Attention Deficit/Hyperactivity Disorder (ADHD)
Attention Deficit/Hyperactivity Disorder (ADHD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a pattern of behaviors, present in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings. Children must have at least six symptoms from either or both the inattention group of criteria and the hyperactivity-impulsivity criteria, while teens and adults must show five symptoms.
ADHD is one of the most common neurological disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors, and may act without thinking about the result of their action, or be overly active.
Based on symptoms, there are three types or versions (presentations) of ADHD that can occur:
- Combined Presentation – if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present the past six 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.
Children with ADHD might be eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Healthcare providers can play an important role in collaborating with schools to help your child get the special services they need.
DSM-5 Criteria for ADHD
People with ADHD must show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or developing.
Six or more symptoms of inattention for children up to age 16, or five or more for 17 and older and adults. Symptoms of inattention must be 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 phones)
- Is often easily distracted
- Is often forgetful in daily activities
Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for ages 17 or 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 and 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 his/her turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
- Several inattention or hyperactive-impulsive symptoms were present before age 12
- 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 a 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 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.
Many children have trouble focusing and behaving, but that doesn’t mean they have ADHD. Children with ADHD do not just grow out of these behaviors. Symptoms continue and can cause difficulty at school, at home, and with friends.
A child with ADHD might:
- Daydream a lot
- Forget or lose things
- Squirm or fidget
- Talk too much
- Make careless mistakes or take unnecessary risks
- Have a hard time resisting temptation
- Have trouble taking turns
- Have difficulty getting along with others
- Having trouble finishing tasks
- Having trouble sharing
The cause and risk factors for ADHD are unknown. Scientists are currently working to find better ways to manage and reduce the chances of a person having ADHD. Recent studies involving twins found a link between ADHD and genes.
In addition to genetics, scientist are studying other factors including:
- Brain injuries
- Exposure to environmental (e.g., lead) during pregnancy or at a young age
- Alcohol and tobacco use during pregnancy
- Premature delivery
- Low birth weight
Research DOES NOT support the popular views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors like poverty or family troubles. These may make symptoms worse, but the evidence is not strong enough to conclude that they cause ADHD.
Deciding if a child has ADHD is a several step process. There is no one test to diagnose ADHD. Many disorders like anxiety, depression, sleep problems, and certain learning disabilities can have similar symptoms to ADHD, and will need to be ruled out before an accurate diagnosis can be made. One step of the process involves having a medical exam, including hearing and vision tests. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.
If you think your child may have ADHD, talk with your child’s doctor. If the doctor has concerns about ADHD, they can recommend a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency or public school for children age 3 and up. In order to make sure your child reaches their full potential, it is very important to get help for ADHD as early as possible.
Behavioral Therapy (includes training for parents) – Research shows that behavior therapy is an important part of treatment for children with ADHD. ADHD 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 ADHD often show behaviors that can be very disruptive to others. Behavior therapy should start as soon as ADHD diagnosis is made.
The goal of behavior therapy is to teach or strengthen positive behaviors and eliminate unwanted or problem behaviors. It can include training for parents, behavior therapy for children, or a combination of the two.
In parent training, parents learn new skills or strengthen their existing skills to teach and guide their children and to manage their behavior. Parent training in behavior therapy has been shown to strengthen the relationship between parent and child, and to decrease negative or problem behaviors. Behavioral training is the recommended first line of treatment.
Medications – Medications can help children with ADHD in their everyday life, and medication treatment may be an effective way to manage ADHD symptoms. Medication is an option that may help control some of the behavior problems that have led to trouble in the past with family, friends, and at school.
There are several different types of medications are FDA-approved to treat ADHD in children:
- Stimulants are best known and most widely used ADHD medications. Between 70-80 percent of children with ADHD have fewer symptoms when they take these fast-acting medications.
- Non-stimulants were approved for treating ADHD in 2003. Non-stimulants do not work as quickly, but they can last up to 24 hours.
- Medications can affect children differently
School Accommodations and Interventions – Children with ADHD might be eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act. An individualized education program (IEP) is one of the services available. The IEP process is complex, but it’s a very effective way to address how your child learns and functions.
Adult ADHD – ADHD lasts into adulthood for at least one-third of children with ADHD. Treatments for adults can include medication, psychotherapy, education or training, or a combination of treatments.
- Create a routine – try following the same schedule every day, from wake-up to bedtime.
- Get organized – encourage your child to put schoolbags, clothing, and toys in the same place every day to discourage your child from losing them.
- Manage distractions – turn off the television, limit noise, and provide a clean workspace when your child is doing homework. Some children with ADHD learn well if they are moving or listening to background music. Watch your child and see what works.
- Limit choices – Offer choices between a few things to not overwhelm and overstimulate your child. For example, offer choices between a few options, such as 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 you child know they have done well by telling your child or rewarding efforts in other ways. Be sure the goals are realistic.
- Discipline effectively – instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
- Create positive opportunities – Children with ADHD 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 ADHD symptoms from getting worse.
- Keep a routine
- Make lists for different tasks and activities
- Use a calendar for scheduling events
- Use reminder notes
- Assigning a special place for keys, bills, and paperwork
- Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment
Links to various resources on the topics discuss on this page.