What is attention deficit hyperactivity disorder (ADHD)?

ADHD is a neurodevelopmental disorder. It is usually first diagnosed in childhood and often lasts into adulthood. But some people don't get diagnosed with ADHD until they are adults. ADHD involves:

• Having trouble paying attention (inattention)
• Having trouble controlling impulsive behaviors (impulsivity)
• Being overly active (hyperactivity)

What are the types of attention deficit hyperactivity disorder (ADHD)?

There are three types of ADHD:

• Mostly Inattentive ADHD. People with this type of ADHD have trouble paying attention and are easily distracted. It's hard for them to organize or finish tasks. They may have trouble following instructions or conversations.
• Mostly Hyperactive-Impulsive ADHD. People with this type of ADHD have symptoms of both hyperactivity and impulsivity:
  • With hyperactivity, people feel a need to always be moving. They have trouble sitting still and may fidget and/or talk too much.
  • With impulsivity, people have trouble controlling their actions and words. They tend to act on sudden ideas or feelings without thinking about the possible results. They may interrupt others a lot or have trouble waiting their turn.
• Combined ADHD. People with this type of ADHD have a mix of inattentive and hyperactive-impulsive symptoms. Combined ADHD is the most common type.

It's normal to sometimes have trouble paying attention or sitting still, especially for children. But people with ADHD have more severe symptoms that can sometimes cause serious problems, for example, failing grades for a child or a job loss for an adult. The symptoms are ongoing and may affect family and social life, too.

What causes attention deficit hyperactivity disorder (ADHD)?

The exact cause of ADHD is unknown. ADHD probably results from a combination of factors, such as genetics and your environment. Researchers are looking at possible environmental factors that might raise the risk of developing ADHD. These factors include brain injuries, nutrition, and social environments.

What are the symptoms of attention deficit hyperactivity disorder (ADHD)?

The symptoms of ADHD depend on the type of ADHD a person has:

People with symptoms of attention problems may often:

• Miss details or make careless mistakes in schoolwork, at work, or in other activities
• Have trouble staying focused on play activities or work tasks
• Not seem to listen when spoken to directly
• Find it hard to follow instructions or finish tasks, or may start but get easily sidetracked
• Have trouble being organized, keeping belongings in order, and managing time
• Avoid doing tasks that require long periods of mental effort
• Lose important items, such as books, wallets, keys, eyeglasses, and cellphones
• Forget about doing daily activities

People with symptoms of hyperactivity-impulsivity may often:

• Fidget and squirm while seated
• Get up when staying seated is expected, such as at school or work
• Run around or climb when it's not appropriate (children) or feel restless (teens and adults)
• Have trouble doing quiet activities
• Be constantly moving or "on the go"
• Talk much more than is normal
• Blurt out answers before questions are completed
• Have trouble waiting for their turn
• Interrupt others for example during conversations or games

People with combined ADHD show a mix of inattention and hyperactivity-impulsivity symptoms

How is attention deficit hyperactivity disorder (ADHD) diagnosed?

There is no single test to diagnose ADHD. One step of the process for diagnosing ADHD involves having a physical exam, including vision tests, hearing tests (for children and adults), and other tests to rule out other problems with symptoms like ADHD. Other problems with similar symptoms include anxiety, depression, sleep problems, and certain types of learning disabilities.

The process also involves a thorough medical history and family history. And it usually includes using standardized ADHD symptom checklists, questionnaires, and/or interview questions. These tools have rating scales (scoring systems) that help the provider see if a person's symptoms and history fit a diagnosis of ADHD.

To make a diagnosis of ADHD, the provider needs to have found all of these things:

• Several symptoms of ADHD that began before age 12.
• Several symptoms of inattention and/or hyperactivity-impulsivity that have lasted for at least 6 months and cause serious problems:
  • For children up to age 16, there must be at least 6 ongoing symptoms.
  • For people 17 and older, there must be at least 5 ongoing symptoms.
  • Symptoms that happen in 2 or more settings, for example, at home and at work or school.
  • Symptoms that clearly get in the way of functioning well at school, work, and/or in social situations.
  • Symptoms aren't caused by another mental health disorder.

