Attention Deficit Hyperactivity Disorder (ADHD)

Condition Basics

What is attention deficit hyperactivity disorder (ADHD)?

Attention deficit hyperactivity disorder (ADHD) is a common condition. A person who has ADHD has trouble paying attention and focusing on tasks, tends to act without thinking, and has trouble sitting still.

It may begin in early childhood and can continue into adulthood. ADHD can be treated with medicines, behavior therapy, and counseling. Treatment can improve your life.

In the past, ADHD was called attention deficit disorder (ADD).

What causes it?

The exact cause of ADHD is not clear. It tends to run in families, so genetics may be involved. Scientists are studying other possible causes, such as things in the environment and things that happen before or after birth.

What are the symptoms?

ADHD is a condition that makes it hard to pay attention. People with ADHD also may be more active than normal and tend to act without thinking. ADHD may make it harder to focus, get organized, and finish tasks.

How is it diagnosed?

A doctor relies on a combination of exams, tests, and other information to diagnose ADHD. It is often diagnosed when a child is between 6 and 12 years old. Parents and teachers may first notice symptoms in children who are in this age group.

How is ADHD treated?

Treatment for ADHD will depend on the age of the person. It may include medicines and behavior therapy. Younger children are first treated with behavior therapy. As children get older, behavior therapy and medicines may be used. Adults are usually treated with medicines. Counseling to learn more about ADHD may also help.

Symptoms

ADHD can cause three types of symptoms:

Trouble paying attention (inattention).

People with ADHD often have a hard time focusing on any one task.

Trouble sitting still for even a short time (hyperactivity).

Children with ADHD may squirm, fidget, or run around at the wrong times. Teens and adults often feel restless and fidgety. They aren't able to enjoy reading or other quiet activities. Most people with ADHD are hyperactive only some of the time, even if hyperactivity is their main symptom.

Acting before thinking (impulsivity).

People with ADHD may talk too loud, laugh too loud, or become angrier than the situation calls for. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children. Teens and adults may make quick decisions that have a long-term impact on their lives. They may spend too much money or change jobs often.

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What Happens

ADHD most often starts in childhood and can last into adulthood.

It can be hard to tell the difference between normal behavior and ADHD symptoms in young children. But after a child starts school, ADHD becomes more noticeable. It is most often diagnosed in children ages 6 to 12. During this time, it can disrupt many aspects of a child's life. Learning, adjusting to change, sleeping, and making friends are all areas where children with ADHD may need extra help.

Adults with ADHD may continue to have trouble focusing, organizing, and finishing tasks. But they are often able to adjust to the workplace better than they did in the classroom as children.

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When to Call a Doctor

Call a doctor if:

• Your child is showing signs of ADHD that are causing problems at home or school. These signs include inattention, impulsivity, and/or hyperactivity. Parents and teachers often notice this behavior during the child's first few years in school.
• Your child shows signs of other mental health disorders, such as depression or anxiety, that last more than a few weeks or seem to be getting worse.
• Your child is having academic or behavioral problems at school.

Exams and Tests

A doctor uses a combination of exams, tests, and other information to check for ADHD. The doctor will look at guidelines created by the American Psychiatric Association. The diagnosis will be based on:

• A talk with your child.
• Your child's medical history. The doctor will ask about your child's social, emotional, educational, and behavioral history.
• A physical exam.
• Behavior rating scales or checklists for ADHD. These are used by parents and teachers to evaluate your child's symptoms.

Before meeting with your doctor, think about at what age your child's symptoms began. You and other caregivers can help by recording when the behavior occurs and how long it lasts. An important part of checking for ADHD is thinking about the kinds of problems caused by the behaviors. How much do they affect schooling and social behavior?

Treatment Overview

Treatment for ADHD will depend on the age of the person. It may include medicines and behavior therapy. For example:

• Children ages 4 to 5 years are treated first with behavior therapy. Your child's doctor will talk to you about medicine if your child's symptoms do not improve.
• Children ages 6 to 11 years are treated with medicine or behavior therapy or both.
• Children ages 12 to 18 years are treated with medicine and usually also with behavior therapy.
• Medicines can help, but they may have side effects and risks.

