Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed disorder in children and teens. Its hallmark symptoms include hyperactivity, inattention, and impulsivity. Children have difficulty concentrating, following instructions, sitting still, and interacting with others. Some kids may call out answers without waiting their turn and make inappropriate comments. Others might be quiet and keep to themselves, daydreaming away at their desks.
ADHD also affects approximately 4 percent of adults, according to the National Institute of Mental Health. These adults have problems with organization, time management, sustaining their attention, completing tasks and controlling their emotions. They can miss deadlines, speak without thinking, get easily distracted, misplace items, and have trouble remembering things. Similar to children, symptoms in adults can vary — some adults might be especially gregarious while others withdraw and isolate themselves.
For both kids and adults, these symptoms create problems at school, work, and in relationships. Though ADHD can make daily life difficult, it’s effectively treated with medication and psychotherapy. If you think you or a loved one has ADHD, see a mental health professional for a comprehensive evaluation.
What Are the Risk Factors and Causes of ADHD?
Like other psychological disorders, ADHD is caused by a multitude of factors, including the following.
- Genetics: Studies show that ADHD runs in families with greater frequency than in the general population. Twin studies have attributed about 80 percent of ADHD to genes (see Faraone, 2004), though estimates vary. Researchers also have explored the contribution of specific genes. A recent large-scale study demonstrated that many genes are involved in ADHD (see genetic determinants of ADHD). Since many symptoms make up the disorder, that would seem to make sense.
- Environment: The maternal environment might increase the risk for ADHD, including smoking during pregnancy (in an already genetically susceptible child), low birth weight and mom’s mental health. Some research has found that preschool children exposed to high levels of lead might be vulnerable to ADHD (Braun, Kahn, Froehlich, Auinger & Lanphea, 2006). Also, ADHD seems to be associated with traumatic events, such as emotional or physical abuse (see Banerjee, Middleton & Faraone, 2007).
- Food additives: The hypothesis that food additives increase ADHD risk has been a controversial one. A recent study found that drinking beverages with food additives increased hyperactivity in children without ADHD (see here and here).
- Brain injury: Head trauma can cause ADHD-like symptoms, though only a small percentage of children with ADHD have experienced brain injury, according to the National Institute of Mental Health (NIMH). Also, a recent study disputes this hypothesis.
Symptoms of ADHD
- Misses details and makes careless mistakes
- Is unable to organize tasks and activities
- Has difficulty following through on instructions and completing assignments
- Gets bored with a task after only several minutes
- Doesn’t seem to listen when spoken to
- Is easily distracted
- Often loses toys, school supplies, or anything necessary for a particular task
- Is often forgetful
- Avoids, dislikes, or hesitates to participate in activities that require continuous mental effort (e.g., homework)
- Fidgets or squirms in seat
- Leaves his or her seat when it isn’t appropriate
- Runs or climbs when it isn’t appropriate (in adults, this might be restlessness)
- Frequently has difficulty playing or participating in activities quietly
- Often acts like he or she is “on the go” or “driven by a motor”
- Talks excessively
- Blurts out answers before questions are completed
- Has a tough time awaiting his or her turn
- Interrupts others (e.g., disrupts a conversation or game)
Issues with Adult Diagnosis
The criteria for diagnosing children with ADHD are reliable. However, since they were originally created with children in mind, they may be inappropriate for diagnosing adults.
Many symptoms adults commonly experience, including procrastination, poor motivation, and time management problems, are excluded from the criteria (see Davidson, 2008). Also, it can be difficult to distinguish ADHD from other psychological disorders, including depression, bipolar disorder, and generalized anxiety.
What Are the Different Types of ADHD?
- Predominantly Inattentive Type: A prevalent diagnosis among adults, this type shows six or more symptoms from the inattention category and fewer than six symptoms from the hyperactive-impulsive (but individuals can exhibit some of these symptoms).
- Predominantly Hyperactive-Impulsive Type: These individuals show six or more symptoms from the hyperactive-impulsive category and fewer than six symptoms from the inattention type (but some of these symptoms can be present).
- Combined Type: Common in children, this type exhibits six or more symptoms of the inattentive type along with six or more symptoms from the hyperactive-impulsive type.
How Is ADHD Diagnosed?
