Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people. An estimated 8.8% of children aged 4-17 have ADHD. While ADHD is usually diagnosed in childhood, it does not only affect children. An estimated 4.4% of adults aged 18-44 have ADHD.
With treatment, people with ADHD can be successful in school, work and lead productive lives. Researchers are using new tools such as brain imaging to better understand the condition and to find more effective ways to treat and prevent ADHD.
While some behaviors associated with ADHD are “normal” and not a cause for concern to most people, someone with ADHD will have trouble controlling these behaviors and will show them much more frequently and for longer than 6 months.
Signs of inattention include:
- Becoming easily distracted, and jumping from activity to activity.
- Becoming bored with a task quickly.
- Difficulty focusing attention or completing a single task or activity.
- Trouble completing or turning in homework assignments.
- Losing things such as school supplies or toys.
- Not listening or paying attention when spoken to.
- Daydreaming or wandering with lack of motivation.
- Difficulty processing information quickly.
- Struggling to follow directions.
Signs of hyperactivity include:
- Fidgeting and squirming, having trouble sitting still.
- Non-stop talking.
- Touching or playing with everything.
- Difficulty doing quiet tasks or activities.
Signs of impulsivity include:
- Acting without regard for consequences, blurting things out.
- Difficulty taking turns, waiting or sharing.
- Interrupting others.
There are several factors believed to contribute to ADHD:
- Genetics. Research shows that genes may be a large contributor to ADHD. ADHD often runs in families and some trends in specific brain areas that contribute to attention.
- Environmental factors. Studies show a link between cigarette smoking and alcohol use during pregnancy and children who have ADHD. Exposure to lead as a child has also been shown to increase the likelihood of ADHD in children.
ADHD occurs in both children and adults, but is most often and diagnosed in childhood. Getting a diagnosis for ADHD can sometimes be difficult because the symptoms of ADHD are similar to typical behavior in most young children. Teachers are often the first to notice ADHD symptoms because they see children in a learning environment with peers every day.
There is no one single test that can diagnose a child with ADHD, so meet with a doctor or mental health professional to gather all the necessary information to make a diagnosis. The goal is to rule out any outside causes for symptoms, such as environmental changes, difficulty in school, medical problems and ensure that a child is otherwise healthy.
ADHD is managed and treated in several ways:
- Medications, including stimulants, nonstimulants and antidepressants
- Behavioral therapy
- Self-management, education programs and assistance through schools or work or alternative treatment approaches
Around two-thirds of children with ADHD also have another condition. Many adults are also impacted by the symptoms of another condition. Common conditions associated with ADHD include the following.
- Learning disabilities
- Oppositional defiant disorder: refusal to accept directions or authority from adults or others
- Conduct disorder, persistent destructive or violent behaviors
- Anxiety and depression
- Obsessive-compulsive disorder
- Bipolar disorder
- Tourette’s syndrome
- Sleep disorders
- Substance use disorders/ Dual Diagnosis
Symptoms from other conditions make treating ADHD more difficult. Talking to a skilled professional to help establish an accurate diagnosis can help increase the effectiveness of treatment.
A treatment plan is most effective when tailored to an individual’s needs, and implemented early on. ADHD treatment plans should consider learning style and include medication prescribed by a professional. A doctor or mental health professional may also include behavioral therapy into treatment.
Medication improves the symptoms of ADHD so that people can focus more on the things they enjoy and improve quality of life. Finding the right medication is a process and not every medication will work for everyone.
Effective medications can improve attention span, your ability to deal with frustration. and lead to better relationships.
The most prescribed medications for ADHD are stimulants. These medications work by making it easier for nerve receptors in the brain to communicate with each other. The impact of stimulants can often noticed quickly, but they may reduce appetite and impact sleep. They can also shorten a growing child’s height a small amount if taken for many years, so be sure to track growth over time.
Stimulants affect how the brain controls impulses and help to regulate behavior and attention. They are usually the first choice of medication to use for the management of ADHD.
- Methylphenidate (Methylin, Ritalin, Concerta)
- Methylphenidate SR (Ritalin SR)
- Transdermal (Daytrana)
- Dexmethylphenidate (Focalin XR, SR Focalin)
- Dextroamphetamine (Dexedrine, Dextrostat, Spansule)
- Amphetamine (Adderall, Adderall XR)
- Lisdexamfetemine or Dimesylate (Vyvanse)
Because of the fast-acting nature and effects, stimulants have the potential for misuse. People have used these medications to improve academic or athletic performance or for the physical reaction. Possession of these medications without a prescription is illegal.
Non-stimulant medications are also commonly prescribed. It may take some time for these medications to become effective. Nonstimulants affect the nerve receptors more indirectly than stimulants. It is necessary to keep track of treatment results over time.
Nonstimulant drugs are used to increase and adjust the levels of neurotransmitters in the brain. This helps with concentration by increasing attention span and reducing impulsivity.
