Overview

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, with symptoms such as difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity.¹  A child may be restless and almost constantly active.  Boys are at four times greater risk than girls.  The average age of onset and diagnosis is 7 years old, but hyperactivity and other symptoms may show up years earlier.  About 6% of school age children in the U.S. are prescribed medication for ADHD and  estimate of the prevalence of ADHD range up to 9%. 

ADHD can continue through adolescence and even though hyperactivity tends to improve as a child becomes a teen, problems with inattention, disorganization, and poor impulse control often continue through the teen years and into adulthood.  ADHD affects about 4% of American adults age 18 years and older.  Persons with ADHD may be predominantly hyperactive-impulsive, or predominantly inattentive but usually they have both symptoms.²

The impulsivity of teens with ADHD can lead to increases in behaviors that are risky. Teenagers with ADHD get 3 times as many speeding tickets and are 4 times more likely to be involved in a car accident than their non-ADHD affected peers.³  Because the long-term deleterious consequences for work performance and social relationships in adulthood are very important, it is urgent to identify ADHD and intervene as early as possible.

Signs and symptoms of ADHD
People with ADHD show an ongoing pattern of three different types of symptoms:

• Difficulty paying attention (inattention)
• Being overactive (hyperactivity)
• Acting without thinking (impulsivity)

These symptoms get in the way of functioning or development. People who have ADHD 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

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 ADHD. Many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. To determine if a child or adult might have ADHD, seek the help of a mental health professional, like a psychiatrist or clinical psychologist, primary care provider, or pediatrician.

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Causes of ADHD
The causes of ADHD are not well understood but many studies suggest that genes play a major role. Other factors including environmental factors such as exposure to lead, exposures in utero through use of alcohol and smoking during pregnancy, brain injuries, delayed brain development, nutrition, and the social environment might contribute to ADHD.  Sugar does not cause ADHD or make symptoms worse.  Like many other illnesses, a number of factors may contribute to ADHD.  A possible link between ADHD and the consumption of certain food additives like artificial colors or preservatives has long been suspected but more research is needed to establish this as a causal relationship.

Treating ADHD
Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments.  Studies show that stimulant medications help reduce the frequency or severity of ADHD symptoms and improve functioning by reducing hyperactivity and impulsivity and improving the ability to focus, work, and learn for many people but provide little to no benefit for others.⁴ These medications are not a “cure,” they may depress appetite, make sleep difficult, and rarely, stimulants cause more serious side effects such as drug dependence, raising blood pressure and heart rate. Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD.⁵   Behavioral interventions may be effective alternatives or additions to medication treatment.⁶

Stimulants:Stimulants are the first line of treatment for ADHD.  It may seem paradoxical to treat ADHD with a medication that is considered a stimulant, but it often is effective. Stimulants may work by increasing the brain chemical dopamine, which plays essential roles in thinking and attention.  The two main classes of stimulant medications are methylphenidates and dextro-amphetamines. All brand-name stimulants are variations of these two medications.  For example, Adderall is a mixture of amphetamines, while Concerta and Ritalin are examples of methylphenidates.  These drugs come in a variety of forms and have a variety of durations of action.

There is concern that twenty years of extensive marketing of these stimulant drugs to physicians and directly to parents has resulted in over-diagnosis and over-treatment.⁷  The sales of stimulants have soared from less than $2 billion in 2002 to more than $8 billion in 2012. 

Non-Stimulants: These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity. If a stimulant is ineffective or causes too many side effects, doctors may prescribe a non-stimulant, in combination with a stimulant to increase effectiveness. Two examples of non-stimulant medications include atomoxetine and guanfacine.

Antidepressants: Although antidepressants are not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. 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.

Those taking medications must be monitored closely and carefully by their prescribing doctor and they need to call their doctor right away if they or their child have any problems with a medication. The doctor may be able to adjust the dose or change the prescription to a different one that may work better.

Therapy: Although therapy may not be effective in treating ADHD symptoms, adding therapy to an ADHD treatment plan may help patients and families better cope with daily challenges.

For Children and Teens: Parents and teachers can help children and teens with ADHD 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 ADHD learn how to organize his or her life with tools such as keeping routines and breaking down large tasks into more manageable, smaller tasks.

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Education and Training
Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed in life. Mental health professionals can educate the parents of a child with ADHD 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 ADHD 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 ADHD and their families to better cope with everyday problems.

School-based Programs
Some schools offer special education services to children with ADHD 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. Learn more about the Individuals with Disabilities Education Act (IDEA), visit http://idea.ed.gov/.

Finding Help
The National Resource Center on ADHD, a program of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD®) supported by the Centers for Disease Control and Prevention (CDC), has information and many resources. You can reach this center online at chadd.org or by phone at 1-800-233-4050. You can also visit the National Institute of Mental Health’s (NIMH) Help for Mental Illness page at www.nimh.nih.gov/findhelp. 

Studies
To learn about studies on ADHD that are currently recruiting at NIMH, visit http://www.nimh.nih.gov/joinastudy. To find a clinical trial near you, visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and phone numbers for more details. This information should be used in conjunction with advice from your health care provider.

To learn more about ADHD, visit:

• National Institute of Mental Health www.nimh.nih.gov
• Centers for Disease Control and Prevention
  https://www.cdc.gov/ncbddd/adhd/
• MedlinePlus (National Library of Medicine) 
  https://www.nlm.nih.gov/medlineplus/attentiondeficithyperactivitydisorder.html

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Endnotes

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