by Cynthia Hammer, MSW, ACSW – Founder of the non-profit ADD Resources
It Seemed So Easy for Others
Are wondering if you might have ADHD? Will it be immediately clear to you that you have ADHD so you’re able to set about getting diagnosed and treated? Is it the eureka moment that we so often hear about? Can it be as simple as a parent takes their child in to be diagnosed for ADHD, recognizes it in themselves, bursts into tears, is diagnosed and treated, and experiences a dramatic improvement in their life?
It Took Me Years
This was not my journey of awareness and acceptance of having ADHD. It took me over a year after learning about ADHD to realize I had this disorder and another year in treatment to develop a positive attitude. For any of you who may be reluctant to start your journey, I assure you that learning to accept and manage your ADHD will bring you more satisfaction and contentment with your life than you have ever experienced.
I Was So Sure It Was the Fault of My Poor Parenting
Although my brother and nephew were diagnosed with ADHD years ago, no bells went off in my head when we started to have problems with two of our children. Russell Barkley, Ph.D, says 40% of children diagnosed with ADHD have a parent with the same disorder while Ted Mandelkorn, MD, says that over 90% of those diagnosed with ADHD have a relative somewhere in the immediate or extended family who also has the condition. I knew there was a familial connection to the condition but thought what our children were exhibiting was plain, old-fashioned misbehavior. If we could only parent better, they would behave better.
And So It Went
Off and on I had read library books about ADHD. Sometimes I would think it described one or another of my sons, but then again, it did not sound quite like them. So it went for several years. Then my husband heard a pediatrician talk on ADHD. He came home convinced it described one son. We took him to be diagnosed and started him in treatment. After a year of attending treatment sessions with my son, along with more reading and attending CHADD meetings, I tentatively told the pediatrician treating my son that I thought I had ADHD as well and he readily agreed!
My Denial Pushed Back Help
The prime reason it took so long to help my children and myself is denial. No one wants to admit there is something the matter. They don’t want to have any impairment. They don’t want to be different from normal people. The condition is called a disorder, such a hopeless sounding label. My relatives with ADHD were having major problems in their lives. I was reluctant to associate my children with the same condition. Wasn’t this consigning them to a bleak future? Wouldn’t it be more hopeful to keep working on better parenting skills than to say they had this disorder? I thought ADHD was a handicapping condition that would be diagnosed and that would be it. I focused on denying the disorder, instead of on how treatment could bring benefit and improvement.
Accepting the Diagnosis for Others But Not for Me
After accepting the diagnosis and treatment for my sons, why did it take so long to see the condition in myself? Denial, along with two other factors, was at work. ADHD is difficult to self-identify because of its complexity and the lack of clarity in the description of the symptoms. One author would stress certain features or describe them in a way that I could relate to. I would say, “Yes, that’s me!” Another author would describe other features and it wouldn’t sound like me! I should have paid more attention to the wording that introduces a list of characteristics, where it says, for example, “will demonstrate 8 of the following 20 characteristics.” I didn’t need to have all the characteristics to have the condition, but the characteristics had to be of a degree and pervasiveness that they caused significant turmoil in my life.
Lack of Self-Awareness Made It So Hard
The other factor that makes self-identification difficult is related to an ADHD characteristic, a lack of self-awareness. For example, I could feel I had offended a coworker, but I had no insight or understanding of how or why. I was too fearful of what they might say to ask them. ADHDers do not realize how they come across to others. (This is why it is helpful to have outside evaluations of your behaviors from people closely associated with you.) In many ways, people with ADHD delude themselves that they are doing just fine; it’s the others that they work with or associate with who have the problems. ADHDers always have good reasons to justify why they did something the way they did, and they do not understand why others might have a problem with that.
My Son Helped
My lack of self-awareness made me unable to examine my own actions and say to myself, “This is typical ADHD behavior.” However, I was able to look at my son’s troublesome behaviors and recognize that I did similar things. What he did (or did not do) that annoyed me were things that I did! As I analyzed my son’s annoying behaviors, I began to have some understanding of how I annoyed and frustrated others.
My Supervisor Helped
Another factor in my developing awareness was my supervisor. Her grandson recently had been diagnosed with ADHD, and she had read about the condition. She knew my two children had been diagnosed, and we sometimes would share information. During my annual evaluation, she brought up some points about my work that could use improvement, e.g., my inability to be a team player; my penchant for getting excited about a new project, but dropping it when only partly finished, blithely expecting someone to finish it because I had moved on to other things; and my not prioritizing my work so that the most important things got done. She said I was a mixed bag and that made it hard to evaluate me. I did some things very, very well and other things inadequately. I recognized these behavior patterns as common to ADHD. When I mentioned that I thought I might have ADHD (again my tentativeness), she said she thought so too.
Treatment Brought Me Relief
After getting diagnosed by a knowledgeable physician, I entered treatment, and like the condition itself, my emotions became very complicated. Of course, I felt relief, mentally saying over and over again, “So that explains it!” After starting on medicine, I immediately noticed improvements in my functioning and relationships. The education and counseling I received helped me learn which behaviors were related to ADHD, and I instituted techniques for managing or minimizing their disruptive influence. So it surprised me, when almost a year after being diagnosed, I blurted out, “I’ve been in a grieving process.” I hadn’t been aware of feeling this way until the words came out of my mouth.
