Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
It is a condition in which a person 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. Without treatment, ADHD can cause problems at home, at school, at work, and with relationships. In the past, ADHD was called attention deficit disorder (ADD).
Three Types of ADHD
For many people, the words “hyperactive” or “out of control” come to mind when they hear the term ADHD. If your child doesn’t have those symptoms, a diagnosis of ADHD can be puzzling. Kids who don’t seem hyperactive often aren’t diagnosed as early.
There are actually three types of ADHD, and one of them doesn’t include symptoms of impulsive and hyperactive behavior.
- ADHD, Predominantly Hyperactive-Impulsive Presentation: Kids who have this type of ADHD have symptoms of hyperactivity and feel the need to move constantly. They also struggle with impulse control.
- ADHD, Predominantly Inattentive Presentation: Kids who have this type of ADHD have difficulty paying attention. They’re easily distracted but don’t have issues with impulsivity or hyperactivity. This is sometimes referred to as attention-deficit disorder (or ADD).
- ADHD, Combined Presentation: This is the most common type of ADHD. Kids who have it show all of the symptoms described above
ADHD IS caused by chemical, structural, and connectivity differences in the brain, mostly as a result of genetics.
- Chemical Differences
Research shows that those with ADHD have abnormalities in how the neurotransmitters dopamine and norepinephrine work to facilitate communication between neurons and activation of various brain functions.
- Brain Activity and Structural Differences
The ADHD brain has differences in activity levels and the way certain areas are structured.
- Brain Communication Differences
The ADHD brain connects and communicates differently than neurotypical brains.
Several genes have been linked to ADHD, which is highly hereditable.
Scientists are not sure what causes ADHD. Like many other illnesses, a number of factors can contribute to ADHD, such as:
- Cigarette smoking, alcohol use, or drug use during pregnancy
- Exposure to environmental toxins during pregnancy
- Exposure to environmental toxins, such as high levels of lead, at a young age
- Low birth weight
- Brain injuries
ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD.
People with ADHD show an ongoing pattern of three different types of symptoms:
- Difficulty paying attention (inattention) – means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension. People with ADHD are easily distracted. They have a hard time focusing on any one task.
- Being overactive (hyperactivity) – means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
- Acting without thinking (impulsivity) – means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
These symptoms get in the way of functioning or development. People who have ADHD have combinations of these symptoms:
- Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
- Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
- Seem to not listen when spoken to directly
- Fail to not follow through on instructions, fail to finish schoolwork, chores, or duties in the workplace, or start tasks but quickly lose focus and get easily sidetracked
- Have problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, keeping work organized, managing time, and meeting deadlines
- Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
- Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
- Become easily distracted by unrelated thoughts or stimuli
- Forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
Signs of hyperactivity and impulsivity may include:
- Fidgeting and squirming while seated
- Getting up and moving around in situations when staying seated is expected, such as in the classroom or in the office
- Running or dashing around or climbing in situations where it is inappropriate, or, in teens and adults, often feeling restless
- Being unable to play or engage in hobbies quietly
- Being constantly in motion or “on the go,” or acting as if “driven by a motor”
- Talking nonstop
- Blurting out an answer before a question has been completed, finishing other people’s sentences, or speaking without waiting for a turn in conversation
- Having trouble waiting his or her turn
- Interrupting or intruding on others, for example in conversations, games, or activities
Showing these signs and symptoms does not necessarily mean a person has ADHD. Many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. If you are concerned about whether you or your child might have ADHD, the first step is to talk with a health care professional to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychiatrist or clinical psychologist, primary care provider, or pediatrician.
Although there is no cure for ADHD, currently available treatments may help reduce symptoms and improve functioning. ADHD is commonly treated with medication, education or training, therapy, or a combination of treatments.
For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. The first line of treatment for ADHD is stimulants.