Antidepressants may also be something a doctor suggests. This is especially true if someone is living with ADHD and depression. For medications that are not first- or second-line treatments for ADHD, ask your doctor why they recommend this treatment. You should also ask about their knowledge and experience with treating ADHD with these kinds of medications. Always be sure to check the FDA approval status of any medicine.
- Nortriptyline (Pamelor, Aventyl)
- Desipramine (Norpramin)
- Imipramine (Tofranil)
- Bupropion (Wellbutrin, Wellbutrin XL, Welbutrin SR)
- Venlafazine (Effexor, Effexor XR)
Remember that dosage and scheduling of medication will impact treatment outcomes. Young children need to be monitored to ensure they are taking the correct dosage of the medication. Dosage may change as they get older. Some parents choose to only give their children medication when they are in school.
Note that any medication may cause side effects. Common side effects of ADHD medications include appetite, sleep problems, anxiety and irritability. You can manage side effects with a change in dosage and often lessen and even disappear over time.
A mental health professional can help a person come up with ways to improve behavior. For example, a doctor may provide guidance on how to organize and complete homework assignments. Mental health professionals may also help you learn how to work through frustrating events. Providing feedback as well as support is key in improving behavior. Having structure, routine and clear expectations of what is allowed and not allowed can help a child learn and feel more in control of their own life. Talk about what behavior and outbursts are acceptable.
Behavior therapy can also help improve social skills, such as sharing and interacting with peers. Learning appropriate responses to everyday situations can help your child have healthier relationships. Better relationships with teachers, friends and family can improve the quality of life for your child.
Complementary Health Approaches
Outside of therapy and medications, there are many approaches to managing ADHD. These alternative methods, called complementary and alternative medicine (CAM), can supplement a treatment plan and support day-to-day health.
- Elimination diets are based on the theory that people are sensitive to sugar and artificially added colors, flavors and preservatives. Eliminating these substances from the diet could improve learning and behavioral problems.
- Nutritional supplements, such as omega-3s, may help the deficiency of fatty acids that are sometimes associated with ADHD.
- Interactive metronome training consists of a computerized metronome making a rhythmic beat that individuals try to match by tapping a hand or foot. It is suggested that improvement in matching the beat reflects gains in motor planning and timing skills.
- Chiropractic medicine addresses muscle tone imbalance that can affect imbalances in brain activity.
- Neurofeedback (EEG biofeedback) teaches individuals how to increase activity in the frontal areas of the brain. This is because people living with ADHD show low levels of arousal in these areas, which results in an impaired ability to focus. Through training, people can learn how to increase arousal on their own.
ADHD is one of the conditions most strongly linked to genetics. People with ADHD do not lack intelligence or discipline. They are just challenged at focusing to complete tasks. Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or firstname.lastname@example.org if you have any questions about anxiety disorders or need to find support and resources.
Many of the strategies that help youth with ADHD, including structure, organizational tips and coaching as well as medication can be helpful for adults living with ADHD as well. An individualized approach to treatment that focuses on strengths and circumstances is critical for adult and children.
One of the major areas of focus for adults living with ADHD is learning to manage the disorder in the workplace. Symptoms can cause difficulties in some or all the following areas:
- Organizing paperwork, prioritizing tasks and estimating the amount of time it takes to get started on and complete projects on time
- Focusing, sustaining and shifting attention from one project to another
- Staying alert, sustaining effort and processing information in a reasonable amount of time
- Remembering facts while actively processing other information
- Regulating impulsivity and picking up on the nonverbal cues from others
There are a lot of things you can do to keep yourself organized and work with a low level of stress. Know your rights and work with your employer to make your environment suitable for your needs. Some common accommodations include:
- Scheduling regular meetings with supervisor to prioritize tasks
- Developing a checklist of assignments, and a workflow chart that provides an idea of time required for each project
- Using an electronic filing system
- Extending deadlines on projects and tasks
- Providing a distraction-free workspace
- Breaking up big assignments into smaller tasks
- Providing structured breaks
- Integrating interesting projects with more mundane tasks
- Allowing the employee to audio record instructions and meetings, and/or providing written instructions on projects and training
- Allowing the employee to work from home
- Engaging the help of a job coach
- Allowing the employee to skip social events
- Assigning a mentor to assist the employee
You will want to talk with your supervisor and ensure that these accommodations will not cause an burden on your place of employment. You can find more information about accommodations by visiting the Job Accommodation Network website.
Coaching has emerged as a new industry over the last half century to enhance the personal and professional development. ADHD Coaching has developed over the last few decades as a component to the treatment of ADHD. It is a support that is well-suited to the needs of people living with ADHD, including adults and youth. In general, ADHD coaching:
- Enhances understanding of ADHD’s impacts on a client’s life
- Provides a framework that includes self-acceptance
- Provides a laboratory for effective, experiential learning
- Works with a client to identify areas of strength
- Identifies avenues for managing challenge areas
- Develops personalized strategies for success
ADHD coaches often work with you on scheduling, goal setting, confidence building, organizing, focusing, prioritizing and persisting at tasks. ADHD coaching is an effective way to create lasting change. A coaching relationship provides the structure to focus on what’s important, find the clarity peopel need to make decisions, determine the actions they want to take—and then hold them accountable.
