Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. It is usually first diagnosed in childhood and often continues into adulthood, though some people are not diagnosed until they are adults. It involves:

• inattention — trouble paying attention;
• impulsivity — trouble controlling impulsive behavior;
• hyperactivity — being overly active.

Everyone has trouble concentrating or sitting still sometimes, children especially. In ADHD the symptoms are more severe and ongoing, and can cause serious problems such as failing grades for a child or losing a job for an adult. They can affect family and social life as well.

Three types

• Mostly inattentive. People have trouble paying attention, are easily distracted, and find it hard to organize or finish tasks or to follow instructions and conversations.
• Mostly hyperactive-impulsive. People have both hyperactivity — a constant need to move, trouble sitting still, fidgeting or talking too much — and impulsivity: trouble controlling what they do and say, acting on sudden ideas or feelings without considering the consequences, often interrupting, or struggling to wait their turn.
• Combined. A mix of inattentive and hyperactive-impulsive symptoms. This is the most common type.

Symptoms

People with attention problems may often:

• miss details or make careless mistakes at school, at work or in other activities;
• have trouble staying focused on play or work;
• seem not to listen when spoken to directly;
• struggle to follow instructions or finish tasks, or start them and get sidetracked;
• have trouble staying organized, keeping belongings in order and managing time;
• avoid tasks that take long mental effort;
• lose important things such as books, wallets, keys, glasses and phones;
• forget daily activities.

People with hyperactivity-impulsivity may often:

• fidget and squirm while seated;
• get up when they are expected to stay seated, as at school or work;
• run around or climb when it is not appropriate (children), or feel restless (teens and adults);
• have trouble with quiet activities;
• be constantly on the go;
• talk far more than usual;
• blurt out answers before a question is finished;
• have trouble waiting their turn;
• interrupt others, for example in conversations or games.

Causes

The exact cause is unknown. ADHD probably comes from a mix of factors such as genetics and environment. Researchers are studying environmental factors that might raise the risk, including brain injuries, nutrition and social environments.

Diagnosis

No single test diagnoses ADHD. The process includes a physical exam with vision and hearing tests and other tests to rule out conditions with similar symptoms, such as anxiety, depression, sleep problems and certain learning disabilities. It also includes a thorough medical and family history, and usually standardized symptom checklists, questionnaires or interview questions whose rating scales help show whether a person's symptoms and history fit ADHD.

A diagnosis requires all of the following:

• several symptoms that began before age 12;
• several symptoms of inattention, hyperactivity-impulsivity or both, lasting at least 6 months and causing serious problems — at least 6 ongoing symptoms for children up to age 16, at least 5 for people 17 and older;
• symptoms in 2 or more settings, such as home and work or school;
• symptoms that clearly interfere with functioning at school, at work or socially;
• symptoms not caused by another mental health disorder.

Treatment

There is no cure, but treatment can reduce symptoms and improve functioning. Common treatments are:

• medicines;
• psychotherapy (talk therapy), including behavior therapy;
• education or training that gives parents skills and strategies to help their child, especially important for younger children;
• a combination of these.

A good treatment plan includes close monitoring, follow-up and changes as needed. A healthy lifestyle, with good eating and regular exercise, may also help manage symptoms. For school-aged children, support at school matters: classroom behavioral approaches such as behavior management plans or teaching organization and study skills, and accommodations such as particular seating, reduced classwork or extra time on tests and exams.

Sources

• MedlinePlus, National Library of Medicine: "Attention Deficit Hyperactivity Disorder," drawing on the National Institute of Mental Health.