Yet, I Grieved for the Loss of My Individuality
Why is there grief! I have two explanations. To accept the diagnosis and treatment, I had a loss in my self-image. Prior to knowing I had ADHD, I knew I was an individual. I did some things, maybe many things, differently than others, but I had a pride in most of my characteristics and abilities. Now I was learning that those characteristics that made me special are a disorder. Even though I had not seen the connection, my special characteristics had made my life more difficult than it is for normal people.
I Felt Disabled, Ashamed and Embarrassed
I felt like a disabled person. As I became more aware of how I came across to others, I felt shame and embarrassment. There was something the matter with me. Others could see it. Often they were reacting negatively to me because of how I acted. Even though part of me could see that my relationships were improving because of treatment, another part of me withdrew from relationships. I felt awkward and self-conscious, feeling that I was less than others.
I Grieved for the Life I’d Lost
The second reason for grief was a realization that my whole life had been less than it could have been. If only someone had only known about my ADHD years ago…. If only I had been diagnosed and treated years earlier…. Much in my life would have been better. These thoughts kept going through my mind. I reflected on the inappropriate actions I had taken, the people I had offended, the mistakes I had made. I felt ADD was accountable for all that had been bad in my life.
I Found Others Who Were Angry Instead
Many ADD adults, in addition to grief, experience anger as they recall their life experiences. They have so many unhappy memories of being demeaned, berated, and made to feel inadequate. Now they wonder why no one knew there was something wrong. They wonder why they weren’t treated with more kindness, patience, understanding, and love. It would have made such a difference!
Now, I Am All That I Was and More
With treatment, both grief and anger subside and resolve. I came to realize that knowing I have ADHD did not make me a new person. I stayed the person I was, my unique, special self. Only now I can better control the kind of person I am, and I am better at perceiving how I come across to others so I can adjust my behavior accordingly. Knowing about my ADHD and getting treatment for it did not make me less, as I initially thought. I am all that I was, and now I have the potential to be even more. In this context, I like to think of the American advertising slogan, New and Improved. While I am not a new model, I am an improved one! Life is a continuing adventure.
*About the Author
Cynthia Hammer, MSW, ACSW, an adult with ADHD and the parent of three sons, two with ADHD. At age 49, she learned that she had ADHD and realized she knew very little about the disorder. Cynthia founded ADD Resources in 1994 and went on to become a nationally recognized advocate for the understanding of ADHD among both those who have it and those who treated it. Cynthia is now retired and lives in Tacoma with her husband.
“Photo courtesy of Vlado-Free Digital Photo.net” – Modified on Canva
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). These symptoms can make it difficult for a child with ADHD to succeed in school, get along with other children or adults, or finish tasks at home.
Brain imaging studies have revealed that, in youth with ADHD, the brain matures in a normal pattern but is delayed, on average, by about 3 years.1 The delay is most pronounced in brain regions involved in thinking, paying attention, and planning. More recent studies have found that the outermost layer of the brain, the cortex, shows delayed maturation overall,2 and a brain structure important for proper communications between the two halves of the brain shows an abnormal growth pattern.3 These delays and abnormalities may underlie the hallmark symptoms of ADHD and help to explain how the disorder may develop.
Treatments can relieve many symptoms of ADHD, but there is currently no cure for the disorder. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
(Note: I’ve also posted this article as a series of shorter posts. See those here.
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.
Children who have symptoms of inattention may:
Be easily distracted, miss details, forget things, and frequently switch from one activity to another
Have difficulty focusing on one thing
Become bored with a task after only a few minutes, unless they are doing something enjoyable
Have difficulty focusing attention on organizing and completing a task or learning something new
Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Not seem to listen when spoken to
Daydream, become easily confused, and move slowly
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
Fidget and squirm in their seats
Talk nonstop
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Be constantly in motion
Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
Be very impatient
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games
Often interrupt conversations or others’ activities.
ADHD Can Be Mistaken for Other Problems
Parents and teachers can miss the fact that children with symptoms of inattention have ADHD because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, whereas children who have more symptoms of hyperactivity or impulsivity tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive symptoms just have disciplinary problems.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
What causes ADHD?
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
Genes. Inherited from our parents, genes are the “blueprints” for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder.4,5 Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
A study of children with ADHD found that those who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.6
Researchers are also studying genetic variations that may or may not be inherited, such as duplications or deletions of a segment of DNA. These “copy number variations” (CNVs) can include many genes. Some CNVs occur more frequently among people with ADHD than in unaffected people, suggesting a possible role in the development of the disorder.7,8
Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.9,10 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, have a higher risk of developing ADHD.11
Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it.12 In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.13 Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.14
In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers whothought their children received aspartame.15
Food additives. There is currently no research showing that artificial food coloring causes ADHD. However, a small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. They may experience fewer ADHD symptoms on a diet without additives, but such diets are often difficult to maintain.12,16
How is ADHD diagnosed?
Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children or seems constantly “unfocused” or “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.
No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood brain disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.
