ADHD Overview: Symptoms, Causes, Treatment

Attention-deficit/hyperactivity disorder (ADHD) begins early in a child’s development and often persists throughout adulthood. Symptoms like difficulty paying attention, disorganization, and needing to stay active are severe enough to interfere with success at school, work, and home.

Though ADHD affects 11% of children and 6% of adults, treatment can dramatically improve their lives. Personalized care plans ease symptoms and teach the coping skills needed to manage ADHD and achieve a thriving life.

ADHD Symptoms

ADHD is a neurodevelopmental disorder caused by differences in brain growth and nerve connections. These differences occur in the brain areas that regulate emotions, behavior, attention, and executive function (working memory and the ability to plan and make decisions).

Though ADHD is often diagnosed in children, it may not be identified until adulthood. Additionally, two-thirds of children have ADHD throughout their adult lives.

The symptoms caused by ADHD, like difficulty paying attention and controlling hyperactive behaviors, are so persistent and severe they affect daily life. People with ADHD have difficulty at school and work and struggle to make friends and build personal relationships.:

Symptoms of attention deficit hyperactivity disorder depend on the type. Children and adults may have one of three types: inattentive, hyperactive/impulsive, or combined:

Inattentive ADHD

People with inattentive ADHD may:

• Have trouble concentrating on one task at a time
• Be easily distracted
• Make reckless mistakes
• Overlook details
• Struggle to follow directions
• Lose important items
• Daydream when they should pay attention

Hyperactive/Impulsive ADHD

People with the hyperactive/impulsive type may:

• Be unable to relax
• Stay constantly active
• Talk constantly (or frequently)
• Interrupt others
• Act without thinking
• Fidget when expected to sit still

Combined ADHD

You may have combined ADHD if you meet the diagnostic criteria for both the inattentive and hyperactive/impulsive types.

Diagnosis

An ADHD evaluation explores your medical history and behavioral and emotional challenges. Healthcare providers ask parents, teachers, and caregivers about children’s problems. They also talk with the child or use age-appropriate techniques to learn about their thoughts and feelings.

Your healthcare provider may diagnose ADHD if your symptoms meet the criteria listed in the Diagnostic and Statistical Manual (DSM-5). These are the broad guidelines:

• Several symptoms present before the age of 12 (even if ADHD is diagnosed later)
• Symptoms persisting for six months or longer
• Symptoms are evident in at least two settings (school, home, work, church, etc.)
• Symptoms that negatively affect social, academic, or occupational functioning.

Children and teens younger than 17 must meet at least six, and adults aged 17 and older must meet at least five of the inattentive or hyperactive/impulsive criteria.

Inattentive ADHD Criteria

You or your child may meet the inattentive criteria if you:

• Forget daily activities
• Have poor listening skills
• Have a short attention span
• Lose or misplace items needed for tasks or activities
• Get sidetracked by stimuli that are unrelated to the task
• Struggle to follow instructions or complete schoolwork or assignments
• Avoid or postpone homework or activities requiring concentration
• Fail to notice details or make careless mistakes on assignments or projects

Hyperactive-Impulsive ADHD Criteria

You or your child meet the criteria for hyperactive-impulsive ADHD if you:

• Talk nonstop
• Have difficulty waiting your turn
• Have restlessness that’s difficult to control
• Interrupt conversations or intrude into activities
• Impulsively blurt out answers
• Can’t stay in your seat (in circumstances where you’re expected to sit still)
• Squirm in your seat or fidget with your hands and feet
• Are constantly on the go or seem to be constantly driven
• Struggle to relax, play, or engage in quiet or leisurely activities

Causes

ADHD’s causes are still being studied. However, research suggests that genetic alterations and environmental factors work together to affect brain growth.

Dozens of gene variations are associated with ADHD. Environmental risk factors that may contribute to ADHD include:

• Low birth rate
• Premature birth
• Exposure to heavy metals like lead during pregnancy or in early life
• Alcohol or cigarette use during pregnancy
• Traumatic brain injury (TBI)

Myths

There are many myths about the potential causes of ADHD that have been proven false. For example, the following do not cause ADHD:

• Poor parenting skills
• Food allergies
• Food additives
• Vaccines
• Eating large amounts of sugar
• Watching too much television
• Family turmoil

Some of these issues may worsen ADHD symptoms. Other can cause similar symptoms. But they don’t contribute to ADHD.

ADHD in Adults

Though adults meet the same diagnostic criteria as children, ADHD symptoms may change as they get older. Hyperactivity tends to decrease while inattentive symptoms increase.

However, instead of disappearing, hyperactivity symptoms may change. For example, the physical behavior of fidgeting in children appears as internal nervousness in adults.

Many adults still have a hard time regulating their emotions, a common problem with ADHD. As a result, they’re quick to anger or have emotional reactions that are out of proportion for the circumstances. Forgetfulness may also become more noticeable.

Adults with ADHD may frequently change (or lose) jobs, often because they’re unhappy with their career or not achieving success. Some adults find ways to compensate for symptoms like disorganization and distractibility. Others develop such stress that they turn to alcohol and drugs.

About 17%–22% of adults seeking help for other mental health conditions learn they have ADHD. Most feel relieved to know there’s a reason for their self-defeating behaviors and that treatments exist to help them overcome their challenges.

Co-Existing Conditions

People with ADHD often have co-existing conditions, such as autism spectrum disorder (ASD), depression, anxiety, oppositional defiant disorder (ODD), Tourette syndrome, and learning disorders. More than half of people with ADHD have another mental health condition. Adults with ADHD may have bipolar disorder or obsessive-compulsive disorder (OCD), to name a few.

Treatment

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:

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:

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 Complementary 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 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 have research that backs 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.

ADD vs ADHD

ADD, short for attention-deficit disorder, is a term that is outdated. When the condition was first named, only the inattentive symptoms were recognized. Then, the experts learned that the same condition caused hyperactive and impulsive symptoms. As a result, they changed the name to ADHD.

Coping

Living with a child or adolescent who has ADHD can come with unique challenges. As a parent, it’s essential 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. Therapy focuses on teaching you and your child practical tips and techniques for managing ADHD and improving daily life.

A few coping tips include:

• Make lists of daily tasks, prioritizing each item
• Break every task down into small steps; create a step-by-step visual guide for children
• Use sticky note reminders; post them on the bathroom mirror, front door, or refrigerator
• Create a system for organizing papers, using files, notebooks, and tablets or smartphones
• Assign a specific place for books, assignments, mail, and other tasks
• Develop a daily routine and follow it consistently
• Coordinate with your child’s teacher; get assignments sent digitally
• Recognize your child when they complete a task, remember details, or take the initiative to organize

Summary

ADHD is a neurodevelopmental disorder that can impact children, teens, and adults. The three types of ADHD include inattentive, hyperactive-impulsive, and combined. While the cause of ADHD is not known, genetics and environmental factors both play a role.

Signs and symptoms of ADHD will vary depending on the type and can change over time. ADHD is diagnosed based on criteria found in the DSM-5 and treatment will vary depending on the individual’s specific needs.