Attention-deficit/hyperactivity disorder (ADHD) is a common condition that is mostly recognized and diagnosed in childhood, although it can also impact many adults. ADHD affects behaviors, concentration, and functioning, and can be effectively managed with various treatments, including therapies and medications.
- ADHD is a neurodevelopmental disorder that can affect both children and adults, impacting focus, behavior, and functioning.
- It is a disability under multiple U.S. laws, granting individuals the right to educational and workplace accommodations.
- Treatment for ADHD includes therapy, medications, and lifestyle changes, which can significantly improve quality of life.
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What is attention-deficit/hyperactivity disorder (ADHD)?
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects many children and adults worldwide. Symptoms emerge in childhood and can impact academic performance, social interactions, and concentration. This can include inattention, impulsivity, and hyperactivity.
Although it is common for ADHD to be identified in childhood, some people do not receive a diagnosis until adulthood, and symptoms can continue throughout a person’s life. Various treatments can help manage symptoms, including therapies and medications. [1]
Is ADHD a disability?
Yes, ADHD is considered a disability. It is listed under the Rehabilitation Act of 1973, the Americans with Disabilities Act, and the Individuals with Disabilities Education Act. [2]
This means that children with ADHD can be eligible for additional support with their learning, such as adaptations to the classroom environment, changes to the curriculum, and additional or alternative teaching and skills techniques.
It also means that adults with ADHD cannot be discriminated against in the workplace and can request accommodations to help them meet their job requirements. [2]
ADHD symptoms
The symptoms of ADHD can present differently from person to person. People may have predominantly inattentive symptoms, predominantly hyperactive-impulsive symptoms, or a combination of both. Symptoms can also change over time, depending on age, life circumstances, or treatments. [1]
Inattentive symptoms of ADHD include: [1][2][3]
- Difficulty focusing on a single task
- Easily distracted
- Quick changes in attention and focus from one activity to another
- Quickly bored by a task or activity
- Often losing or forgetting things
- Difficulty paying attention or listening when being spoken to
- Trouble completing tasks
- Difficulty following directions and instructions
- Making careless mistakes and missing details
- Poor time management and organizational skills
- Unable to process information quickly
Hyperactive and impulsive symptoms of ADHD include: [1][2][3]
- Often interrupting people’s conversations or activities
- Answering before a question is finished or speaking over people in conversations
- Being very talkative
- Describable by others as ‘non-stop’ or ‘on-the-go’
- Issues sitting still for long periods
- Always fidgeting
- Young children might be seen to be always running, jumping, or moving
- Impatience and difficulty waiting in line or for their turn
- Often failing to consider the consequences before acting or speaking
- Rarely engaging in activities quietly
- Being prone to accidents
- Restlessness
Causes of ADHD
ADHD is not caused by a single event or circumstance and its development is likely influenced by a combination of genetic and environmental risk factors. For example, ADHD is often hereditary, and it is common for parents with ADHD to have children who also have symptoms of the condition. Studies show a strong genetic link, with a heritability estimate of around 74%. [3][4]
Additionally, certain risk factors may be associated with an increased risk of ADHD, including: [2][5]
- Brain injury
- Low birth weight
- Fetal exposure to cigarettes or alcohol
- Exposure to lead in childhood
Who is likely to have ADHD?
It is most common for ADHD to be diagnosed in childhood, as this is when symptoms emerge and may be at their most apparent. However, in some cases, ADHD is only identified in adulthood. [1]
A child with ADHD will likely have siblings and/or parents with ADHD. [4]
It is more common for boys to be diagnosed with ADHD than girls. This might be due to several factors, including the type of ADHD symptoms. Boys are more likely to present with externalized hyperactive/impulsive symptoms, while girls are more likely to have internalized and inattentive symptoms, meaning that boys’ symptoms tend to be more noticeable. [2]
Typical behavioral development vs. ADHD
Many of the symptoms of ADHD are behaviors and traits that are commonly seen in children and young people, such as being high energy, chatty, and impulsive. However, these behaviors occur only occasionally in those who do not have ADHD, while they are more frequent and severe and affect function more in those with ADHD.
The key difference between typical behavioral development and ADHD is the persistence and impact of symptoms. Excessive and frequent inattention, hyperactivity, and impulsivity are likely to significantly impact functioning, whereas occasional instances of these behaviors are more manageable. [2][3]
ADHD vs. ODD
Oppositional defiant disorder (ODD) is a behavioral disorder that impacts a child’s behaviors and interactions with others. [6]
Similarities between ADHD and ODD include:
- Issues with attention and focus
- Trouble following directions and rules
- Behavioral issues, such as distracting others in class
- Impact on mood
- Emerges in childhood
Differences between ODD and ADHD include:
- ODD is behavioral and affected by environmental factors, while ADHD is neurodevelopmental
- Children with ODD may be more likely to exhibit hostile or aggressive behaviors
- Children with ADHD have difficulty with instruction due to cognitive issues, while those with ODD are more likely to refuse to comply
Other symptoms of ODD include:
- Frequent angry outbursts
- Being argumentative with others
- Defiance and refusal to do as told or asked
- Blaming others
- Speaking with anger and hostility to others
Diagnosing ADHD
A specialist professional such as a pediatrician, psychiatrist, or mental health professional can diagnose ADHD. They will gather information from the child, parents, and teachers to help determine the presence of behaviors and functional issues that indicate ADHD.