Between them, the referring pediatrician and specialist will determine if a child:
Is experiencing undetected seizures that could be associated with other medical conditions
Has a middle ear infection that is causing hearing problems
Has any undetected hearing or vision problems
Has any medical problems that affect thinking and behavior
Has any learning disabilities
Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.
A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.
The specialist also will ask:
Are the behaviors excessive, and do they affect all aspects of the child’s life?
Do they happen more often in this child compared with the child’s peers?
Are the behaviors a continuous problem or a response to a temporary situation?
Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?
The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.
Finally, after gathering all this information, if the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.
How is ADHD treated?
Currently available treatments aim at reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education and training, or a combination of treatments.
Medications
Stimulants such as methylphenidate and amphetamines are the most common type of medication used for treating ADHD. Although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behavior, thus reducing hyperactivity. In addition, a few non-stimulant medications, such as atomoxetine, guanfacine, and clonidine, are also available. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medications also may improve physical coordination.
However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors.
Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a child to take the medication just once a day before school, so he or she doesn’t have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.
For more information about stimulants and other medications used for treating mental disorders, see the booklet, Mental Health Medications, on the National Institute of Mental Health (NIMH) website. The Food and Drug Administration (FDA) website has the latest information on medication approvals, warnings, and patient information guides.
What are the side effects of stimulant medications?
The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.
Decreased appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child’s doctor. Also talk to the doctor if you have concerns about your child’s growth or weight gain while he or she is taking this medication.
Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing “flat” or without emotion. Talk with your child’s doctor if you see any of these side effects.
Are stimulant medications safe?
Under medical supervision, stimulant medications are considered safe. Stimulants do not make children with ADHD feel high, although some kids report feeling slightly different or “funny.”
Preschoolers are more sensitive to the side effects of methylphenidate, and some may experience slower than average growth rates. Very young children should be closely monitored while taking ADHD medications.17,18,19
FDA warning on possible rare side effects
In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data suggested that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications. Recently published studies, however, have not found evidence that using stimulants to treat ADHD increases the risk for cardiovascular problems.20,21
The FDA review also found a slight increased risk, about 1 in 1,000, for medication- related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood), even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD include an initial health history, including family history, and examination for existing cardiovascular and psychiatric problems.
One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another warning. Studies show that children and teenagers who take atomoxetine are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take it.22If your child is taking atomoxetine, watch his or her behavior carefully. A child may develop serious symptoms suddenly, so it is important to pay attention to your child’s behavior every day. Ask other people who spend a lot of time with your child to tell you if they notice changes in your child’s behavior. Call a doctor right away if your child shows any unusual behavior. While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment, and be sure that your child keeps all appointments with his or her doctor.
Do medications cure ADHD?
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a child pay attention and complete schoolwork. It is not clear, however, whether medications can help children learn better. Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems. NIMH-funded research has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs.23
Psychotherapy and Parent strategies
Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child 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 child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.
Therapists may 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.
How can parents help?
Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to overcome bad feelings. Mental health professionals can educate parents about ADHD and how it impacts a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
Parenting skills training 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 they want to discourage. In some cases, the use of “time-outs” may be used when the child’s behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.
Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child’s strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become overstimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps. Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child’s behavior.
Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups typically meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Tips to Help Kids Stay Organized and Follow Directions
Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
Use 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.
Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.
Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
What conditions can coexist with ADHD?
Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:
A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.
Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
Tourette syndrome. Very few children have this brain disorder, but, among those who do, many also have ADHD. People with Tourette syndrome have nervous tics, which can be evident as repetitive, involuntary movements, such as eye blinks, facial twitches, or grimacing, and/or as vocalizations, such as throat-clearing, snorting, sniffing, or barking out words inappropriately. These behaviors can be controlled with medication, behavioral interventions, or both.
ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses. For more information on these disorders, visit the NIMH website.
Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.
How can I work with my child’s school?
If you think your child has ADHD, or a teacher raises concerns, you may be able to request that the school conduct an evaluation to determine whether he or she qualifies for special education services.
Start by speaking with your child’s teacher, school counselor, or the school’s student support team, to begin an evaluation. Also, each state has a Parent Training and Information Center and a Protection and Advocacy Agency (link works) that can help you get an evaluation. A team of professionals conducts the evaluation using a variety of tools and measures. It will look at all areas related to the child’s disability.
Once your child has been evaluated, he or she has several options, depending on the specific needs. If special education services are needed and your child is eligible under the Individuals with Disabilities Education Act, the school district must develop an “individualized education program” specifically for your child within 30 days.
If your child is considered not eligible for special education services—and not all children with ADHD are eligible—he or she still can get “free appropriate public education,” available to all public-school children with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of the nature or severity of the disability.
For more information on Section 504, consult the U.S. Department of Education’s Office for Civil Rights, which enforces Section 504 in programs and activities that receive Federal education funds.
Transitions can be difficult. Each school year brings a new teacher and new schoolwork, a change that can be especially hard for a child with ADHD who needs routine and structure. Consider telling the teachers that your child has ADHD when he or she starts school or moves to a new class. Additional support will help your child deal with the transition.
Do teens with ADHD have special needs?
