorder. Pediatrics, September 30th, 2019.