What are the treatments for attention deficit hyperactivity disorder (ADHD)?

Although there is no cure for ADHD, treatments may help reduce symptoms and improve functioning. ADHD is commonly treated with:

• Medicines.
• Psychotherapy (talk therapy), including behavior therapy.
• Education or training for parents to give them the skills and strategies to help their child. This is especially important for younger children.
• A combination of these treatments.

Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Having a healthy lifestyle, such as healthy eating and regular exercise, may also help manage symptoms.

For school-aged children, school support is important. This could include classroom-based behavioral interventions such as behavior management plans or teaching your child organizational and study skills. It may also include accommodations such as specific seating in the classroom, reduced classwork, or extended time on tests and exams.

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

• Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.
• Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

What is Attention Deficit-Hyperactivity Disorder?

Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects 3-5 percent of all American children. It interferes with a person's ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral). Some of the warning signs of ADHD include failure to listen to instructions, inability to organize oneself and school work, fidgeting with hands and feet, talking too much, leaving projects, chores and homework unfinished, and having trouble paying attention to and responding to details. There are several types of ADHD: a predominantly inattentive subtype, a predominantly hyperactive-impulsive subtype, and a combined subtype. ADHD is usually diagnosed in childhood, although the condition can continue into the adult years.

Is there any treatment?

The usual course of treatment may include medications such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine), which are stimulants that decrease impulsivity and hyperactivity and increase attention. The U.S. Food and Drug Administration has approved the generic versions of Strattera (atomoxetine) to treat ADHD in pediatric and adult individuals. Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. Treatment should include structured classroom management, parent education (to address discipline and limit-setting), and tutoring and/or behavioral therapy for the child.

What is the prognosis?

There is no "cure" for ADHD. Children with the disorder seldom outgrow it; however, some may find adaptive ways to accommodate the ADHD as they mature.

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Types

There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

• Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.

In addition to genetics, scientists are studying other possible causes and risk factors including:

• Brain injury
• Exposure to environmental (e.g., lead) during pregnancy or at a young age
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Diagnosis

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Treatments

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may help:

• Developing healthy eating habits such as eating plenty of fruits, vegetables, and whole grains and choosing lean protein sources
• Participating in daily physical activity based on age
• Limiting the amount of daily screen time from TVs, computers, phones, and other electronics
• Getting the recommended amount of sleep each night based on age

Get Help!

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

The Centers for Disease Control and Prevention (CDC) funds the National Resource Center on ADHD, a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their website has links to information for people with ADHD and their families. The National Resource Center operates a call center (1-800-233-4050) with trained staff to answer questions about ADHD.

ADHD in Adults

ADHD can last into adulthood. Some adults have ADHD but have never been diagnosed. The symptoms can cause difficulty at work, at home, or with relationships. Symptoms may look different at older ages, for example, hyperactivity may appear as extreme restlessness. Symptoms can become more severe when the demands of adulthood increase.

Attention-deficit/Hyperactivity Disorder (ADHD) is exhibited by not being able to focus, being overactive, not being able to control behavior, or a combination of these. For these symptoms to be diagnosed as ADHD, they must be out of the normal range for a person's age and development.

Causes

ADHD is the most commonly diagnosed behavioral disorder in children. Although it usually begins in childhood, it is a condition that affects many adults as well.

It is not clear what causes ADHD, but a combination of genes and environmental factors likely plays a role in the development of the condition.

Signs & Symptoms

Symptoms of ADHD fall into three groups:

• Not being able to focus (inattention)
• Being extremely active (hyperactivity)
• Difficulties controlling behavior (impulsivity)

Some people with ADHD mainly have symptoms of inattention and are given the diagnosis of ADHD, Inattentive Presentation. Others mostly have symptoms of hyperactivity and impulsivity and are given the diagnosis of ADHD, Hyperactive and/Impulsive Presentation.