Diagnosing ADHD can be a complex process, as many symptoms of ADHD overlap with or may be masked by other conditions. As such, it will be necessary to rule out other conditions during this process, such as anxiety, sleep issues, learning disabilities, or physical issues such as hearing or vision problems. [1]
There isn’t a specific test that can be administered to diagnose ADHD. The professional will typically gather a full history of presenting symptoms and associated issues and will refer to criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This criteria defines ADHD symptoms and states that: [1][7]
- Symptoms must have emerged before the age of 12
- Children must show at least six symptoms of ADHD
- Adults must show at least five symptoms of ADHD
- Symptoms have continued for over six months
- Symptoms are present in and impact two or more settings, such as home, school, social life, or work
Knowing when to seek a diagnosis
It may be necessary to seek a diagnosis if there are regular, noticeable issues with a child’s mood, behaviors, or academic performance that are thought to be potential signs of ADHD. Once a diagnosis has been made, treatments can commence, which can improve the child’s quality of life.
Adults may be able to manage their symptoms but might wish to seek a diagnosis if they feel that symptoms cause persistent impairments in social, professional, or personal functioning. [8]
ADHD in adults
For many people with a diagnosis of ADHD in childhood, symptoms continue to cause issues with functioning into adulthood. Some people do not receive a diagnosis of ADHD until adulthood, such as those with mild ADHD in childhood, those who manage their symptoms well as a child, or those whose symptoms have gone undiagnosed for many years. [2]
Symptoms of adult ADHD may present slightly differently and might vary depending on the circumstances and demands of the individual’s life. For example, impulsivity might involve engaging in substance use or risky behaviors, and hyperactivity might present as extreme restlessness. [1][8]
Complications of ADHD
ADHD can cause complications in multiple areas of a child or adult’s life, including: [2][8]
- Social interactions: ADHD symptoms can impact relationships, potentially causing issues with communication, sharing, or behaving inappropriately in social situations.
- Academic or professional performance: People may struggle to focus on projects or multitasking, which can impair functioning at school or work.
- Personal functioning and well-being: Symptoms might cause problems with general day-to-day functioning and self-care, such as forgetting or losing items needed during the day, managing health and hygiene, or keeping to a schedule.
- Mental health: ADHD can influence mental well-being and can lead to or worsen psychological symptoms such as stress and low mood.
Coexisting conditions
It is common for people with ADHD to have at least one other condition. Conditions that are commonly seen to coexist in people with ADHD include: [9]
- Anxiety
- Mood disorders such as depression or bipolar
- ODD or conduct disorder (CD)
- Tourette’s syndrome
- Learning disorders
- Substance use disorders
Prevention
ADHD can develop as a result of various risk factors, some of which cannot be avoided. However, certain measures can be taken to help prevent or reduce some of these risks, including: [10]
- Healthy pregnancy: Avoiding alcohol, cigarettes, and drugs, eating a healthy and nutritious diet, and managing stress during pregnancy.
- Childhood environment: Ensuring the child has a supportive and safe environment can help reduce the risk of ADHD development.
- Enriching activities: Physical exercise and cognitive or intellectual activities can stimulate and enrich the brain, potentially helping to reduce the risk of ADHD and improve brain function.
- Early intervention: Identifying ADHD symptoms and implementing treatments early can help reduce the impact of ADHD and coexisting symptoms as the child develops.
Treatment
Treatments for ADHD can include therapeutic interventions and medications, which can be used in combination. Additionally, lifestyle changes such as healthy diets, exercise, and mindfulness practices can also help to manage symptoms of ADHD. [1]
ADHD medication
- Stimulants: Often, ADHD is treated with stimulant medications, such as Adderall (amphetamine and dextroamphetamine) or Concerta (methylphenidate). These medications are effective at improving concentration and cognitive functioning. It is necessary for a medical professional to prescribe and monitor these medications, and they can have side effects. [11]
- Non-stimulants: Other medications might be used to treat symptoms of ADHD, such as atomoxetine, which is less effective than stimulant medications but may be suitable for those who cannot tolerate stimulants. Additionally, antidepressants might be prescribed to manage mood symptoms. [1][11]
Medications impact people differently, and it may be necessary to try more than one medication before finding an effective treatment.
ADHD therapy
Behavioral therapies, such as cognitive behavioral therapy (CBT), can help improve ADHD symptoms. For example, it can improve organizational skills, attention and focus, and social skills. Other individual and family therapies can also help manage issues with mood, interpersonal relationships, and home dynamics. [1][5]
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