- ADHD is a condition that involves struggling with hyperactivity/impulsivity and/or attention.
- ADHD’s causes are complex, but you’re more likely to experience it if a first-degree relative does.
- A careful balance of lifestyle changes, medications, and talking therapies can treat ADHD.
ADHD is a condition that affects the way people behave. Around 9.8 percent of children received an ADHD diagnosis between 2016 and 2019. The number of adults aged between 18 and 44 who have ADHD is approximately 8.1 percent.
ADHD’s causes aren’t well understood, but a range of treatment options is available. Knowing more about the condition can make it easier to recognize and manage.
ADHD Symptoms
ADHD’s symptoms fall into two categories: inattention and hyperactivity/impulsivity. Symptoms may present differently in adults, or they might be more subtle than when they’re present in children.
ADHD Inattention Symptoms
ADHD’s inattention symptoms can include:
- Difficulty paying attention to tasks or games
- Avoiding tasks that require a lot of effort over a long period of time
- Experiencing difficulty with organizing tasks
- Struggling to follow the instructions that are necessary to complete tasks at work or school
- Making careless mistakes with schoolwork and projects
- Losing items that are essential for completing tasks, such as textbooks, notebooks, and stationary
- Appearing vacant or inattentive when being spoken to
- Difficulty with finishing books or TV shows
ADHD Hyperactivity and Impulsivity Symptoms
ADHD’s hyperactivity and inattention symptoms include:
- Interrupting conversations or interrupting a conversation before the speaker finishes
- Interrupting games and projects
- Difficulty with waiting to take a turn
- Excessive talking
- Struggling to participate with activities quietly
- Fidgeting excessively and struggling to sit still
- Restlessness, even in situations where a person should remain still
- In children, running around and jumping up and down in situations where they should remain still
- Struggling to remain in one place, even when a situation requires it
ADHD Causes and Risk Factors
ADHD’s causes are not fully understood. However, certain biological and environmental elements may contribute.
Biological Causes of ADHD
- First-degree relatives. A meta analysis of twin studies reveals how heritability is 77 to 88 percent among twins. A high heritability among twins suggests there’s a strong genetic component to ADHD.
- Brain structure. A meta analysis of MRI studies investigating the neurobiological causes of ADHD identifies how disconnections between different areas of the brain may contribute to the disorder.
- Premature birth. Being born before 37 weeks may increase the risk of developing neurological disorders, including ADHD.
- Maternal psychiatric disorders. One cohort study suggests that there’s a link between some antipsychotics taken by the mother during pregnancy and an increased chance of developing ADHD.
- Epilepsy. Around 30 to 40 children with epilepsy also have ADHD.
Environmental Causes
- In-vitro exposure. A number of maternal states and habits during pregnancy may increase the risk of ADHD. Smoking, pre-eclampsia, pollution, stress, and depression can increase maternal inflammation, which may then make ADHD more likely in the child.
- Upbringing. Children who live in an unsupportive environment or growing up in poverty may be at higher risk of ADHD.
- Toxin exposure. A systematic review of studies found that there’s a significant link between lead exposure and ADHD.
- Hyperthyroidism. There’s a small amount of evidence suggesting that newborns with hyperthyroidism are at increased risk of ADHD. This risk is higher in girls.
ADHD Diagnosis
There is no strict test for diagnosing ADHD. However, healthcare professionals will look for certain symptoms before they reach a conclusion. The approach a healthcare professional takes usually differs depending on the patient’s age.
Children Aged up to 16 Years
In children aged up to 16 years, healthcare providers look for:
- Six or more inattention symptoms.
- Inattention symptoms for at least six months.
- Inattention symptoms that are inappropriate for the child’s developmental level
- Six or more symptoms of impulsivity or hyperactivity
- Impulsivity and hyperactivity symptoms for at least six months
- Impulsivity and hyperactivity symptoms that are disruptive for the child’s developmental level
- Several symptoms present in more than one setting, such as both home and school
- Symptoms that disrupt the child’s ability to function in educational environments
- Symptoms that don’t stem from another mental health disorder, such as depression
- In the case of children aged 13 and above, several symptoms that existed before the age of 12
Children may display six symptoms from either the inattention or hyperactivity-impulsivity category to be diagnosed with ADHD. They may also have a mix of symptoms from both categories.
Adults and Children Aged 17 and Over
Adults and adolescents may display symptoms in a different way than children. While they may not run around at inappropriate times, for example, they might struggle to remain in one place at work.
When diagnosing individuals aged 17 and over, healthcare professionals look for five or more symptoms from the inattention or impulsivity-hyperactivity list. In adolescents and adults, they may look like:
- Having a short attention span
- Starting new activities before completing an old one
- Being forgetful and losing things
- Being unable to focus on boring tasks
- Struggling to stay organized
- Constant fidgeting and moving around a lot
- Acting without thinking
- Talking excessively
- Having a poor sense of danger
- Interrupting conversations and/or finishing people’s sentences
Defining the ADHD Diagnosis: ADHD Types
After assessing a patient’s symptoms, healthcare professionals may diagnose one of three types of ADHD:
- Predominantly inattentive. More inattentive symptoms must be present than hyperactive-impulsive symptoms.