Inattention

• Fails to give close attention to details or makes careless mistakes
• Has difficulty keeping attention during tasks or play
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish tasks
• Has problems organizing tasks and activities
• Avoids, or dislikes, tasks that require sustained mental effort
• Often loses personal items or tools needed for tasks or activities
• Is easily distracted, can often be forgetful in daily activities

Hyperactivity

• Fidgets with hands or feet
• Has difficulty sitting still or remaining seated
• Runs around or climbs in inappropriate situations
• Has difficulty performing activities or tasks quietly
• Talks excessively

Impulsivity

• Blurts out answers before questions have been completed
• Has difficulty awaiting turn
• Interrupts or intrudes on others

Testing for ADHD

There is no one test to diagnose ADHD in children or adults. Clinicians may personally observe the patient, use questionnaires and scales that measure symptoms, conduct psychological tests, and interview or collect rating scales from the patient’s relatives, teachers, or others who are in their lives. They may also use clinical testing to rule out other possible conditions.

Get Help

Although there is no cure for ADHD, there are many forms of treatment that can improve daily life and reduce symptoms. Treatment plans can include medication, psychotherapy, trainings, education, or a combination of these.

Is your child in constant motion? Does he or she talk incessantly? Or have trouble focusing and prefer to daydream?

Then your child may have attention deficit hyperactivity disorder (ADHD).

This disorder often begins between ages 3 and 6, according to the National Institute of Mental Health (NIMH). And it’s not just a childhood disease. ADHD may continue through the teenage years and into adulthood.

There are three types of ADHD:

• inattentive (trouble focusing, following instructions, and finishing tasks)
• hyperactive-impulsive (constantly on the go, talking excessively, and interrupting others)
• combined (symptoms of both inattention and hyperactivity-impulsivity)

Diagnosing ADHD

Studies show that the number of children being diagnosed with ADHD continues to increase, according to the Centers for Disease Control and Prevention (CDC). About 11% of children ages 4 to 17 (6.4 million kids) have been diagnosed with ADHD as of 2011, up from 7.8% in 2003, according to the CDC. Child psychiatrist Tiffany R. Farchione, M.D., who reviews drugs at the U.S. Food and Drug Administration (FDA) to treat ADHD, says that increase might be because of greater public awareness of the disorder and psychiatric illnesses in general.

Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD. Boys also are more likely to have the hyperactive-impulsive type, which is easier to spot than the quieter child who is inattentive, says Farchione.

If you suspect your child might have ADHD, see your family doctor or pediatrician. Your child’s vision, hearing, and anything else that may contribute to inattention should also be checked. The doctor may diagnose ADHD or refer your child to a mental health specialist for evaluation.

Treatments for ADHD

FDA has approved two types of medications—stimulants and non-stimulants—to help reduce the symptoms of ADHD and improve functioning in children as young as age 6.

It may seem counterintuitive, Farchione says, but despite their name, stimulants, which contain various forms of methylphenidate and amphetamine, actually have a calming effect on hyperactive children with ADHD. They are believed to increase brain levels of dopamine—a neurotransmitter associated with motivation, attention, and movement.

FDA has also approved three non-stimulants to treat the symptoms of ADHD: Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine). These provide a useful alternative for children who do not tolerate stimulants well. Talk with your health care professional about what medications may be best for your child.

In addition to medication, some children with ADHD receive behavioral therapy to help manage symptoms and provide added coping skills. Moreover, concerned parents can reach out to their children’s schools and community support groups for information and guidance on how to cope with ADHD behavior. “It’s helpful to engage with the different individuals who are involved in a child’s life when managing the disorder,” Farchione says.

Testing the Effects of Medication in Younger Kids

FDA-approved medications currently on the market have been tested for safety and effectiveness in clinical trials of children 6 and older. But once a drug has been approved and is on the market, FDA is now asking for clinical trials with participants of children as young as 4 and 5.