Medicines that may be used for ADHD include:

Stimulant medicines.

One example is amphetamine (for example, Adderall). Another is methylphenidate (for example, Concerta or Ritalin).

Nonstimulant medicines.

Examples are atomoxetine (Strattera), clonidine (Kapvay), or guanfacine (Intuniv). These medicines may be used if stimulant medicines aren't effective or have side effects that bother the person. They may be used alone. Or they may be used in combination with stimulant medicines.

With behavior therapy:

• Parents learn strategies, such as positive reinforcement, to improve a child's behaviors.
• Children learn skills for problem solving, communication, and self-advocacy.

Even though medicine can help improve your child's symptoms, it can't solve all of your child's behavior problems. Your child may also benefit from counseling, behavior therapy, or social skills training.

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Caring for a Child Who Has ADHD

There are many things you can do at home to help your child who has ADHD.

You can help your child build social skills. Consider working with a specialist or taking classes to learn behavior management methods that you can use with your child. Behavior therapy and social skills training can help your child be less aggressive and impulsive, manage anger, and behave in a more socially acceptable way.

You also can help your child build self-esteem. You can do this by encouraging a sense of belonging, confidence in learning, and an awareness of your child's own contributions.

Model patience, persistence, and creative thinking. It can help your child learn skills for doing tasks at home and at school.

It's important to remember to take care of yourself too. Caring for your own physical and mental health is an important part of helping your child. And it will help you have the energy you need to take care of your child.

Caring for your teen

Regular, open communication with your teen and your teen's teachers and doctors is the first step in helping your teen with ADHD to thrive. And being aware of what's happening in your teen's life will allow you to work together to solve problems that might occur.

The teen years present many challenges. These include more schoolwork and the need to be more attentive and organized. Making good decisions becomes more important during these years when peer pressure, sexuality, and other issues surface.

Work with your teen to create reasonable goals. And use the right consequences when goals aren't met. That may include losing privileges or having more chores at home. Allow your teen to help decide rewards when the goals are met.

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Self-Care for Adults Who Have ADHD

• Learn all you can about ADHD. This will help you and your family understand it better.
• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• If you miss a dose of your medicine, do not take an extra dose.
• If your doctor suggests counseling, find a counselor you like and trust. Talk openly and honestly. Be willing to make some changes.
• Find a support group for adults with ADHD. Talking to others with the same problems can help you feel better. It can also give you ideas about how to best cope with the condition.
• Get rid of distractions at your work space. Keep your desk clean. Try not to face a window or busy hallway.
• Use files, planners, and other tools to keep you organized.
• Limit use of alcohol, and do not use drugs. People with ADHD tend to develop substance use disorder more easily than others. Tell your doctor if you need help to quit. Counseling, support groups, and sometimes medicines can help you stay free of alcohol or drugs.
• Get at least 30 minutes of physical activity on most days of the week. Exercise may help manage the symptoms of ADHD. For many people, walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.

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Medicines

Medicines are used to help control the symptoms of ADHD.

Children should be closely watched after they start medicines. The doctor can assess if your child is getting the right dose.

Be sure that medicine for ADHD is taken on schedule. You'll also need to keep track of the effects of the medicine. Talk often with your child's doctor.

Medicines to treat ADHD include:

• Stimulants. Examples are amphetamine (such as Adderall or Dexedrine) and methylphenidate (such as Concerta, Metadate CD, or Ritalin).
• Nonstimulants. Examples are atomoxetine (Strattera), clonidine (Kapvay), and guanfacine (Intuniv).
• Antidepressants. At times, certain antidepressants are also recommended.

Most often, stimulants are used to treat ADHD. These work well for people of all ages. In general, stimulants improve symptoms quickly.

If stimulants don't work or have side effects that cause problems, your child's doctor might recommend a nonstimulant. These medicines may be used alone or along with stimulant medicines.

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