- Predominantly hyperactive-impulsive. Hyperactive-impulsive symptoms are more dominant than inattentive symptoms.
- Combined diagnosis. A combined diagnosis requires symptoms from the inattentive and hyperactive-impulsive categories.
ADHD Complications
When ADHD goes untreated, it comes with a range of complications:
- Poor school and work performance. Being unable to focus on school and work can result in someone performing poorly, even when they’re capable of achieving more.
- Impacted relationships. Caregivers, relatives, friends, and partners may struggle to understand someone who has ADHD. They can find some of the symptoms frustrating, which can place strain on relationships.
- Self-esteem. When you struggle to meet social expectations and experience strained relationships, self-esteem may start to suffer.
- Social problems. Not having the right support can increase your risk of social issues. Social issues can include breaking the law, poor financial management, and struggling to hold a job.
Having ADHD may increase your risk of other conditions, including:
- Depression. When you struggle to navigate the world without the right support, you may feel isolated and depressed. If you have a mood disorder such as bipolar disorder, your ADHD symptoms may worsen them.
- Psychiatric disorders. Having ADHD may increase your risk of other psychiatric disorders, including personality disorder and substance misuse disorder.
- Suicide. When ADHD becomes particularly frustrating, you may be at higher risk of suicide.
- Anxiety. Experiencing ADHD symptoms without support can increase your risk of anxiety disorder.
ADHD Treatment
It’s possible to treat ADHD with a combination of lifestyle changes, talking therapies, and medications. In the case of young children and pre-teens, parents should direct the lifestyle changes.
Lifestyle Changes
The American Academy of Pediatrics (AAP) recommends that children under the age of six try a behavioral management program before trying medications. Behavioral management programs are directed by parents and (where relevant) their teachers.
Other lifestyle changes recommended for children include:
- Healthy eating. Ensuring that children eat a healthy diet early on in life reduces their risk of chronic diseases and malnutrition as they get older.
- Physical activity. Evidence shows that regular physical activity can reduce aggression, anxiety, depression, and thought disorganization in children with ADHD. It’s important to ensure that the physical activity is appropriate for the child’s age group.
- Reducing screen time. Although screen time doesn’t cause ADHD, children may find it easier to focus on a screen than other activities. Reducing screen time encourages them to develop the skills needed to focus on alternative activities.
- Promoting sleep. It’s important for children to get the right amount of sleep for their age. Not getting enough sleep may exacerbate some ADHD symptoms.
Adults can also benefit from the same lifestyle adaptations as children. Additional management tips adults can try include:
- Routines. Sticking to a routine can make it easier to manage tasks.
- Meditation. Regularly practicing mindfulness meditation can improve executive function and reduce emotional dysregulation.
- Deep breathing techniques. Trying deep breathing is a useful way to reduce in-the-moment stress.
- Breaking tasks down. Breaking tasks down can make them feel less daunting and more manageable. One useful technique involves focusing on a task for 25 minutes at a time and taking small breaks in between.
Talking Therapies
Cognitive behavioral therapy (CBT) can prove useful in both children and adults who have ADHD. A therapist may take the following approaches when treating ADHD:
- Challenging negative thoughts. The more negative thoughts you experience, the less likely you are to complete tasks. Challenging negative thoughts can make tasks feel less daunting.
- Psychoeducation. Psychoeducation allows you to understand your condition. It also helps parents understand their children’s condition.
- Positive self-talk. When you struggle to complete goals, using positive self-talk techniques can prevent you from abandoning them altogether.
- Alternative perspectives. Your therapist can help you explore alternative perspectives when you feel frustrated with yourself. A good example is thinking, “It’s good that I sometimes get things done” rather than, “I’m a complete failure for not finishing that task.”
Medications
Medications are usually available to adults and children over the age of six. In a small number of cases, children under the age of six can take ADHD medications under a pediatrician’s guidance.
Some of the medications available to treat ADHD include:
- Short-acting stimulants. Short-acting stimulants are useful for boosting concentration. Drugs such as dextroamphetamine (Dexedrine) can increase concentration for a few hours at a time.
- Long-acting stimulants. Long-acting stimulants promote longer periods of concentration, sometimes reaching up to 12 hours. Long-acting drugs such as methylphenidate (Ritalin) are available in a slow-release form.
- Non-stimulant medications. Non-stimulant medications are available to reduce impulse control and boost concentration. Medications such as clonidine (Catapres) remain effective for up to seven days when used as patches.
- Antidepressants. Doctors can prescribe antidepressants to improve concentration. Although prescribing antidepressants for ADHD is an off-label approach, medications such as bupropion (Wellbutrin) can improve dopamine and sertraline levels.
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