“We know ADHD medications are being prescribed for younger children, and we think it’s essential that the data from clinical studies reflect the safety and effectiveness for this age group,” Farchione adds.

Left untreated, ADHD can have serious consequences. A child may fall behind in school, encounter difficulties in friendships, and have conflicts with parents, according to the American Academy of Child and Adolescent Psychiatry.

Studies show that children with untreated ADHD have more emergency room visits and are more likely to have self-inflicted injuries than those treated for the disorder. Untreated adolescents with ADHD are more likely to take risks, such as drinking and driving. And they have twice as many motor vehicle accidents as those who are treated.

Adults and ADHD

Studies suggest that about 4% of adults may have ADHD. For adults, the symptoms are the same as those in children but might show up somewhat differently. Adults with ADHD may have poor time management skills and trouble with multitasking, become restless with downtime, and avoid activities that require sustained concentration.

A diagnosis of ADHD in an adult is given only when it’s known that some of the symptoms were present early in childhood, usually under the age of seven.

“For some adults, a diagnosis of ADHD can bring a sense of relief,” says Farchione. Receiving a diagnosis allows adults to understand the reasons for their problems, and treatment can help them to deal with challenges more effectively.

Most children get restless, rowdy, or distracted at times. That’s all part of being a kid. But some kids have such trouble paying attention, staying focused, and finishing tasks that it interferes with their schoolwork, home life, and friendships. These difficulties might be signs of a developmental disorder called attention deficit hyperactivity disorder, or ADHD.

ADHD is a common brain condition in children. Nationwide, more than 1 in 10 kids ages 4 to 17 have been diagnosed with ADHD. Many will have all or some of their symptoms as adults too. While there’s no cure for ADHD, it can be treated and managed with medication and therapy.

“Kids with ADHD are impaired in their functioning in school, with friends, in activities, at home, or in the community,” says Dr. Benedetto Vitiello, a psychiatrist and child mental health expert at NIH. “The diagnosis is made because the level of hyperactivity or lack of concentration is extreme and prevents the child from engaging in what would be expected activities appropriate to their development.”

Children with ADHD usually get diagnosed around age 7, but more severe cases may be identified earlier. Often a teacher or parent notices the child seems out of control and has more serious and persistent behavior problems than other kids the same age.

Some children with ADHD are hyperactive (overactive) and impulsive (acting quickly without thinking). These kids are constantly in motion, fidget a lot, and find it hard to sit still. They’re impatient and have trouble controlling their behavior or waiting their turn.

Other children with ADHD, especially girls, are mainly inattentive (have trouble paying attention). Kids with the inattentive kind of ADHD have a hard time concentrating and following instructions. They often forget and lose things; they can’t seem to get organized or complete assignments or chores. Most kids with ADHD have a combination of the hyperactive-impulsive and inattentive types.

Researchers have been studying what might cause ADHD. The condition tends to run in families, but experts believe many complex factors may play a role.

Studies suggest that some aspects of brain development can be delayed by 2 or 3 years in kids with ADHD, especially in the parts of the brain involved in thinking, planning, and paying attention. For many kids, Vitiello says, the brain later develops normally and these kids catch up, even though some symptoms may continue throughout their lives.

There’s no single test to diagnose ADHD. If you’re concerned about it, talk with your child’s doctor or a mental health specialist. Medication and counseling can help kids focus and learn skills so they eventually won’t need constant reminders to do and finish routine tasks.

“Make sure there’s a good schedule of activities and a system of reinforcing the child to follow through on assignments,” says Vitiello. “Reward the child for good behavior and discourage distraction, impulsiveness, and other problematic behaviors.”

The most effective ADHD medications are stimulants, Vitiello says. In kids with ADHD, stimulants reduce hyperactivity and improve attention. Children taking these drugs should be monitored by a doctor. If symptoms don’t improve, or if side effects occur (such as loss of appetite, difficulty sleeping, or anxiety), the doctor might lower the dose or change the medicine.