Most children with ADHD continue to have symptoms as they enter adolescence. Some children are not diagnosed with ADHD until they reach adolescence. This is more common among children with predominantly inattentive symptoms because they are not necessarily disruptive at home or in school. In these children, the disorder becomes more apparent as academic demands increase and responsibilities mount. For all teens, these years are challenging. But for teens with ADHD, these years may be especially difficult.
Although hyperactivity tends to decrease as a child ages, teens who continue to be hyperactive may feel restless and try to do too many things at once. They may choose tasks or activities that have a quick payoff, rather than those that take more effort, but provide bigger, delayed rewards. Teens with primarily attention deficits struggle with school and other activities in which they are expected to be more self-reliant.
Teens also become more responsible for their own health decisions. When a child with ADHD is young, parents are more likely to be responsible for ensuring that their child maintains treatment. But when the child reaches adolescence, parents have less control, and those with ADHD may have difficulty sticking with treatment.
To help them stay healthy and provide needed structure, teens with ADHD should be given rules that are clear and easy to understand. Helping them stay focused and organized—such as posting a chart listing household chores and responsibilities with spaces to check off completed items—also may help.
Teens with or without ADHD want to be independent and try new things, and sometimes they will break rules. If your teen breaks rules, your response should be as calm and matter-of-fact as possible. Punishment should be used only rarely. Teens with ADHD often have trouble controlling their impulsivity and tempers can flare. Sometimes, a short time-out can be calming.
If your teen asks for later curfews and use of the car, listen to the request, give reasons for your opinions, and listen to your child’s opinion. Rules should be clear once they are set, but communication, negotiation, and compromise are helpful along the way. Maintaining treatments, such as medication and behavioral or family therapy, also can help with managing your teenager’s ADHD.
What about teens and driving?
Although many teens engage in risky behaviors, those with ADHD, especially untreated ADHD, are more likely to take more risks. In fact, in their first few years of driving, teens with ADHD are involved in nearly four times as many car accidents as those who do not have ADHD. They are also more likely to cause injury in accidents, and they get three times as many speeding tickets as their peers.24
Most states now use a graduated licensing system, in which young drivers, both with and without ADHD, learn about progressively more challenging driving situations.25The licensing system consists of three stages—learner’s permit, during which a licensed adult must always be in the car with the driving teen; intermediate (provisional) license; and full licensure. Parents should make sure that their teens, especially those with ADHD, understand and follow the rules of the road. Repeated driving practice under adult supervision is especially important for teens with ADHD.
Can adults have ADHD?
Some children with ADHD continue to have it as adults. And many adults who have the disorder don’t know it. They may feel that it is impossible to get organized, stick to a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.
These adults may have a history of failure at school, problems at work, or difficult or failed relationships. Many have had multiple traffic accidents. Like teens, adults with ADHD may seem restless and may try to do several things at once, most of them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the steps needed to achieve greater rewards.
How is ADHD diagnosed in adults?
Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional. But the professional may need to consider a wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear cut as symptoms seen in children.
To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued throughout adulthood.26 Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria for ADHD. The mental health professional also will look at the person’s history of childhood behavior and school experiences, and will interview spouses or partners, parents, close friends, and other associates. The person will also undergo a physical exam and various psychological tests.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.
How is ADHD treated in adults?
Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a combination of treatments.
Medications. ADHD medications, including extended-release forms, often are prescribed for adults with ADHD.27
Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. The antidepressant bupropion (Wellbutrin), which affects the brain chemical dopamine, showed benefits for adults with ADHD.28 Older antidepressants, called tricyclics, sometimes are used because they, like stimulants or atomoxetine, affect the brain chemical norepinephrine.
Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, such as diabetes or high blood pressure, or for anxiety and depression. Some of these medications may interact badly with stimulants. An adult with ADHD should discuss potential medication options with his or her doctor. These and other issues must be taken into account when a medication is prescribed.
Education and psychotherapy. A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into smaller, more manageable steps so that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one’s poor self-image by examining the experiences that produced it. The therapist encourages the adult 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.
Citations
Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation.Proc Natl Acad Sci U S A. 2007Dec 4;104(49):19649–54. Epub 2007 Nov 16. PubMed PMID: 18024590; PubMed Central PMCID: PMC2148343.
Shaw P, Malek M, Watson B, Sharp W, Evans A, Greenstein D. Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder.Biol Psychiatry. 2012 Aug 1;72(3):191–7. Epub 2012 Mar 13. PMID: 22418014.
Gilliam M, Stockman M, Malek M, Sharp W, Greenstein D, et al. Developmental trajectories of the corpus callosum in attention-deficit/hyperactivity disorder.Biol Psychiatry. 2011 May 1;69(9):839–46. Epub 2011 Jan 17. PMID: 21247556.
Faraone SV, Mick E. Molecular genetics of attention deficit hyperactivity disorder.Psychiatr Clin North Am. 2010 Mar;33(1):159–80. Review. PubMed PMID: 20159345; PubMed Central PMCID: PMC2847260.
Gizer IR, Ficks C, Waldman ID. Candidate gene studies of ADHD: a meta-analytic review.Hum Genet. 2009 Jul;126(1):51–90. Epub 2009 Jun 9. Review. PubMed PMID: 19506906.
