- 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.
- 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.
- Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have a high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Symptoms in children and teenagers
The symptoms of ADHD in children and teenagers are well defined, and they’re usually noticeable before the age of 6. They occur in more than 1 situation, such as at home and at school.
The main signs of inattentiveness are:
- having a short attention span and being easily distracted
- making careless mistakes – for example, in schoolwork
- appearing forgetful or losing things
- being unable to stick to tasks that are tedious or time-consuming
- appearing to be unable to listen to or carry out instructions
- constantly changing activity or task
- having difficulty organising tasks
Hyperactivity and impulsiveness
The main signs of hyperactivity and impulsiveness are:
- being unable to sit still, especially in calm or quiet surroundings
- constantly fidgeting
- being unable to concentrate on tasks
- excessive physical movement
- excessive talking
- being unable to wait their turn
- acting without thinking
- interrupting conversations
- little or no sense of danger
These symptoms can cause significant problems in a child’s life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.
Related conditions in children and teenagers with ADHD
Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:
- anxiety disorder – which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
- oppositional defiant disorder (ODD) – this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
- conduct disorder – this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
- sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
- autistic spectrum disorder (ASD) – this affects social interaction, communication, interests and behaviour
- epilepsy – a condition that affects the brain and causes repeated fits or seizures
- Tourette’s syndrome – a condition of the nervous system, characterised by a combination of involuntary noises and movements (tics)
- learning difficulties – such as dyslexia
Symptoms in adults
In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.
As ADHD is a developmental disorder, it’s believed it cannot develop in adults without it first appearing during childhood.
But it’s known that symptoms of ADHD often persist from childhood into a person’s teenage years and then adulthood.
Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood.
By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.
The symptoms in children and teenagers are sometimes also applied to adults with possible ADHD.
But some specialists say the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children.
For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressures of adult life increase.
Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.
Some specialists have suggested the following as a list of symptoms associated with ADHD in adults:
- carelessness and lack of attention to detail
- continually starting new tasks before finishing old ones
- poor organisational skills
- inability to focus or prioritise
- continually losing or misplacing things
- restlessness and edginess
- difficulty keeping quiet, and speaking out of turn
- blurting out responses and often interrupting others
- mood swings, irritability and a quick temper
- inability to deal with stress
- extreme impatience
- taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously
Related conditions in adults with ADHD
As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions.
One of the most common is depression. Other conditions that adults may have alongside ADHD include:
- personality disorders – conditions in which an individual differs significantly from the average person in terms of how they think, perceive, feel or relate to others
- bipolar disorder – a condition affecting your mood, which can swing from one extreme to another
- obsessive-compulsive disorder (OCD) – a condition that causes obsessive thoughts and compulsive behaviour
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships and social interaction.
ADHD tends to run in families and, in most cases, it’s thought the genes you inherit from your parents are a significant factor in developing the condition.
Research shows that parents and siblings of a child with ADHD are more likely to have ADHD themselves.
However, the way ADHD is inherited is likely to be complex and is not thought to be related to a single genetic fault.
Brain function and structure
Research has identified a number of possible differences in the brains of people with ADHD from those without the condition, although the exact significance of these is not clear.
For example, studies involving brain scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger.
Other studies have suggested that people with ADHD may have an imbalance in the level of neurotransmitters in the brain, or that these chemicals may not work properly.
Groups at risk
Certain groups are also believed to be more at risk of ADHD, including people:
- who were born prematurely (before the 37th week of pregnancy) or with a low birth weight
- with epilepsy
- with brain damage – which happened either in the womb or after a severe head injury later in life
- about your symptoms or those of your child
- when these symptoms started
- where the symptoms occur – for example, at home or in school
- whether the symptoms affect your or your child’s day-to-day life – for example, if they make socialising difficult
- if there have been any recent significant events in your or your child’s life, such as a death or divorce in the family
- if there’s a family history of ADHD
- about any other problems or symptoms of different health conditions you or your child may have
If the GP thinks your child may have ADHD, they may first suggest a period of “watchful waiting” – lasting around 10 weeks – to see if your child’s symptoms improve, stay the same or get worse.
They may also suggest starting a group-based, ADHD-focused parent training or education programme. Being offered a parent training and education programme does not mean you have been a bad parent – it aims to teach you ways of helping yourself and your child.
If your child’s behaviour does not improve, and both you and the GP believe it’s affecting their day-to-day life, the GP should refer you and your child to a specialist for a formal assessment.