“Considering there are different types and forms of the condition,” says Vitiello, “each child and each family needs to identify and tailor the approach to that child, without relying just on medication alone.”

Managing ADHD

Help kids with ADHD stay on top of their game:

• Keep children on the same daily schedule, from waking up to bedtime.
• Organize clothes, toys, and other commonly used items. Keep everything in its place.
• Use organizers for schoolwork and supplies.
• Be clear and consistent with rules; praise and reward kids when they achieve goals.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological disorder that affects a person's ability to control their behavior and pay attention to tasks.

What causes ADHD?

ADHD has many causes. Among these causes are: 1) familial: ADHD often runs in families; 2) abnormal brain development; or 3) brain injuries occuring before, during or after birth.

Why is ADHD considered a neurological condition?

Brain images of children with ADHD may show differences compared to children without ADHD. For example, in some children with ADHD certain parts of the brain are smaller or less active than the brains of children without ADHD. These changes may be linked to specific brain chemicals that are needed for tasks such as sustaining attention and regulating activity levels.

What are some of the other conditions that are common in children with ADHD?

Some children with ADHD may also have learning disabilities, behavioral disorders or disorders of mood such as depression or anxiety. Problems with planning, memory, schoolwork, motor skills, social skills, control of emotions, and response to discipline are common. Sleep problems can also be more frequent.

What is the risk of having ADHD if other family members have ADHD?

Children who have ADHD usually have at least one close biological (blood) relative who also has ADHD. At least one-third of all fathers who had ADHD in their youth have children with ADHD. Research has shown that ADHD can have a genetic basis, which means that it is likely that a person diagnosed with ADHD has a close relative with similar symptoms.

Researchers are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other disorders, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors that might raise the risk of developing ADHD and are studying how brain injuries, nutrition, and social environments might play a role in ADHD.

ADHD is more common in males than females, and females with ADHD are more likely to primarily have inattention symptoms. People with ADHD often have other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance use disorder.

Some people with ADHD mainly have symptoms of inattention. Others mostly have symptoms of hyperactivity-impulsivity. Some people have both types of symptoms.

Many people experience some inattention, unfocused motor activity, and impulsivity, but for people with ADHD, these behaviors:

• Are more severe
• Occur more often
• Interfere with or reduce the quality of how they function socially, at school, or in a job

Inattention

People with symptoms of inattention may often:

• Overlook or miss details and make seemingly careless mistakes in schoolwork, at work, or during other activities
• Have difficulty sustaining attention during play or tasks, such as conversations, lectures, or lengthy reading
• Not seem to listen when spoken to directly
• Find it hard to follow through on instructions or finish schoolwork, chores, or duties in the workplace, or may start tasks but lose focus and get easily sidetracked
• Have difficulty organizing tasks and activities, doing tasks in sequence, keeping materials and belongings in order, managing time, and meeting deadlines
• Avoid tasks that require sustained mental effort, such as homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
• Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
• Be easily distracted by unrelated thoughts or stimuli
• Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Hyperactivity-Impulsivity

People with symptoms of hyperactivity-impulsivity may often:

• Fidget and squirm while seated
• Leave their seats in situations when staying seated is expected, such as in the classroom or the office
• Run, dash around, or climb at inappropriate times or, in teens and adults, often feel restless
• Be unable to play or engage in hobbies quietly
• Be constantly in motion or on the go, or act as if driven by a motor
• Talk excessively
• Answer questions before they are fully asked, finish other people’s sentences, or speak without waiting for a turn in a conversation
• Have difficulty waiting one’s turn
• Interrupt or intrude on others, for example in conversations, games, or activities

Primary care providers sometimes diagnose and treat ADHD. They may also refer individuals to a mental health professional, such as a psychiatrist or clinical psychologist, who can do a thorough evaluation and make an ADHD diagnosis.