Coaches can also help parents of children living with ADHD. For parents, coaching offers a way to:
- Help kids determine their strengths and motivations
- Expose kids to the benefits of celebrating successes
- Teach kids to shift perspectives and get “unstuck”
- Pass on life lessons, both positive and negative
- Support kids in figuring out what they want in their lives
- Provide constructive feedback and accountability
- Share their values, beliefs and perspectives
To learn more and find ADHD coaches, visit the EdgeFoundation (for ADHD students), Impact ADHD (for parents), the Institute for the Advancement of ADHD Coaching (IAAC) and the International Coach Federation.
If you live with a mental health condition, learn more about managing your mental health and finding the support you need.
Helping A Family Member Or Friend
ADHD is one of the most common conditions in children, so first you should know that you and your child are not alone.
ADHD is not a byproduct of parenting style. Also, children living with ADHD do not lack intelligence or discipline—they are just challenged by sustaining the focus needed to complete tasks appropriate for their age.
To provide support for your child at home there are many things you can do:
Maintain a positive attitude. Focus on successes and victories and less on the challenges or obstacles of the condition. Always have his strengths, goals and interests help drive the services and supports he receives to manage the symptoms of ADHD. For example, if your child is always moving, consider engaging him in physical activities like yoga, dance class, running, martial arts or similar activities in which the symptoms of ADHD may actually help him excel. It is helpful to create experiences that build on strengths and bolster self-esteem. Your positive attitude is the best tool in helping your child overcome the challenges of ADHD.
Create and maintain structure. Children living with ADHD are more likely to succeed when they have a regular schedule of tasks each day. They can experience serious problems if their daily structure changes, or they are forced to make a big change. Create and sustain a supportive structure so that your child knows what to expect every day.
Communicate rules and expectations. Children living with ADHD do well with clear and simple rules and expectations that they can easily understand and follow. Write down any rules and expectations and post them in a place where your child can easily read them. You may also want to create a chores chart for her to look at every day. She may also respond well to an organized system of rewards and consequences—consistency is key. Explain the consequences when rules are broken and to praise her when they are obeyed. Rewards should be immediate experiences and activities with a parent to encourage bonding and connection rather than tangible rewards or treats. Consequences should not punish the child but the behavior (e.g., time out from any reinforcing activities).
Encourage movement and sleep. Children who live with ADHD have energy to burn. Organized sports and other physical activities can help them increase their self-esteem and unleash their energy in healthy and productive ways with other children in their age group. Children living with ADHD who exercise often tend to sleep better, which can greatly reduce ADHD symptoms. Have a nighttime routine that encourages a healthy sleep cycle—this may include reading, avoiding electronics and encouraging self-soothing activities before bed. Martial arts can be a helpful strategy as they emphasize self-control and increase confidence.
Focus on social skills. Children living with ADHD often have difficulty with peer relationships and making friends. They may have trouble with reading social cues, talking too much, interrupting frequently or coming off as inappropriately aggressive. Their emotional immaturity may cause them to stand out among other kids in their age group, contributing to low self-esteem. Model social skills, hire a life coach or work with your child’s therapist to address this issue. Being connected to family and friends is an important part of living well with ADHD.
Students living with ADHD may experience unique challenges in the classroom. The common symptoms of ADHD—inattention, hyperactivity and impulsivity—can cause disruptions to a child’s learning, peer relationships, functional performance and behavior within the school setting. ADHD may manifest itself differently in the classroom than what you see at home. Girls living with ADHD are at times overlooked as their presentation often involves less behavioral disruption than boys.
Your child’s school will likely offer programs and special educational services if you feel that he may need them. The school can conduct an evaluation to see if he qualifies. You should speak with your child’s teacher and other counselors about these opportunities.
The following is a list of typical accommodations that a student living with ADHD may receive from their school:
- Modified homework assignments, testing and deadlines
- Use of helpful tools (calculator, tape recorder, computer and electric spell-checker)
- A behavioral plan or social skills training
- Continual progress reports assessing behavior and assignments
- Peer, volunteer tutors or working one-on-one with the teacher
- Sitting the student near the teacher and away from doors and windows
- Increased parent and teacher collaboration
- Providing the student with a note-taking partner
- Letting the student run occasional errands for the teacher to burn off some energy
The following is a list of more intensive services and supports that may be provided for students living with ADHD:
- Supplementary aids and services
- School-based counseling
- Family counseling and training
- Resource room services (small group work)
- Test modifications, such as small group testing in a separate location
- One-on-one service providers, such as crisis management services, transportation services and more
- Collaborative team teaching