For adults with possible ADHD, the GP will assess your symptoms and may refer you for an assessment if:
- you were not diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since
- your symptoms cannot be explained by a mental health condition
- your symptoms significantly affect your day-to-day life – for example, if you’re underachieving at work or find intimate relationships difficult
You may also be referred to a specialist if you had ADHD as a child or young person and your symptoms are now causing moderate or severe functional impairment.
There are a number of different specialists you or your child may be referred to for a formal assessment, including:
- a child or adult psychiatrist
- a paediatrician – a specialist in children’s health
- a learning disability specialist, social worker or occupational therapist with expertise in ADHD
Who you’re referred to depends on your age and what’s available in your local area.
There’s no simple test to determine whether you or your child has ADHD, but your specialist can make an accurate diagnosis after a detailed assessment. The assessment may include:
- a physical examination, which can help rule out other possible causes for the symptoms
- a series of interviews with you or your child
- interviews or reports from other significant people, such as partners, parents and teachers
The criteria for making a diagnosis of ADHD in children, teenagers and adults are outlined below.
Diagnosis in children and teenagers
Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have 6 or more symptoms of inattentiveness or 6 or more symptoms of hyperactivity and impulsiveness.
To be diagnosed with ADHD, your child must also have:
- been displaying symptoms continuously for at least 6 months
- started to show symptoms before the age of 12
- been showing symptoms in at least 2 different settings – for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or to parental control
- symptoms that make their lives considerably more difficult on a social, academic or occupational level
- symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition
Diagnosis in adults
Diagnosing ADHD in adults is more difficult because there’s some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults.
In some cases, an adult may be diagnosed with ADHD if they have 5 or more of the symptoms of inattentiveness, or 5 or more of hyperactivity and impulsiveness, listed in diagnostic criteria for children with ADHD.
As part of your assessment, the specialist will ask about your present symptoms. However, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot be confirmed unless your symptoms have been present from childhood.
If you find it difficult to remember whether you had problems as a child, or you were not diagnosed with ADHD when you were younger, your specialist may wish to see your old school records or talk to your parents, teachers or anyone else who knew you well when you were a child.
For an adult to be diagnosed with ADHD, their symptoms should also have a moderate effect on different areas of their life, such as:
- underachieving at work or in education
- driving dangerously
- difficulty making or keeping friends
- difficulty in relationships with partners
If your problems are recent and did not occur regularly in the past, you’re not considered to have ADHD. This is because it’s currently thought that ADHD cannot develop for the first time in adult.
Ways to cope
Although it can be difficult at times, it’s important to remember that a child with ADHD cannot help their behaviour. People with ADHD find it difficult to suppress impulses, which means they do not stop to consider a situation or the consequences before they act.
If you’re looking after a child with ADHD, you may find the below advice helpful.
Plan the day
Plan the day so your child knows what to expect. Set routines can make a difference in how a child with ADHD copes with everyday life.
For example, if your child has to get ready for school, break it down into structured steps, so they know exactly what they need to do.
Set clear boundaries
Make sure everyone knows what behaviour is expected, and reinforce positive behaviour with immediate praise or rewards. Be clear, using enforceable consequences, such as taking away a privilege, if boundaries are overstepped and follow these through consistently.
Give specific praise. Instead of saying a general: “Thanks for doing that,” you could say: “You washed the dishes really well. Thank you.”
This will make it clear to your child that you’re pleased and why.
If you’re asking your child to do something, give brief instructions and be specific. Instead of asking: “Can you tidy your bedroom?” say: “Please put your toys into the box and put the books back onto the shelf.”
This makes it clearer what your child needs to do and creates opportunities for praise when they get it right.
Set up your own incentive scheme using a points or star chart, so good behaviour can earn a privilege. For example, behaving well on a shopping trip will earn your child time on the computer or some sort of game.
Involve your child in it and allow them to help decide what the privileges will be.
These charts need regular changes or they become boring. Targets should be:
- immediate – for example, daily
- intermediate – for example, weekly
- long-term – for example, 3-monthly
Try to focus on just 1 or 2 behaviours at a time.
Watch for warning signs. If your child looks like they’re becoming frustrated, overstimulated and about to lose self-control, intervene.
Distract your child, if possible, by taking them away from the situation. This may calm them down.
Keep social situations short and sweet. Invite friends to play, but keep playtimes short so your child does not lose self-control. Do not aim to do this when your child is feeling tired or hungry, such as after a day at school.
Make sure your child gets lots of physical activity during the day. Walking, skipping and playing sport can help your child wear themselves out and improve their quality of sleep.
Make sure they’re not doing anything too strenuous or exciting near to bedtime.
Keep an eye on what your child eats. If your child is hyperactive after eating certain foods, which may contain additives or caffeine, keep a diary of these and discuss them with a GP.