For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for their age. Stress, sleep disorders, anxiety, depression, and other physical conditions or illnesses can cause similar symptoms to those of ADHD. Therefore, a thorough evaluation is necessary to determine the cause of the symptoms.

Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12.

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in children who primarily have symptoms of inattention, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and symptoms may more likely include feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Deciding if a child has ADHD is a process with several steps. This page gives you an overview of how ADHD is diagnosed. There is no single test to diagnose ADHD, and many other problems, like sleep disorders, anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

If you are concerned about whether a child might have ADHD, the first step is to talk with a healthcare provider to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a pediatrician.

The American Academy of Pediatrics (AAP) recommends that healthcare providers ask parents, teachers, and other adults who care for the child about the child’s behavior in different settings, like at home, school, or with peers. Read more about the recommendations.

The healthcare provider should also determine whether the child has another condition that can either explain the symptoms better, or that occurs at the same time as ADHD. Read more about other concerns and conditions.

How is ADHD diagnosed?

Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5), to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD, and how public health is impacted by this condition.

Here are the criteria in shortened form. Please note that they are presented just for your information. Only trained healthcare providers can diagnose or treat ADHD.

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
   • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
   • Often has trouble holding attention on tasks or play activities.
   • Often does not seem to listen when spoken to directly.
   • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
   • Often has trouble organizing tasks and activities.
   • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
   • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
   • Is often easily distracted
   • Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
   • Often fidgets with or taps hands or feet, or squirms in seat.
   • Often leaves seat in situations when remaining seated is expected.
   • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
   • Often unable to play or take part in leisure activities quietly.
   • Is often “on the go” acting as if “driven by a motor”.
   • Often talks excessively.
   • Often blurts out an answer before a question has been completed.
   • Often has trouble waiting their turn.
   • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

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.

Diagnosing ADHD in Adults

ADHD often lasts into adulthood. To diagnose ADHD in adults and adolescents age 17 years or older, only 5 symptoms are needed instead of the 6 needed for younger children. Symptoms might look different at older ages. For example, in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.

My Child Has Been Diagnosed with ADHD – Now What?

When a child is diagnosed with attention-deficit/hyperactivity disorder (ADHD), parents often have concerns about which treatment is right for their child. ADHD can be managed with the right treatment. There are many treatment options, and what works best can depend on the individual child and family. To find the best options, it is recommended that parents work closely with others involved in their child’s life—healthcare providers, therapists, teachers, coaches, and other family members.

Types of treatment for ADHD include

• Behavior therapy, including training for parents; and
• Medications.

Treatment recommendations for ADHD

For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried. For children 6 years of age and older, the recommendations include medication and behavior therapy together — parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents. Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school supports. Learn more about how the school environment can be part of treatment.

Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, as well as making changes as needed along the way. To learn more about AAP recommendations for the treatment of children with ADHD, visit the Recommendations page.

Behavior Therapy, Including Training for Parents

ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and other children. Children with ADHD often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is made.

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy for ADHD can include

• Parent training in behavior management;
• Behavior therapy with children; and

• Behavioral interventions in the classroom.

These approaches can also be used together. For children who attend early childhood programs, it is usually most effective if parents and educators work together to help the child.

Children younger than 6 years of age

For young children with ADHD, behavior therapy is an important first step before trying medication because:

• Parent training in behavior management gives parents the skills and strategies to help their child.
• Parent training in behavior management has been shown to work as well as medication for ADHD in young children.
• Young children have more side effects from ADHD medications than older children.
• The long-term effects of ADHD medications on young children have not been well-studied.

School-age children and adolescents

For children ages 6 years and older, AAP recommends combining medication treatment with behavior therapy. Several types of behavior therapies are effective, including:

• Parent training in behavior management;
• Behavioral interventions in the classroom;
• Peer interventions that focus on behavior; and
• Organizational skills training.

These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.

Medications

Medication can help children manage their ADHD symptoms in their everyday life and can help them control the behaviors that cause difficulties with family, friends, and at school.

