Attention Deficit Hyperactivity Disorder (ADHD)

Learn the signs, risk factors, treatment options, and support activities related to attention deficit hyperactivity disorder (ADHD).

Learn more about ADHD:

Definition

Attention deficit hyperactivity disorder (ADHD), sometimes called attention deficit disorder (ADD), is a common mental disorder. A person with ADHD is more inattentive, hyperactive, and impulsive than others in their age group. ADHD affects people of all ages. It is often identified in childhood. But growing numbers of adolescents and adults find that they have ADHD.

A person with ADHD may:

  • Have trouble paying attention or being patient
  • Act without thinking about the results
  • Be overly active or talkative
  • Have problems sitting still

Due to these symptoms, a person with ADHD tends to have problems in school, at work, and in social relationships.

Signs and Symptoms

A person with ADHD can have various symptoms. The two main types of ADHD symptoms are inattention and hyperactivity-impulsivity. The symptoms occur in two or more settings such as school, work, home, child care, sports, or social situations. A person may have problems just with inattention or just with hyperactivity-impulsivity, but most people with ADHD have both. The symptoms tend to cause problems in daily life and in dealing with others.

For children with ADHD, the symptoms seem to stay stable up to early adolescence. As the person gets older, the symptoms often decrease, become less obvious, or go away. For some, the symptoms stay steady throughout life.

Inattention

A person with ADHD experiences symptoms of inattention for at least six months. The symptoms are not appropriate for the person’s developmental level or age. The person often:

  • Fails to give close attention to details or makes careless mistakes in school, work, or other activities
  • Has trouble holding attention on tasks or play
  • Does not seem to listen when spoken to directly
  • Does not follow instructions and fails to finish schoolwork, chores, or work duties
  • Has trouble organizing tasks and activities
  • Avoids or dislikes tasks that require mental effort for a long period, such as schoolwork or homework
  • Loses things needed for tasks and activities, such as school materials, tools, wallets, keys, eyeglasses, or phones
  • Is easily distracted
  • Is forgetful in daily activities

Hyperactivity-Impulsivity

A person with ADHD experiences symptoms of hyperactivity-impulsivity for at least six months. The symptoms are not appropriate for the person’s developmental level or age. The person often:

  • Fidgets with or taps hands or feet, or squirms in seat
  • Leaves seat when remaining seated is expected
  • Runs about or climbs when it is not appropriate (adolescents or adults may just feel restless)
  • Is unable to take part in leisure activities quietly
  • Is “on the go” and acts as if “driven by a motor”
  • Talks too much
  • Interrupts others, butts into conversations, or blurts out an answer before a question is completed
  • Has trouble waiting for his or her turn

Healthcare practitioners may use blood and urine tests and psychological testing to ensure that no medical illnesses are causing the symptoms.

Risk and Protective Factors

About 6–9% of children and adolescents have ADHD. Symptoms can start as early as age three and can last into adulthood. About 4–6% of adults have ADHD.

ADHD is more common in males than females. Compared with males, females with ADHD are more likely to have problems mainly with inattention, and to have a later diagnosis.

People with ADHD often have other disorders, such as learning disabilities, anxiety disorder, conduct disorder, oppositional defiant disorder, depression, and substance use disorders. Several factors likely play a role in the risk of ADHD. Scientists are not sure of the exact causes.

Genetic Factors

ADHD often runs in families. Many genes are linked to ADHD. A combination of genes likely plays a role. There are no genetic tests for ADHD.

Brain Structure and Function

In young people with ADHD, the brain matures in a normal way but may be delayed three years in some areas, compared to youth without the disorder. The delay in ADHD is greatest in brain areas that help control thinking, attention, and planning. The brain’s executive functions seem to be impaired in ADHD. Executive functions describe how the brain helps a person work toward a goal, make decisions, assess risks, plan, sequence actions, and cope with new situations.

Environmental and Other Factors

Environmental factors that may increase a child’s risk for ADHD include:

  • Smoking or drinking by the mother during pregnancy
  • Birth complications, premature delivery, and very low birth weight
  • Exposure to lead, other toxic substances, or infections causing brain inflammation
  • Abuse or neglect

There is little support for the popular belief that ADHD is caused by eating too much sugar, food additives, watching too much television, bad parenting, or social factors such as poverty or family stress.

Protective Factors

Factors that can be helpful for a person with ADHD include:

  • Effective parenting methods used by a caregiver (for young people)
  • Good relationships with friends
  • Good academic functioning and school successes (for young people)
  • Improved self-regulation skills

For statistics on ADHD, visit ADHD Among Children from the National Institute of Mental Health (NIMH) and ADHD Among Adults from NIMH.

Evidence-based Treatments

Treatment can reduce symptoms and improve a person’s ability to function in daily life. For children over age six, adolescents, and adults, psychotherapy and medication are good options. For children under age six, psychotherapy should be tried before using medications.

A full assessment is needed before treatment. No laboratory tests, brain imaging, or psychological tests can diagnose ADHD. Diagnosis requires interviews by a medical or mental health professional and complete information on a person’s functioning in daily life, including  in school, work, family, social relationships, and with friends. For children, parent and teacher symptom checklists help identify problem areas. The assessment influences the treatment plan.

