Attention Deficit Hyperactivity Disorder (ADHD)

What ADHD is

ADHD is a difference in how the brain develops, particularly in networks that control executive functions: planning, organizing, holding information in mind, starting and finishing tasks, and stopping an action. Brain chemicals such as dopamine and norepinephrine are involved.

People with ADHD can focus, sometimes intensely, on things they find interesting (hyperfocus). The problem is regulating attention: shifting it to what is needed rather than what is most stimulating.

Symptoms of ADHD

The DSM-5-TR lists two groups of symptoms. For a diagnosis, children need 6 or more symptoms in a group (adults and teens 17 and older need 5 or more), lasting at least 6 months, with several present before age 12, occurring in 2 or more settings and clearly interfering with life.

Inattention

• makes careless mistakes, overlooks details
• has trouble staying focused in tasks, lectures or long reading
• seems not to listen when spoken to directly
• does not follow through on instructions or finish tasks
• struggles to organize tasks, time and belongings
• avoids tasks that need sustained mental effort
• loses things such as keys, phones and school materials
• is easily distracted by noises or thoughts
• forgets daily activities, appointments and chores

Hyperactivity and impulsivity

• fidgets, taps, squirms
• leaves their seat when expected to stay seated
• runs or climbs inappropriately (in adults, feels restless)
• has trouble playing or relaxing quietly
• is "on the go", as if driven by a motor
• talks excessively
• blurts out answers
• has trouble waiting their turn
• interrupts or intrudes on others

Types of ADHD

The presentation can change with age. Hyperactivity tends to lessen in teens and adults, while inattention persists. For more on the inattentive type, see ADD (inattentive ADHD).

ADHD at different ages

Preschool children

Constant motion, difficulty following routines, aggression and accidents. ADHD can be diagnosed from age 4, but normal behavior at this age varies widely.

School-age children

Problems become clearer as demands rise: unfinished work, losing materials, calling out, difficulty with friendships and frequent reprimands.

Teenagers

Struggles with independent study, time management, risk-taking, and driving safety. Teens with ADHD have higher rates of car crashes, substance use and emotional difficulties.

ADHD in girls and women

Girls more often have the inattentive type and may mask difficulties by working extra hard. They may be seen as chatty, dreamy or anxious. Many are diagnosed only as adults, sometimes after a child is diagnosed. Hormonal changes around periods, pregnancy and menopause can worsen symptoms.

ADHD in adults

Adult ADHD often shows as chronic lateness, procrastination, disorganization, forgetfulness, difficulty finishing projects, restlessness, impulsive spending or speech, and emotional reactivity. Many adults have developed coping strategies that break down with new demands such as a promotion or parenthood.

Causes and risk factors

• Genetics: ADHD is highly heritable. A child with a parent or sibling with ADHD has a much higher chance of having it.
• Prematurity and low birth weight.
• Exposures during pregnancy: smoking, alcohol and some drugs.
• Early lead exposure.
• Brain injury in a small number of cases.

ADHD is not caused by sugar, screen time, vaccines or parenting style, although structure and routines at home help manage it.

Conditions that often occur with ADHD

Most people with ADHD have at least one other condition:

• learning disorders such as dyslexia (learning disabilities)
• anxiety and depression
• oppositional defiant disorder and conduct problems
• autism spectrum disorder
• tic disorders and Tourette syndrome
• sleep problems, including delayed sleep phase
• substance use disorders in teens and adults
• bipolar disorder

How ADHD is diagnosed

There is no single test. A pediatrician, psychiatrist, psychologist or other trained clinician:

1. takes a detailed history of development, behavior and school or work performance
2. uses standardized rating scales (such as the Vanderbilt scales in children) completed by parents, teachers or partners
3. checks that symptoms appear in more than one setting and started in childhood
4. looks for other explanations: hearing or vision problems, sleep disorders, anxiety, depression, learning disorders, trauma, thyroid problems, substance use
5. screens for co-occurring conditions

Treatment

Children aged 4 to 5

The American Academy of Pediatrics recommends parent training in behavior management first. Medicine (usually methylphenidate) is considered if behavior therapy does not help enough and problems are significant.

Children 6 and older and teens

A combination of FDA-approved medicine and behavioral therapy, plus school supports, works best.

Adults

Medicine, cognitive behavioral therapy focused on ADHD, coaching, and workplace adjustments.

Medicines

Common side effects of stimulants are reduced appetite, trouble sleeping, headaches, stomachaches, irritability as the dose wears off, and small increases in heart rate and blood pressure. Doctors monitor height, weight, blood pressure and pulse. Stimulants are controlled medicines and should be stored securely and never shared.

Behavioral and practical strategies

• Parent training: consistent routines, clear instructions, praise and rewards for target behaviors, and calm consequences.
• School supports: a 504 plan or IEP in the US, with seating near the teacher, extra time, breaks and written instructions.
• Organization tools: planners, phone reminders, checklists, timers and breaking tasks into small steps.
• Exercise, sleep and regular meals improve focus and mood.

Outlook

Symptoms often improve with age, especially hyperactivity, but many people continue to have significant symptoms in adulthood. With treatment and support, people with ADHD do well at school, work and in relationships. Untreated ADHD is linked with lower academic achievement, injuries, car crashes and substance problems, which treatment reduces.

Frequently asked questions

What are the main symptoms of ADHD?

The main symptoms are inattention (distractibility, forgetfulness, disorganization, trouble finishing tasks), hyperactivity (fidgeting, restlessness, excessive talking) and impulsivity (interrupting, blurting out, difficulty waiting). Symptoms must start in childhood, appear in more than one setting and interfere with daily life.

What does ADHD look like in adults?

Adults with ADHD often struggle with lateness, procrastination, losing things, disorganization, forgetfulness, restlessness, impulsive decisions and strong emotional reactions. Hyperactivity often shows as an inner restlessness. Many adults were never diagnosed as children, especially women.

Is ADD different from ADHD?

ADD is an older term. Today it is all called ADHD, with three presentations: predominantly inattentive (what people often mean by ADD), predominantly hyperactive-impulsive, and combined. The inattentive type involves focus and organization problems without obvious hyperactivity.

Can ADHD be treated without medication?

Yes, especially in young children and milder cases. Parent training, behavioral therapy, school supports, cognitive behavioral therapy for adults, exercise and good sleep all help. For many school-age children and adults, combining these with medicine gives the best results.

Do ADHD medications change personality?

At the right dose, ADHD medicines should not change who you are. If someone seems flat, withdrawn or overly quiet, the dose or medicine may need adjusting. Report mood changes, poor sleep, appetite loss or heart symptoms to the prescriber.

Can you develop ADHD as an adult?

ADHD begins in childhood, but many people are not diagnosed until adulthood, when symptoms become harder to manage with new responsibilities. Symptoms that begin for the first time in adulthood usually have another cause, such as depression, anxiety, sleep problems or a medical condition.