Several different types of medications are FDA-approved to treat ADHD in children as young as 6 years of age:

• Stimulants are the best-known and most widely used ADHD medications. Between 70-80% of children with ADHD have fewer ADHD symptoms when taking these fast-acting medications.
• Nonstimulants were approved for the treatment of ADHD in 2003. They do not work as quickly as stimulants, but their effect can last up to 24 hours.

Medications can affect children differently and can have side effects such as decreased appetite or sleep problems. One child may respond well to one medication, but not to another.

Healthcare providers who prescribe medication may need to try different medications and doses. The AAP recommends that healthcare providers observe and adjust the dose of medication to find the right balance between benefits and side effects. It is important for parents to work with their child’s healthcare providers to find the medication that works best for their child.

Parent Education and Support

CDC funds the National Resource Center on ADHD (NRC), a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). The NRC provides resources, information, and advice for parents on how to help their child.

Tips for Parents

The following are suggestions that may help with your child’s behavior:

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized. Encourage your child to put schoolbags, clothing, and toys in the same place every day so that they will be less likely to lose them.
• Manage distractions. Turn off the TV, limit noise, and provide a clean workspace when your child is doing homework. Some children with ADHD learn well if they are moving or listening to background music. Watch your child and see what works.
• Limit choices. To help your child not feel overwhelmed or overstimulated, offer choices with only a few options. For example, have them choose between this outfit or that one, this meal or that one, or this toy or that one.
• Be clear and specific when you talk with your child. Let your child know you are listening by describing what you heard them say. Use clear, brief directions when they need to do something.
• Help your child plan. Break down complicated tasks into simpler, shorter steps. For long tasks, starting early and taking breaks may help limit stress.
• Use goals and praise or other rewards. Use a chart to list goals and track positive behaviors, then let your child know they have done well by telling them or by rewarding their efforts in other ways. Be sure the goals are realistic—small steps are important!
• Discipline effectively. Instead of scolding, yelling, or spanking, use effective directions, time-outs or removal of privileges as consequences for inappropriate behavior.
• Create positive opportunities. Children with ADHD may find certain situations stressful. Finding out and encouraging what your child does well—whether it’s school, sports, art, music, or play—can help create positive experiences.
• Provide a healthy lifestyle. Nutritious food, lots of physical activity, and sufficient sleep are important; they can help keep ADHD symptoms from getting worse.

ADHD in Adults

ADHD lasts into adulthood for at least one-third of children with ADHD. Treatments for adults can include medication, psychotherapy, education or training, or a combination of treatments. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD and the National Institutes of Mental Health

While there is no cure for ADHD, currently available treatments may reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.

Medication

For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely by their prescribing doctor.

Stimulants. The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works by increasing the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.

Under medical supervision, stimulant medications are considered safe. However, like all medications, they can have side effects, especially when misused or taken in excess of the prescribed dose, and require an individual’s health care provider to monitor how they may be reacting to the medication.

Non-stimulants. A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant: when a person has bothersome side effects from stimulants, when a stimulant was not effective, or in combination with a stimulant to increase effectiveness.

Although not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, some antidepressants are used alone or in combination with a stimulant to treat ADHD. Antidepressants may help all of the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder. Non-stimulant ADHD medications and antidepressants may also have side effects.

Doctors and patients can work together to find the best medication, dose, or medication combination.

Psychotherapy and Psychosocial Interventions

Several specific psychosocial interventions have been shown to help individuals with ADHD and their families manage symptoms and improve everyday functioning.

For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need specialized help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

All types of therapy for children and teens with ADHD require parents to play an active role. Psychotherapy that includes only individual treatment sessions with the child (without parent involvement) is not effective for managing ADHD symptoms and behavior. This type of treatment is more likely to be effective for treating symptoms of anxiety or depression that may occur along with ADHD.

Behavioral therapy is a type of psychotherapy that aims to help a person change their 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 person how to:

• Monitor their own behavior
• Give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting

Parents, teachers, and family members also can give feedback on certain behaviors and help establish clear rules, chore lists, and structured routines to help a person control their behavior. Therapists may also 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.