Shaw P, Gornick M, Lerch J, Addington A, Seal J, et al. Polymorphisms of the dopamine D4 receptor, clinical outcome, and cortical structure in attention-deficit/hyperactivity disorder.Arch Gen Psychiatry. 2007 Aug;64(8):921–31. PMID: 17679637.
Elia J, Glessner JT, Wang K, Takahashi N, Shtir CJ, et al. Genome-wide copy number variation study associates metabotropic glutamate receptor gene networks with attention deficit hyperactivity disorder.Nat Genet. 2011 Dec 4;44(1):78–84. doi: 10.1038/ng.1013. PMID: 22138692.
Williams NM, Franke B, Mick E, Anney RJ, Freitag CM, et al. Genome-wide analysis of copy number variants in attention deficit hyperactivity disorder: the role of rare variants and duplications at 15q13.3.Am J Psychiatry. 2012 Feb;169(2):195–204. PMID: 22420048.
Nomura Y, Marks DJ, Halperin JM. Prenatal exposure to maternal and paternal smoking on attention deficit hyperactivity disorders symptoms and diagnosis in offspring.J Nerv Ment Dis. 2010 Sep;198(9):672–8. PubMed PMID: 20823730; PubMed Central PMCID: PMC3124822.
Froehlich TE, Lanphear BP, Auinger P, Hornung R, Epstein JN, Braun J, Kahn RS. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder.Pediatrics. 2009 Dec;124(6):e1054–63. Epub 2009 Nov 23. PubMed PMID: 19933729; PubMed Central PMCID: PMC2853804.
Millichap JG, Yee MM. The diet factor in attention-deficit/hyperactivity disorder.Pediatrics. 2012 Feb;129(2):330–7. Epub 2012 Jan 9. Review. PubMed PMID: 22232312.
Wolraich M, Milich R, Stumbo P, Schultz F. Effects of sucrose ingestion on the behavior of hyperactive boys.J Pediatr. 1985 Apr;106(4):675–82. PMID: 3981325.
Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children.N Engl J Med. 1994 Feb 3;330(5):301–7. PMID: 8277950.
Hoover DW, Milich R. Effects of sugar ingestion expectancies on mother-child interactions.J Abnorm Child Psychol. 1994 Aug;22(4):501–15. PMID: 7963081.
Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives.J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86–97.e8. PMID: 22176942.
Wigal T, Greenhill L, Chuang S, McGough J, Vitiello B, et al. Safety and tolerability of methylphenidate in preschool children with ADHD.J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1294–303. PubMed PMID: 17028508.
Swanson J, Greenhill L, Wigal T, Kollins S, Stehli A, et al. Stimulant-related reductions of growth rates in the PATS.J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1304–13. PubMed PMID: 17023868.
Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M, et al. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD.J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1284–93. Erratum in:J Am Acad Child Adolesc Psychiatry. 2007 Jan;46(1):141. PubMed PMID: 17023867.
Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, et al. ADHD drugs and serious cardiovascular events in children and young adults.N Engl J Med. 2011 Nov 17;365(20):1896–904. Epub 2011 Nov 1. PMID: 22043968.
Vitiello B, Elliott GR, Swanson JM, Arnold LE, Hechtman L, et al. Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD.Am J Psychiatry. 2012 Feb;169(2):167–77. PMID: 21890793.
Warning on Strattera for attention-deficit hyperactivity disorder.FDA Consum. 2005 Nov–Dec;39(6):4. PubMed PMID: 16671156.
The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder.Arch Gen Psychiatry. 1999 Dec;56(12):1073–86. PMID: 10591283.
Cox DJ, Merkel RL, Moore M, Thorndike F, Muller C, Kovatchev B. Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder.Pediatrics. 2006 Sep;118(3):e704–10. PMID: 16950962.
U.S. Department of Transportation, National Highway Traffic Safety Administration, Legislative Fact Sheets. Traffic Safety Facts, Laws. Graduated Driver Licensing System. January 2006.
Post RE, Kurlansik SL. Diagnosis and management of adult attention-deficit/hyperactivity disorder.Am Fam Physician. 2012 May 1;85(9):890–6. PMID: 22612184.
Ramos-Quiroga JA, Corominas M, Castells X, Bosch R, Casas M. OROS methylphenidate for the treatment of adults with attention-deficit/hyperactivity disorder.Expert Rev Neurother. 2009 Aug;9(8):1121–31. Review. PubMed PMID: 19673602.
Wilens TE, Haight BR, Horrigan JP, Hudziak JJ, Rosenthal NE, Connor DF, Hampton KD, Richard NE, Modell JG. Bupropion XL in adults with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled study.Biol Psychiatry. 2005 Apr 1;57(7):793–801. PubMed PMID: 15820237.
Vitiello B, Elliott GR, Swanson JM, Arnold LE, Hechtman L, Abikoff H, Molina BS, Wells K, Wigal T, Jensen PS, Greenhill LL, Kaltman JR, Severe JB, Odbert C, Hur K, Gibbons R. Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD.Am J Psychiatry. 2012 Feb;169(2):167–77. PMID: 21890793.
