Attention deficit/hyperactivity disorder (commonly referred to as ADD or ADHD – though AD/HD is the technically correct abbreviation) is a neurologically based condition characterized by problems with attention, impulse control, and hyperactivity.
Symptoms of ADHD develop in childhood, but can persist into adolescence and adulthood. Without appropriate identification and treatment, ADHD can have serious consequences including chronic under-achievement, school/work failure, problematic and strained relationships, lowered self-esteem and can result in increased risk for depression, anxiety and substance abuse.
According to the National Institute of Mental Health, ADHD affects an estimated 3 to 5 percent of preschool and school age children in the United States. To put these numbers into perspective, in a class of 25 to 30 children, it is likely that at least one student will have ADHD. The majority of these children will continue to experience impairing symptoms into adolescence and adulthood.Boys are diagnosed two to three times as often as girls, though this difference in rate of diagnosis for males and females seems to even out in adulthood with adult males and adult females being diagnosed at a more equal ratio of one to one.
Symptoms of ADHD
Symptoms of ADHD can present very differently from person to person and across the lifespan. The ways these symptoms impact an individual can range from mild to severely impairing. Presentation of symptoms can also vary depending on situational factors. There are three primary subtypes of ADHD that are identified depending on the combination of symptoms a person experiences. The assignment of these subtypes is not fixed. In other words, a person may move from one subtype to another depending on the primary symptoms he or she currently exhibits.
Below is a listing of the subtypes along with characteristic behaviors seen in each.
- ADHD: Predominately Inattentive Type
- fails to give close attention to details, makes careless mistakes in schoolwork, work or other activities
- is easily distracted, has difficulty paying attention in tasks, especially on tasks that are long and tedious
- does not seem to listen when spoken to directly, may daydream, mind seems to be elsewhere even in the absence of any obvious distraction
- struggles to follow through on instructions and to finish schoolwork, chores, or duties in the workplace
- has difficulty with organization
- avoids or dislikes activities that require sustained mental effort
- often loses things
- is frequently forgetful
- ADHD: Predominately Hyperactive-Impulsive Type
- fidgets with hands or feet or squirms in seat
- often leaves seat in classroom or in other situations in which remaining seated is expected, may feel restless during activities or situations in which remaining seated is expected
- runs around or climbs excessively in situations in which it is inappropriate (in teens and adults may be limited to feelings of restlessness)
- has difficulty engaging in activities quietly
- is often “on the go” or acts as if “driven by a motor,” is uncomfortable being still for an extended time
- talks excessively, hyper-talkative
- tends to act without thinking, such as starting on tasks without adequate preparation (for example, before listening or reading through directions) or blurting out answers before questions have been completed, hyper-reactive
- uncomfortable doing things slowly and systematically, tends to rush through activities
- often has difficulty awaiting turn, impatient (this may be displayed through feelings of restlessness)
- interrupts or intrudes on others, butts into conversations or games
- may make impulsive decisions without thinking through consequences, impaired ability to stop, think, inhibit, plan and then act
- ADHD: Combined Type
- meets both inattentive and hyperactive-impulsive criteria
As a child moves through the teenage years and adulthood, the overt symptoms of ADHD may diminish or present in more subtle ways. For example, hyperactivity may be replaced with feelings of restlessness or a person may struggle with chronic procrastination, problems with time management, disorganization, and impulsive decision making, saying things without thinking, and in marital relationships
Receiving a Diagnosis of ADHD
There is no definitive “test” for ADHD as there are for other medical conditions such as diabetes or high blood pressure. ADHD is diagnosed based on the presence of a set of behaviors or symptoms -- diagnostic criteria -- published by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders. Symptoms must be present at such intensity that they significantly impair a person’s ability to function day-to-day in social, academic, or occupational settings. Impairments must persistent, occurring over a period of time, and must not be caused by other factors or a co-existing condition. Some hyperactive-impulsive or inattentive symptoms that caused impairment must have been present in childhood. Read more about the assessment and diagnosis of ADHD, as well as testing for adult ADHD.
Causes of ADHDADHD is not caused by consuming too much sugar, watching television or playing video games, allergic reactions or food sensitivities (though some sensitivities may cause behaviors that look very similar to ADHD), and it is not the result of poor parenting or a lack of discipline. While the exact cause of ADHD is not known, research has shown that heredity and genetics seem to play the largest role in the development of ADHD. Read more about the causes of ADHD.
Treatment of ADHD
There is no “quick fix” or “cure” for ADHD; rather treatment for ADHD means the implementation of strategies and interventions to help manage the symptoms of ADHD more effectively. Treatment for ADHD includes education of the individual and his or her family about the nature of ADHD and its management; positive and proactive behavioral interventions that provide structure, consistency, predictability, and teach appropriate skills; parent training to teach and support effective parenting approaches for a child with ADHD; and modifications, support, and accommodations to increase success at school or work.
For many children and adults with ADHD, medication -- when carefully and appropriately utilized -- is also an integral part of a comprehensive treatment plan. Medication does not cure ADHD, but is often helpful in alleviating many of the symptoms that are causing impairments for that person and can improve daily functioning. In addition, ADHD coaching, social skills training, and psychotherapy (to address any self-esteem issues, depression, anxiety, or family discord resulting from ADHD) are also frequently a part of treatment.
ADHD is a complex and chronic condition that can present very differently from person to person, with new challenges that can arise at each developmental stage of life and symptoms that can present in differing ways as a person ages. In order for treatment to be most effective, strategies must be tailored to the individual. Understanding the unique ways ADHD affects a person’s life and developing effective management strategies is an active and individualized process. This process takes time and ongoing adjustment and tweaking in order to find the treatment approaches that work best for that individual. Read more about ADHD treatment.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) DSM-IV Washington, D.C. 2000
Barkley PhD, Russell A. Attention Deficit Hyperactivity Disorders: A Handbook for Diagnosis and Treatment. New York: Guildford Press. 1998
Center for Disease Control and Prevention. “Prevalence of Diagnosis and Medication Treatment for Attention-Deficit Hyperactivity Disorder: United States, 2003.” Morbidity and Mortality Weekly Report, Mental Health in the United States. 54(34);842-847. 02 Sept. 2005
National Institute of Mental Health. Department of Health and Human Services. National Institutes of Health. 2006