Cognitive behavioral therapy helps a person learn how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person 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.

Family and marital therapy can help family members and spouses find productive ways to handle disruptive behaviors, encourage behavior changes, and improve interactions with the person with ADHD.

Parenting skills training (behavioral parent management training) teaches parents skills for encouraging and rewarding positive behaviors in their children. Parents are taught to use a system of rewards and consequences to change a child’s behavior, to give immediate and positive feedback for behaviors they want to encourage, and to ignore or redirect behaviors they want to discourage.

Specific behavioral classroom management interventions and/or academic accommodations for children and teens have been shown to be effective for managing symptoms and improving functioning at school and with peers. Interventions may include behavior management plans or teaching organizational or study skills. Accommodations may include preferential seating in the classroom, reduced classwork load, or extended time on tests and exams. The school may provide accommodations through what is called a 504 Plan or, for children who qualify for special education services, an Individualized Education Plan (IEP).

Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.

Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

Behavior therapy is an effective treatment for attention-deficit/hyperactivity disorder (ADHD) that can improve a child’s behavior, self-control, and self-esteem. It is most effective in young children when it is delivered by parents. Experts recommend that healthcare providers refer parents of children younger than 12 years old for training in behavior therapy. For children younger than 6 years old, parent training in behavior management should be tried before prescribing ADHD medication.

When parents become trained in behavior therapy, they learn skills and strategies to help their child with ADHD succeed at school, at home, and in relationships. Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child and the family.

What should parents look for?

If possible, families should look for a therapist who focuses on training parents. Some therapists will have training or certification in a parent training program that has been proven to work in young children with ADHD.

Therapists may also use strategies like those in proven programs. The following list of questions can be used to find a therapist who uses a proven approach:

• Does this therapist
  • Teach parents skills and strategies that use positive reinforcement, structure, and consistent discipline to manage their child’s behavior?
  • Teach parents positive ways to interact and communicate with their child?
  • Assign activities for parents to practice with their child?
  • Meet regularly with the family to monitor progress and provide coaching and support?
  • Re-evaluate treatment plans and remain flexible enough to adjust strategies as needed?

What can parents expect?

Parents typically attend eight or more sessions with a therapist. Sessions may involve working with groups of parents or with one family alone. The therapist meets regularly with the parents to review their progress, provide support, and adjust strategies, as needed, to ensure improvement. Parents typically practice with their child between sessions.

Parents have the greatest influence on their young child’s behavior. Only therapy that focuses on training parents is recommended for young children with ADHD because young children are not mature enough to change their own behavior without their parents’ help. Some therapists may use play therapy or talk therapy to treat young children with ADHD. Play therapy provides a way for children to communicate their experiences and feelings through play. Talk therapy uses verbal communication between the child and a therapist to treat mental and emotional disorders. Neither of these has been proven to improve symptoms in young children with ADHD.

Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child. Ask your healthcare provider about the benefits of parent training in behavior therapy for young children with ADHD.

What can healthcare providers do?

Healthcare providers can:

• Follow the clinical practice guideline for diagnosis and treatment of ADHD in young children
• Discuss with parents the benefits of behavior therapy and why they should consider getting training.
• Identify parent training providers in their area and refer parents of young children with ADHD for training in behavior therapy before prescribing medicine.

For Kids:

Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:

• Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or a bulletin board. Write changes on the schedule as far in advance as possible.
• Organizing everyday items. Have a place for everything, (such as clothing, backpacks, and toys), and keep everything in its place.
• Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home necessary books.
• Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
• Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior and praise it.

For Adults:

A professional counselor or therapist can help an adult with ADHD learn how to organize their life with tools such as:

• Keeping routines.
• Making lists for different tasks and activities.
• Using a calendar for scheduling events.
• Using reminder notes.
• Assigning a special place for keys, bills, and paperwork.
• Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.