Good treatment plans include watching how much the treatment helps the child’s behavior and making changes as needed along the way. The treatment plan should consider each person’s needs and choices. A person or caregiver should consult a healthcare professional with expertise in ADHD when choosing the right treatment and consider the patient’s gender, race, ethnicity, language, and culture.

Psychotherapy

Behavior therapy is a type of psychotherapy, sometimes called “talk” therapy. The therapist works with the person to teach new behaviors to replace those that don’t work or cause problems. Behavior therapy can be used with children, adolescents, and adults.

Child-focused Therapy

Behavior therapy for children involves using structure and consequences to help the child learn more positive behaviors. The child is rewarded for behaving in a desirable way and discouraged from behaving in ways that may cause problems in daily life.

Parent training in behavior therapy can be used for children, in combination with behavior therapy. Parents strengthen their skills and learn new skills to guide their child and manage their child’s behavior. This therapy may be called behavior management training for parents, parent behavior therapy, behavioral parent training, or just parent training.

Other types of behavior therapy are helpful for children with ADHD, and sometimes a combination is most effective. These include:

  • Training parents, teachers, and others in the setting where problem behaviors often occur
  • Behavioral classroom management
  • Behavioral peer interventions
  • Organizational skills training

Adolescent-focused Therapy

When children reach adolescence, they are starting the transition to adulthood. They are more self-reliant and independent. As a result, some behavior therapy methods used with young children are less helpful. There are therapies that focus on the needs of adolescents.

Behavior therapy with adolescents involves activities such as parent–teen contracting, organizational skills training, and academic interventions. Parents and caregivers are encouraged to stay involved. Interactions within the family are considered.

Parent training in behavior therapy can be used with adolescents to help parents understand their teenager’s behaviors and how to help their teen manage symptoms.

Other effective services include training approaches that involve working directly with the young person to help him or her develop skills that can lead to success at school and with peers. These include organization training, self-management, and note taking.

Many of the most serious problems that students with ADHD face occur at school. School staff can use many effective approaches to help students with ADHD succeed, including daily report cards, organization interventions, and self-management.

Programs for middle and high school students can provide a comprehensive approach to helping students with ADHD. These include the Challenging Horizons Program and the Homework, Organization, and Planning Skills (HOPS) program.

Adult-focused Therapy

Behavior therapy for adults focuses on how thoughts and actions work together to influence how a person interacts with others and in certain situations. There is a strong focus on learning helpful skills and controlling problematic behaviors and thoughts.

Medication

Medications are effective and safe for reducing ADHD symptoms and improving a person’s ability to function in daily life. Sometimes several medications or dosages must be tried before finding the right one. It is important to monitor how well the medication is working and make changes when needed.

Stimulants are the most common medications for ADHD. It may seem unusual to treat ADHD with a stimulant, but it works by increasing the brain chemicals dopamine and norepinephrine, which are involved in thinking and attention. With medical supervision, stimulant medications are considered safe. Still, side effects may occur.

ADHD-specific non-stimulants are also used in treatment. These take longer to start working than stimulants, but they can improve focus, attention, and impulsivity. Physicians may prescribe a non-stimulant when a person experiences side effects from stimulants, when a stimulant was not effective, or in combination with a stimulant to increase effectiveness.

Doctors and patients can work together to find the best medication, dose, or medication combination. For basic information about medications, visit Mental Health Medications from NIMH. For up-to-date information on medications, side effects, and warnings, visit the Food and Drug Administration.

Complementary Therapies and Activities

Complementary therapies and activities can help a person with ADHD improve their well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, see the National Center for Complementary and Integrative Health.

Many complementary health approaches have been studied for ADHD, but none is clearly helpful. Examples include omega-3 fatty acids and other dietary supplements, acupuncture, meditation, special diets, computer-based cognitive training, equine therapy, and neurofeedback.

ADHD psychoeducation informs people with ADHD about what causes ADHD, the symptoms and how they may change over time, problems that often co-occur with ADHD, and individual differences in ADHD. Psychoeducation can improve medication and behavior treatment effects.

Stress management techniques can help people with ADHD to deal better with frustration. Methods may include yoga, exercises, and mindfulness.

Family therapy may help support the home environment of a young person with ADHD. For adults, family therapy can help address problems within the person’s family and allow family members to understand and support the person with ADHD.

Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, access the Federal Government Mobile App Directory.

Recovery and Support Services and Activities

Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with behavioral health conditions. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills. To learn more, visit the SAMHSA Recovery and Recovery Support topic.

Resources for people with ADHD and their families include:

Future Directions in Research and Treatment

Research is exploring the causes of ADHD. Researchers are studying how genetics, brain structure, biochemicals, and environmental factors affect people with ADHD. Knowing more about the factors that cause ADHD can help researchers find ways to reduce the risk of ADHD.

Researchers also are looking for the most effective treatments for ADHD and studying the long-term effects of treatments. Other research aims include understanding how ADHD symptoms change during life, the long-term effects of treating ADHD with medications, and whether additional symptoms should be considered.

Finding Treatment

Consult a healthcare professional who has training and experience working with ADHD. For general information on mental disorders and how to locate treatment services in your area, contact SAMHSA’s National Helpline, 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the NIMH Help for Mental Illnesses webpage have more information and resources.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255). 

Last Updated: 04/05/2017