Ghuman JK, Riddle MA, Vitiello B, Greenhill LL, Chuang SZ, et al. Comorbidity moderates response to methylphenidate in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS).J Child Adolesc Psychopharmacol. 2007 Oct;17(5):563–80. PMID: 17979578.
Republished from NIMH – “What is Attention Deficit Disorder?” – Retrieved May 26, 1915 – No longer posted online. They now use an “Easy to Read” article instead. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml National Institute of Mental Health publications are in the public domain and may be reproduced or copied without permission.
“Photo courtesy of Master Isolated Images/FreeDigitalPhoto.net” Modified on Canva
The core symptoms of ADHD are hyperactivity, impulsiveness, distractibility and inattention as evidenced by problems organizing, planning, procrastinating, and time management. But doesn’t everybody have these problems? Yes, but for the diagnosis to be applicable, the doctor will consider the severity and duration and the extent to which your problems interfere with the quality of your life. For a diagnosis, you must see a doctor who is knowledgeable in ADHD and related problems. The principle tool for diagnosis is the interview.
Before seeing your doctor, take some quiet time to think about what is really bothering you and write it down. (People with AD/HD often forget the key things to say). If your office looks like the aftermath of a hurricane and you feel depressed, be sure to tell the doctor both facts. You may be depressed because you can’t deal with the office, or your office may be a disaster because you are depressed. Which came first?
Medication
“Pills? I don’t take pills!”
Well, you aren’t alone. Many people feel that way. Consider for a moment. Do the pills make you a different person? Is it not you, if you take a pill? Who is the real you?
That person who loses his temper at the slightest excuse,
the nerd who walks past his best friend without saying “Hello”,
the wife who is too tired to clean up the mess and greet hubby with a smile and kiss when he comes home?
Or are you the smiling affable, competent person you know is inside trying to get out?
Let’s go back to our car. Do you expect your car to run without oil or gasoline? Would you drive a car that worked on two or three of its four cylinders? Your brain needs fuel.
Ideally, every brain would produce just the right amount of all the ingredients it needs, but there is no such thing as an ideal brain. Some brains are chronically undersupplied with the chemicals they need to function properly. Clinical trials have shown that medication is the most effective method of dealing with an under functioning brain
There are a number of medications available. Your doctor may need to try more than one, to find the right one for you. He will probably start with a low dose to see if you tolerate it and then increase the dose to find the most effective dosage and timing. So don’t be discouraged if you don’t get a positive result immediately.
When you start taking the medication it would be a good idea to keep a record of the time you take it and any sensations you may feel and the time when they occur. Be sure to tell your doctor about all the effects. Some unpleasant effects like a headache or dizziness may, in fact, be what are called rebound effects which occur when the medication wears off. The problem can often be resolved by changing the timing of the next dose or even by increasing the dosage. Help your doctor to know what’s happening and he can help you to find the best solution for you.
For information about medication, you must see a doctor who has experience with ADHD.
For treatment guidelines and which medications are available, see
A PHYSICIAN’S PERSPECTIVE on ADHD Medications by Theodore Mandelkorn, MD
Editor’s note: Not everyone wants to take medication or is helped by traditional ADHD medications. Nor is medication alone enough. Some type of outside intervention, however, is usually helpful. You may prefer to try cognitive behavior therapy, coaching, diet changes, supplements, mindfulness meditation or any number of holistic or alternative treatments. Many treat their ADHD with a combination of these, searching for the right mix. Please see the Pinterest boards listed below for examples.
Published by Sarah Jane Keyser, Copyright 2006, all rights reserved. Coaching Key to ADD
“Image courtesy of SalvatoreVuono-FreeDigitalPhoto.net” Modified on Canva
ADHD is often thought of as a childhood diagnosis that magically disappears in late adolescence. In fact, this disorder, which affects upwards of 10% of the population, often persists into adulthood and typically causes individuals to continue to struggle with core symptoms of impulsivity, inattention, and hyperactivity. Despite this, until the last couple of decades the ADHD Adult diagnosis simply did not exist.
As adults, we often stumble upon our own or our partner’s ADHD diagnosis after one or more of our children is diagnosed with the disorder. As diligent parents, we learn much about ADHD and how it affects our children, many of us finding our own “ah-ha” moment somewhere along this journey. This is hardly surprising given that ADHD is a highly inheritable disorder. It is also not surprising that many adults who were never diagnosed as children continue to remain undiagnosed or misdiagnosed as adults. One reason for this is that adults who have ADHD commonly also have co-existing symptoms of anxiety and depression, which compound the diagnostic difficulty. If after reviewing the common symptoms presented in this article you suspect that you or your partner has undiagnosed ADHD, it is essential to receive a comprehensive ADHD evaluation. The key to effective treatment for ADHD, as with any disorder, is an accurate diagnosis.
Knowledge is Power
Just what is Adult ADHD and how might it be impacting your daily life? First, it is important to know that ADHD, despite what some may believe, is real. ADHD is a neurological disorder. It is not the result of laziness, lack of willpower or a creation of the pharmaceutical industry. The information that follows is intended to present an overview of the common symptoms of Adult ADHD.