- Stimulants: Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it is effective. Many researchers think that stimulants are effective because the medication increases the brain chemical dopamine, which plays essential roles in thinking and attention.
- Non-Stimulants: These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant if a person had bothersome side effects from stimulants, if a stimulant was not effective, or in combination with a stimulant to increase effectiveness. Two examples of non-stimulant medications include atomoxetine and
- Antidepressants: Although antidepressants are not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Older antidepressants, called tricyclics, sometimes are used because they, like stimulants, affect the brain chemicals norepinephrine and dopamine.
There are many different types and brands of these medications—all with potential benefits and side effects. Sometimes several different medications or dosages must be tried before finding the one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.
Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.
Therapy focuses on making changes in the environment to improve the child’s behavior. Often, counseling and extra support at home and at school help children succeed at school and feel better about themselves
There are different kinds of therapy that have been tried for ADHD, but research shows that therapy may not be effective in treating ADHD symptoms. However, adding therapy to an ADHD treatment plan may help patients and families better cope with daily challenges.
For Children and Teens: Parents and teachers can help children and teens with ADHD stay organized and follow directions with tools such as keeping a routine and a schedule, organizing everyday items, using homework and notebook organizers, and giving praise or rewards when rules are followed.
For Adults: A licensed mental health provider or therapist can help an adult with ADHD learn how to organize his or her life with tools such as keeping routines and breaking down large tasks into more manageable, smaller tasks.
3. Education and Training
Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. Mental health professionals can educate the parents of a child with ADHD about the condition and how it affects a family. They can also help the child and his or her parents develop new skills, attitudes, and ways of relating to each other. Examples include:
- Parenting skills training teaches parents the skills they need to encourage and reward positive behaviors in their children.
- Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.
- Support groups can help parents and families connect with others who have similar problems and concerns.
Adding behavioral therapy, counseling, and practical support can help people with ADHD and their families to better cope with everyday problems.
What conditions are related to ADHD?
Kids with ADHD often have other conditions as well. Doctors refer to this as comorbidity. Some conditions look a lot like ADHD because they have some of the same symptoms. It’s important that your child’s issues are properly identified so you can start an appropriate treatment program. Here are issues that often coexist with ADHD:
- Learning disabilities. Some learning disabilities make it hard for children to stay organized. Children with certain forms of dyslexia have trouble processing and responding to directions (written or spoken).
- Social (pragmatic) communication disorder. This condition makes it hard for a child to converse in socially appropriate ways. Kids with social communication disorder may have trouble understanding body language, puns, sarcasm and statements that don’t mean exactly what they say.
- Auditory processing disorder. This can make it hard for kids to understand and follow spoken directions. There’s a “disconnect” somewhere between the ear and brain, making a child appear inattentive or unable to follow directions. Auditory processing disorder can coexist with ADHD. But sometimes one gets misdiagnosed for the other.
- Motor and oral (vocal) tic disorders. Although the most commonly known tic disorder is Tourette syndrome, there are others as well. Tic disorders can cause body movements and vocal sounds that kids can’t control.
- Behavior disorders. Oppositional defiant disorder is common in children with the combined type of ADHD. So is conduct disorder.
- Emotional regulation issues. More than just temporary emotional difficulties, mental health conditions such as anxiety disorders, depressive disorders and obsessive-compulsive and related disorders can cause symptoms beyond a child’s control. Some of those symptoms are also seen with ADHD, such as emotional outbursts, high energy and the need to have things be “just so.”
ADHD and many of the issues described above share a common thread: executive functioning issues. Executive functioning skills allow us to plan, organize, remember things, prioritize, pay attention and get started on tasks. A child with ADHD or another disorder may lack skill in one or more executive functions.
Tips to Help Kids and Adults with ADHD Stay Organized
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:
- Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
- Organizing everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
- Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
- Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
- Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:
- Keeping routines
- Making lists for different tasks and activities
- Using a calendar for scheduling events
- Using 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.