Stick to a routine. Make sure your child goes to bed at the same time each night and gets up at the same time in the morning.
Avoid overstimulating activities in the hours before bedtime, such as computer games or watching TV.
Sleep problems and ADHD can be a vicious circle. ADHD can lead to sleep problems, which in turn can make symptoms worse.
Many children with ADHD will repeatedly get up after being put to bed and have interrupted sleep patterns. Trying a sleep-friendly routine can help your child and make bedtime less of a battleground.
Help at school
Children with ADHD often have problems with their behaviour at school, and the condition can negatively affect a child’s academic progress.
Speak to your child’s teachers or their school’s special educational needs co-ordinator (SENCO) about any extra support your child may need.
Adults with ADHD
If you’re an adult living with ADHD, you may find the following advice useful:
- if you find it hard to stay organised, then make lists, keep diaries, stick up reminders and set aside some time to plan what you need to do
- let off steam by exercising regularly
- find ways to help you relax, such as listening to music or learning relaxation techniques
- if you have a job, speak to your employer about your condition, and discuss anything they can do to help you work better
- talk to a doctor about your suitability to drive, as you’ll need to tell the Driver and Vehicle Licensing Agency (DVLA) if your ADHD affects your driving
- contact or join a local or national support group – these organisations can put you in touch with other people in a similar situation and can be a good source of support, information and advice.
Signs and Symptoms
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity, and impulsivity, but for people with ADHD, these behaviors:
- are more severe
- occur more often
- interfere with or reduce the quality of how they function socially, at school, or in a job
People with symptoms of inattention may often:
- 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
- Not seem to listen when spoken to directly
- Not follow through on instructions and 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 what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet 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
- Be easily distracted by unrelated thoughts or stimuli
- Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
People with symptoms of hyperactivity-impulsivity may often:
- Fidget and squirm in their seats
- Leave their seats in situations when staying seated is expected, such as in the classroom or the office
- Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
- Be unable to play or engage in hobbies quietly
- Be constantly in motion or “on the go,” or act as if “driven by a motor”
- Talk nonstop
- Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in a conversation
- Have trouble waiting for his or her turn
- Interrupt or intrude on others, for example in conversations, games, or activities
Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12.
ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.
ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.
Researchers are not sure what causes ADHD. Like many other illnesses, several 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.
Treatment and Therapies
While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.
For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.
Stimulants. The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works by increasing the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.
Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose. For example, stimulants can raise blood pressure and heart rate and increase anxiety. Therefore, a person with other health problems, including high blood pressure, seizures, heart disease, glaucoma, liver or kidney disease, or an anxiety disorder should tell their doctor before taking a stimulant.
Talk with a doctor if you see any of these or other side effects while taking stimulants:
- decreased appetite
- sleep problems
- tics (sudden, repetitive movements or sounds)
- personality changes
- increased anxiety and irritability
Non-stimulants. A few other ADHD medications are 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: when a person has bothersome side effects from stimulants; when a stimulant was not effective; or in combination with a stimulant to increase effectiveness.
Although not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, some antidepressants are sometimes used alone or in combination with a stimulant to treat ADHD. Antidepressants may help all of the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.
Doctors and patients can work together to find the best medication, dose, or medication combination. Learn the basics about stimulants and other mental health medications on the NIMH Mental Health Medications webpage and check the FDA website for the latest information on warnings, patient medication guides, or newly approved medications.
Psychotherapy and Psychosocial Interventions
Several specific psychosocial interventions have been shown to help patients and their families manage symptoms and improve everyday functioning. In addition, children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed.
For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need specialized help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
Behavioral therapy is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:
- monitor his or her own behavior
- give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting
Parents, teachers, and family members also can give positive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.
Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage and ignore or redirect behaviors that they want to discourage. They may also learn to structure situations in ways that support desired behavior.
Specific behavioral classroom management interventions have been shown to be effective for managing youths’ symptoms and improving their functioning at school and with peers. These research-informed strategies typically include teacher-implemented reward programs that often utilize point systems and communication with parents via Daily Report Cards.
Many schools offer special education services to children with ADHD who qualify. Educational specialists help the child, parents, and teachers make changes to classroom and homework assignments to help the child succeed. Public schools are required to offer these services for qualified children, which may be free for families living within the school district. Learn more about the Individuals with Disabilities Education Act (IDEA), visit the U.S. Department of Education’s IDEA website.
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. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
The National Resource Center on ADHD, a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD®) supported by the Centers for Disease Control and Prevention (CDC), has information and many resources. You can reach this center online or by phone at 1-866-200-8098.
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 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, (such as clothing, backpacks, and toys), and keep everything in its place.
- 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.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.