Difficulty Concentrating and Staying Focused
Adults with ADHD often have difficulty maintaining focus and are easily distracted. This is the “oooh, look at the shiny ball over there” symptom that derails concentration and causes you to bounce from one activity to another. You may find yourself having difficulty paying attention, zoning out without realizing it, having trouble staying focused while reading, struggling to complete even simple tasks, overlooking details, listening poorly and having a hard time remembering conversations or directions.
Disorganization and Forgetfulness
With Adult ADHD, your life may seem out of control as you struggle to stay on top of daily responsibilities. Staying organized, setting priorities, keeping track of tasks and schedules, managing time effectively and remembering what needs to be accomplished are extremely challenging. You may have poor organizational skills at home or work which is often evidenced by extreme clutter in one’s home, office or car. You may have a tendency to put things off and procrastinate due to difficulties with getting tasks started. You may forget appointments, commitments, or work deadlines. You may constantly misplace things, be chronically late or underestimate the time needed to complete tasks.
Impulsivity
This is the “ready, fire, aim” response commonly seen in individuals with ADHD, who may act first, and, think later. Adults with ADHD may interrupt others, act or speak before thinking, blurt out thoughts that are rude or inappropriate, talk excessively loud, have poor self-control, display addictive behaviors, and may behave or drive recklessly without regard for consequences.
Emotional Difficulties
Just as it is hard for individuals with ADHD to regulate impulses and attention, it is also often difficult to regulate emotions. Many adults with ADHD have difficulty managing their feelings, particularly when they are angry or frustrated. Often, adults with ADHD have poor self-esteem, deal with frustration poorly, tend to be insecure, have spotty relationships, are easily stressed-out, irritable, hypersensitive to criticism, have short fuses, frequent mood swings, and a pervasive sense of underachievement.
Restlessness
Hyperactivity in childhood often morphs into a sense of inner restlessness in adults. Some adults may still be “driven by a motor” but, for many, the symptoms become subtler. Adults with ADHD may feel agitated, become easily bored, have racing thoughts, trouble sitting still, talk non-stop, crave excitement, and take excessive risks.
The Adult ADHD Impact
Maintaining one’s balance in our complex world can be a challenging balancing act for any adult. As a child, you may have been able to compensate for the symptoms of ADHD, only to find that your symptoms increased as you faced the increasing responsibilities of adulthood. Managing careers, homes, children, spouses and other types of relationships places greater demands on your ability to focus, stay organized and remain calm. The more balls you have in the air, the harder they become to juggle.
The Good News
No matter how challenging the struggles in your life may seem, Adult ADHD can be managed through accurate diagnosis, education and effective treatment. With support, structure and knowledge, it is possible to turn ADHD weaknesses into strengths, longstanding limitations into achievements and dreams into realities. One pathway to success lies in utilizing a coach to guide you through this process. Renowned author, Ned Hallowell, in his groundbreaking book Driven to Distraction “particularly likes the idea of an ADHD Coach…keeping the player focused on the task at hand and offering encouragement along the way…. the coach can stave off habits of procrastination, disorganization, and negative thinking.”
Editor’s note: There are no quick and easy answers with ADHD. Although medication helps, there are no magic pills. Strategies for providing effective treatment abound, but no SINGLE treatment will be enough. Your own needs will be unique and the ideas that you used so effectively one month might not work the next. It will take effort and experimentation to find what works best for you. A good place to start would be 16 Steps to Better Self-Esteem with ADHD by Kari Taylor-Hogan or 6 Steps to Survive ADHD Overwhelm – Learn to Plan Your Day by Sarah Jane Keyser.
According to Russell Barkley, Ph.D., “ADHD is not a problem with knowing what to do, rather it is a problem with DOING what you KNOW— the performance part.” You need someone to remind you of how special you are WHILE they help you put together the to-do lists, planners, and calendars that work for YOU. It’s so good to have someone to keep you accountable and cheer you on while you build routines and habits that will help the days go smoother. That’s where ADHD coaching comes in.
Take a look at this series of short articles by Sarah Jane Keyser for more on coaching: Life Styles for ADHD, Maintaining the ADHD Brain, and ADHD Coaching Strategies. I want to change my ADHD life. What can I do?
Note: I’ve divided this extensive article into a number of smaller posts. You may read this article in its entirety here: What is ADHD? – NIMH
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). These symptoms can make it difficult for a child with ADHD to succeed in school, get along with other children or adults, or finish tasks at home.
Brain imaging studies have revealed that, in youth with ADHD, the brain matures in a normal pattern but is delayed, on average, by about 3 years.1 The delay is most pronounced in brain regions involved in thinking, paying attention, and planning. More recent studies have found that the outermost layer of the brain, the cortex, shows delayed maturation overall,2 and a brain structure important for proper communications between the two halves of the brain shows an abnormal growth pattern.3 These delays and abnormalities may underlie the hallmark symptoms of ADHD and help to explain how the disorder may develop.
Treatments can relieve many symptoms of ADHD, but there is currently no cure for the disorder. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
Some children with ADHD continue to have it as adults. And many adults who have the disorder don’t know it. They may feel that it is impossible to get organized, stick to a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.
