Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school. Most cases are diagnosed when children are 6 to 12 years old.
The symptoms of ADHD usually improve with age, but many adults who are diagnosed with the condition at a young age continue to experience problems.
People with ADHD may also have additional problems, such as sleep and anxiety disorders.
Many children go through phases where they're restless or inattentive. This is often completely normal and doesn't necessarily mean they have ADHD.
However, you should consider raising your concerns with your child's teacher, their school's special educational needs co-ordinator (SENCO) or GP if you think their behaviour may be different to most children their age.
It's also a good idea to speak to your GP if you're an adult and you think you may have ADHD, but you weren't diagnosed with the condition as a child.
The exact cause of ADHD is unknown, but the condition has been shown to run in families. Research has also identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition.
Other factors that have been suggested as potentially having a role in ADHD include:
being born prematurely (before the 37th week of pregnancy)
having a low birthweight
smoking, alcohol or drug abuse during pregnancy
It's thought that around 2% to 5% of school-aged children may have ADHD.
ADHD can occur in people of any intellectual ability, although it's more common in people with learning difficulties.
The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into two types of behavioural problems.
These categories are:
hyperactivity and impulsiveness
Most people with ADHD have problems that fall into both these categories, but this isn't always the case.
For example, some people with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious.
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 six. They occur in more than one situation, such as at home and at school.
The main signs of each behavioural problem are detailed below.
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 at 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
being unable to concentrate on tasks
excessive physical movement
being unable to wait their turn
acting without thinking
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
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
In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.
ADHD is a developmental disorder; it's believed that it can't 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, which are listed above, is sometimes also applied to adults with possible ADHD. But some specialists say that 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 pressure of adult life increases. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.
Some specialists have suggested the following 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
taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously
Additional problems 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 conditions is depression. Other conditions that adults may have alongside ADHD include:
personality disorders– conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others
bipolar disorder– a condition that affects your moods, which can swing from one extreme to another
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job.
Causes of ADHD
The exact cause of attention deficit hyperactivity disorder (ADHD) isn't fully understood, although a combination of factors is thought to be responsible.
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 both parents and siblings of a child with ADHD are four to five times more likely to have ADHD themselves.
However, the way ADHD is inherited is likely to be complex and isn't 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 compared to those who don't have the condition, although the exact significance of these isn't 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.
Research has also shown that the brain may take an average of two to three years longer to mature in children with ADHD, compared to children who don't have the condition.
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.
Other possible causes
Various other causes have also been suggested as playing a role in the development of ADHD, including:
being born prematurely (before the 37th week of pregnancy)
having a low birthweight
brain damage either in the womb or in the first few years of life
drinking alcohol, smoking or misusing drugs while pregnant
exposure to high levels of toxic lead at a young age
However, the evidence for many of these factors is inconclusive, and more research is needed to determine if they contribute to ADHD.
If you think that you or your child may have attention deficit hyperactivity disorder (ADHD), you might want to consider speaking to your GP about it.
If you're worried about your child, it may help to speak to their teachers before seeing your GP, to find out if they have any concerns about your child's behaviour.
Your GP can't formally diagnose ADHD, but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.
When you see your GP, they may ask you:
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 life or your child's, 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 your 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 parent training or education programme to teach you ways of helping your child (see treating ADHD for more information).
If your child's behaviour doesn't improve, and both you and your GP believe it's seriously affecting their day-to-day life, your GP should refer you and your child to a specialist for a formal assessment (see below).
For adults with possible ADHD, your GP will assess your symptoms and may refer you for an assessment if:
you weren't diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since then
your symptoms can't be explained by a mental health condition
your symptoms have a significant impact on 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 that 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 have ADHD, but your specialist can make an accurate diagnosis after a detailed assessment that 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 six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity and impulsiveness.
To be diagnosed with ADHD, your child must also have:
been displaying symptoms continuously for at least six months
started to show symptoms before the age of 12
been showing symptoms in at least two 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 parental control
symptoms that make their lives considerably more difficult on a social, academic or occupational level
symptoms that aren't just part of a developmental disorder or difficult phase, and aren't 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 five or more symptoms of inattentiveness, or five or more symptoms of hyperactivity and impulsiveness, that are 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 can't 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 weren't 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 impact on different areas of their life, such as:
underachieving at work or in education
difficultly making or keeping friends
difficulty in relationships with partners
If your problems are recent and didn't occur regularly in the past, you're not considered to have ADHD. This is because it's currently not thought that ADHD can develop for the first time in adults.
Treatment for attention deficit hyperactivity disorder (ADHD) can help relieve the symptoms and make the condition much less of a problem in day-to-day life.
ADHD can be treated using medication or therapy, but a combination of both is often best.
Treatment is usually arranged by a specialist, such as a paediatrician or psychiatrist, although the condition may be monitored by your GP.
There are five types of medication licensed for the treatment of ADHD:
These medications aren't a permanent cure for ADHD, but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.
Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.
In the UK, all of these medications are licensed for use in children and teenagers. Atomoxetine is also licensed for use in adults who had symptoms of ADHD as children.
If you weren't diagnosed with ADHD until adulthood, your GP and specialist can discuss which medications and therapies are suitable for you.
If you or your child is prescribed one of these medications, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to see your GP for regular check-ups, to ensure the treatment is working effectively and to check for signs of any side effects or problems.
Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.
Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants that work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.
Methylphenidate can be used by teenagers and children with ADHD over the age of six. Although methylphenidate isn't licensed for use in adults, it may be taken under close supervision from your GP and specialist.
The medication can be taken as either immediate-release tablets (small doses taken two to three times a day), or as modified-release tablets (taken once a day in the morning, and they release the dose throughout the day).
Common side effects of methylphenidate include:
a small increase in blood pressure and heart rate
loss of appetite, which can lead to weight loss or poor weight gain
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. A CBT therapist would try to change how your child feels about a situation, which would in turn potentially change their behaviour.
CBT can be carried out with a therapist individually or in a group.
Other possible treatments
There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there's no strong evidence these work, and they shouldn't be attempted without medical advice.
People with ADHD should eat a healthy, balanced diet. Don't cut out foods before seeking medical advice.
Some people may notice a link between types of food and worsening ADHD symptoms. For example, sugar, food colourings and additives, and caffeine are often blamed for aggravating hyperactivity, and some people believe they have intolerances to wheat or dairy products, which may add to their symptoms.
If this is the case, keep a diary of what you eat and drink, and what behaviour this causes. Discuss this with your GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).
Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial in people with ADHD, although the evidence supporting this is very limited.
It's advisable to talk to your GP before using any supplements, because some can react unpredictably with medication or make it less effective.
You should also remember that some supplements shouldn't be taken long term, as they can reach dangerous levels in your body.
Living with ADHD
Caring for a child with attention deficit hyperactivity disorder (ADHD) can be draining.
The impulsive, fearless and chaotic behaviours typical of ADHD can make normal everyday activities exhausting and stressful.
Ways to cope
Although it can be difficult at times, it's important to remember that a child with ADHD can't help their behaviour. People with ADHD find it difficult to suppress impulses, which means they don't 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 to 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 if boundaries are overstepped (such as taking away a privilege) 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 chart 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, three-monthly)
Try to focus on just one or two 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, which may calm them down.
Keep social situations short and sweet. Invite friends to play, but keep playtimes short, so your child doesn't lose self-control. Don't 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.
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