A trained mental health professional, such as a psychologist, psychiatrist, or therapist, can accurately diagnose ADHD. This is done with a face-to-face clinical interview. The practitioner will take a comprehensive history, including current and past symptoms, medical conditions, co-existing psychological disorders and family history. When diagnosing ADHD in children, the practitioner will gather information from parents and teachers.
What Treatments Exist for ADHD?
Both children and adults with ADHD are treated with psychotherapy, medication, or both.
What Kinds of Medications Are Used for ADHD?
Both stimulants and nonstimulants are prescribed to treat ADHD, helping to improve academic, occupational and social functioning. Medication is available in either a short-acting dose (which lasts for about four hours) or a long-acting dose (which lasts about 12 hours).
Contrary to their name, stimulants actually calm patients and are used as the first line of treatment. They help control hyperactivity, impulsivity, and inattention, improving an individual’s ability to concentrate, learn, follow instructions, and interact with others.
There are two primary types of stimulants—methylphenidate-based (Ritalin, Concerta, Metadate) and amphetamine-based (Adderall, Dexedrine).
Studies have shown that these medications are safe. Side effects may include trouble sleeping, loss of appetite and anxiety. Because of this, stimulants might not be appropriate for someone who already has anxiety.
There are several concerns with prescribing stimulants for children:
- Stunted growth. Though there might be subtle effects, it seems stimulants don’t affect one’s ultimate height and weight, according to a recent review (Faraone, Biederman, Morley & Spencer, 2008). The authors did note that doctors should still monitor children’s height.
- Addiction and future drug abuse. Many parents also worry their kids will become addicted to stimulants and develop drug abuse problems. However, a great deal of research has found that taking stimulants does not increase an individual’s risk for substance abuse (see Biederman, Monuteaux, Spencer, Wilens, MacPherson & Faraone, 2008). Interestingly, some research has even shown protective effects—children who respond well to stimulants are at lower risk for alcohol and substance-related problems. (This might not be true for adults).
- Heart problems. Rare, but fatal cardiac complications may occur in children with underlying heart disease. For this reason, the American Heart Association has recommended that all children with ADHD have cardiovascular screenings before they’re prescribed stimulants.
- Nonstimulants. Atomoxetine (Strattera) was the first and so far only nonstimulant medication to receive approval to treat childhood ADHD. It also was the first ADHD medication approved for adults. Strattera lasts 24 hours as opposed to the four- or 12-hour effects of other stimulants. Its side effects also include insomnia and loss of appetite, though this is more common with stimulants.The FDA has required that Strattera be sold with a black box warning about suicidal risk; it might increase children’s and teens’ suicidal thinking and behavior.
- Medication concerns for adults. All of the above medications also are prescribed to adults with ADHD. However, because of the high risk for abuse, there is controversy over prescribing stimulants to adults with a history of substance abuse — prevalent among adults with ADHD, reports ADDitude.
Psychotherapy is a significant component of ADHD treatment, because it teaches both children and adults the skills they need to succeed. In addition to therapy, many adults with ADHD work with a coach who helps them get organized and develop and achieve their goals and can provide valuable feedback and support. For more details on ADD coaches see here and here.
Behavior therapy is just as it sounds: It helps promote appropriate behavior (e.g., doing one’s homework) and decrease problem behavior (e.g., acting out in class). The therapist, parents, and teachers establish rewards and consequences to promote positive behaviors.
Cognitive-behavioral therapy helps adults identify negative thoughts and behaviors and change them. In addition, individuals learn how to overcome everyday struggles, including problems with organization and time management.
Social skills training teaches both adults and children how to interact appropriately with others and build healthy relationships. Individuals with ADHD tend to have difficulty understanding social cues (e.g., facial expressions; body language) and might come off as inattentive or offensive.
What Do I Do Next?
If you think you have or a loved one has ADHD, you’ve already accomplished your first step: educating yourself about the disorder. For more detailed information, check out our ADHD guide and complete an ADHD questionnaire. Sometimes it helps to know that you’re not alone, and that many famous people also live with ADD.
To receive a comprehensive clinical assessment, see a mental health professional or check with your primary care physician or community mental health clinic. Remember that ADHD can be successfully managed, so it’s essential to get evaluated as soon as possible.