What is Attention Deficit Hyperactivity Disorder?

Everyone gets distracted sometimes. Lack of sleep, stress and trying to do too much at once can all lead to problems focusing on a particular task. It’s also normal for people – especially children – to be restless, fidgety or irritable from time to time. But in attention deficit hyperactivity disorder, commonly known as ADHD, symptoms of inattention, hyperactivity and impulsivity are present most of the time and disrupt a person’s social, work and/or school life.

One of the most common neurodevelopmental disorders in kids, ADHD is typically diagnosed in childhood and often lasts into adulthood. There are three types of ADHD, identified by their most prominent symptoms, predominantly inattentive presentation, predominantly hyperactive/impulsive presentation or combined presentation. 

Signs and Symptoms

For a diagnosis of ADHD, a person must show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily function or development. Six or more of the following symptoms must last at least six months and negatively impact social, academic or occupational activities.

• Inattention symptoms
• Failing to give close attention to details or making careless mistakes in schoolwork, at work or during other activities
• Having difficulty sustaining attention in tasks or play activities
• Not seeming to listen when spoken to directly
• Not following through on instructions and failing to finish schoolwork, chores or duties in the workplace
• Having difficulty organizing tasks and activities
•  Avoiding, disliking or being reluctant to engage in tasks that require sustained mental effort
• Losing things necessary for tasks or activities
• Being easily distracted by extraneous stimuli
• Being forgetful in daily activities
•   Hyperactivity and impulsivity symptoms
• Fidgeting with or tapping hands or feet or squirming in seat
• Leaving seat in situations when remaining seated is expected
• Running about or climbing in situations where it is inappropriate (children) or feeling restless (older teens and adults)
• Being unable to play or engage in leisure activities quietly
• Being “on the go” or acting as if “driven by a motor”
• Talking excessively
• Blurting out an answer before a question has been completed
• Having difficulty waiting his or her turn
• Interrupting or intruding on others

In ADHD, several symptoms are often present before age 12; inattention, hyperactivity and/or impulsivity are present in two or more settings (home, work, school, social activities) and there is clear evidence that symptoms interfere with functioning. The symptoms are not related to schizophrenia or another psychotic disorder and are not better explained by another mental disorder.

Diagnosis

Diagnosing ADHD requires a thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for ADHD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your or your child’s symptoms indicate the condition.

Diagnostic tests include:

Physical examination: A provider will perform a physical exam and ask questions about your or your child’s health to determine if your symptoms could be linked to an underlying physical health problem, medication side effects or unhealthy behaviors (like drug use). 

Psychiatric evaluation: A behavioral health provider will ask questions about your or your child’s social, emotional, educational and behavioral history, and – if diagnosing your child – give you behavior rating scales or checklists for ADHD that you or your child’s teacher can use to evaluate symptoms.

Causes

The cause of ADHD is unknown, but researchers believe genetics, certain environmental factors and central nervous system problems during key developmental moments may all play a role.

Risk Factors

Risk factors that could contribute to ADHD include:

Environmental exposures: Lead exposure, typically through paint and pipes in older buildings, is a risk factor for ADHD development.

Family history: If a blood relative, such as a parent or sibling, has attention deficit hyperactivity disorder or another mental or behavioral health disorder, your risk of developing ADHD may be higher.

Maternal habits: If a woman smokes, drinks alcohol or uses drugs during pregnancy, her baby may be at an increased risk of developing ADHD.

Prematurity: Babies born early are at a slightly higher risk of developing ADHD.

Prevention

ADHD cannot be prevented. But healthy prenatal behaviors; ensuring you and/or your child eats a healthy and balanced diet; developing structured routines and following through on your, or your child’s, treatment can all help reduce the severity of ADHD.

Prognosis

While ADHD is a chronic condition, treatment can help relieve the symptoms and make the condition more manageable in your or your child’s daily life.

Treatment

Most people with ADHD benefit from a combination of medication and behavior therapy. 

Medication

Common medications prescribed for ADHD include:

• Stimulant medications: The most commonly prescribed medications for ADHD, stimulants seem to boost and balance levels of brain chemicals called neurotransmitters, improving the signs and symptoms of inattention and hyperactivity. Examples include amphetamines and methylphenidates. These should be avoided in people with underlying heart disease or defects.
• Atomoxetine: This selective norepinephrine reuptake inhibitor also affects levels of brain chemicals to treat ADHD. 
• Antidepressants: While not specifically approved to treat ADHD, these medications can sometimes help treat inattention, hyperactivity and impulsiveness.
• Guanfacine: This drug, commonly used to reduce blood pressure, has also been shown to reduce the symptoms of ADHD.
• Clonidine: Another blood pressure-reducing drug, this has shown promise in some people with ADHD.

Behavior Therapy

Children and adults can benefit from a combination of behavior-changing strategies, psychotherapy (also known as talk therapy), family therapy, social skills training and parenting skills training (to help parents understand and guide a child’s behavior). 

Complications

Complications of ADHD include:

• Classroom and workplace struggles
• Increased risk of alcohol or drug abuse or other negative behaviors
• Low self-esteem
• More accidents and injuries (from engaging in risky activities)
• Trouble with relationships and social situations