These adults may have a history of failure at school, problems at work, or difficult or failed relationships. Many have had multiple traffic accidents. Like teens, adults with ADHD may seem restless and may try to do several things at once, most of them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the steps needed to achieve greater rewards.
How is ADHD diagnosed in adults?
Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional. But the professional may need to consider a wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear cut as symptoms seen in children.
To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued throughout adulthood.26 Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria for ADHD. The mental health professional also will look at the person’s history of childhood behavior and school experiences, and will interview spouses or partners, parents, close friends, and other associates. The person will also undergo a physical exam and various psychological tests.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.
How is ADHD treated in adults?
Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a combination of treatments.
Medications. ADHD medications, including extended-release forms, often are prescribed for adults with ADHD.27
Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. The antidepressant bupropion (Wellbutrin), which affects the brain chemical dopamine, showed benefits for adults with ADHD.28 Older antidepressants, called tricyclics, sometimes are used because they, like stimulants or atomoxetine, affect the brain chemical norepinephrine.
Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, such as diabetes or high blood pressure, or for anxiety and depression. Some of these medications may interact badly with stimulants. An adult with ADHD should discuss potential medication options with his or her doctor. These and other issues must be taken into account when a medication is prescribed.
Education and psychotherapy. A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into smaller, more manageable steps so that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one’s poor self-image by examining the experiences that produced it. The therapist encourages the adult 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.
What is ADHD? – NIMH ADHD section (National Institute of Mental Health)
Republished from NIMH – “What is Attention Deficit Disorder?” – NIMH publications are in the public domain and may be reproduced or copied without permission.
“Photo courtesy of artur 84/FreeDigitalPhoto.net” Modified on Canva
Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:
A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.
Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
Tourette syndrome. Very few children have this brain disorder, but, among those who do, many also have ADHD. People with Tourette syndrome have nervous tics, which can be evident as repetitive, involuntary movements, such as eye blinks, facial twitches, or grimacing, and/or as vocalizations, such as throat-clearing, snorting, sniffing, or barking out words inappropriately. These behaviors can be controlled with medication, behavioral interventions, or both.
ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses. For more information on these disorders, visit the NIMH website.
Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.
What is ADHD? – NIMH ADHD section (National Institute of Mental Health)
Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children or seems constantly “unfocused” or “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.
No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood brain disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.
Between them, the referring pediatrician and specialist will determine if a child:
Is experiencing undetected seizures that could be associated with other medical conditions
Has a middle ear infection that is causing hearing problems
Has any undetected hearing or vision problems
Has any medical problems that affect thinking and behavior
Has any learning disabilities
Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.
A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.
The specialist also will ask:
Are the behaviors excessive, and do they affect all aspects of the child’s life?
Do they happen more often in this child compared with the child’s peers?
Are the behaviors a continuous problem or a response to a temporary situation?
Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?
The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.
Finally, after gathering all this information, if the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.
What is ADHD? – NIMH ADHD section (National Institute of Mental Health)
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
Genes. Inherited from our parents, genes are the “blueprints” for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder.4,5 Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
A study of children with ADHD found that those who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.6
Researchers are also studying genetic variations that may or may not be inherited, such as duplications or deletions of a segment of DNA. These “copy number variations” (CNVs) can include many genes. Some CNVs occur more frequently among people with ADHD than in unaffected people, suggesting a possible role in the development of the disorder.7,8
Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.9,10 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, have a higher risk of developing ADHD.11
Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it.12 In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.13 Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.14
In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who thought their children received aspartame.15
Food additives. There is currently no research showing that artificial food coloring causes ADHD. However, a small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. They may experience fewer ADHD symptoms on a diet without additives, but such diets are often difficult to maintain.12,16
What is ADHD? – NIMH ADHD section (National Institute of Mental Health)
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.
Children who have symptoms of inattention may:
Be easily distracted, miss details, forget things, and frequently switch from one activity to another
Have difficulty focusing on one thing
Become bored with a task after only a few minutes, unless they are doing something enjoyable
Have difficulty focusing attention on organizing and completing a task or learning something new
Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Not seem to listen when spoken to
Daydream, become easily confused, and move slowly
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
Fidget and squirm in their seats
Talk nonstop
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Be constantly in motion
Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
Be very impatient
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games
Often interrupt conversations or others’ activities.
ADHD Can Be Mistaken for Other Problems
Parents and teachers can miss the fact that children with symptoms of inattention have ADHD because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, whereas children who have more symptoms of hyperactivity or impulsivity tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive symptoms just have disciplinary problems.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
What is ADHD? – NIMH ADHD section (National Institute of Mental Health)
by Cynthia Hammer, MSW, ACSW – Founder of the non-profit ADD Resources
Cynthia Hammer, MSW, ACSW, an adult with ADHD and the parent of three sons, two with ADHD. At age 49, she learned that she had ADHD and realized she knew very little about the disorder. Cynthia founded ADD Resources in 1994 and went on to become a nationally recognized advocate for the understanding of ADHD among both those who have it and those who treated it. Cynthia is now retired and lives in Tacoma with her husband.
