Attention-Deficit/Hyperactivity Disorder (ADHD) is a treatable condition that affects about 11% of children between the ages of four and 17 in the United States. Symptoms of ADHD usually appear by age seven (they may appear before this age), and are seen in boys three times more often than in girls; in adulthood, symptoms are found in men and women equally.
The “core,” or main, symptoms of ADHD include:
Some children may have ADHD without hyperactivity. This condition is more difficult to discover early because these children do not "act up" in class or at home. They are often bright and manage their workload in the early grades with little effort, not drawing attention to themselves. They may seem bored and fail to complete work, or they may show signs of confusion, forgetfulness, daydreaming, and disorganization.
At times, children seem to be “overfocused” in areas they are interested in. As a result, they do not appear disobedient or defiant, but simply don’t do their assigned chores or self-care routines when their parents ask them to, since they are so absorbed in their interests.
ADHD has two main classes of symptoms: inattention and hyperactivity/impulsivity.
The child with inattention has the following signs and symptoms:
The child with hyperactive and impulsive behavior has these signs and symptoms:
Research has shown that ADHD is caused by neurological (nervous system) and biological (related to the body) factors, though the exact causes are not yet known.
Risk factors for ADHD include the following:
Although the following factors may contribute to ADHD or make it worse, they are not causes:
*Note: A small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. Children with specific sensitivities and/or allergies may have fewer ADHD symptoms on a diet without food additives. Generally, food additives are not considered a cause of ADHD.
Though all children show behaviors similar to ADHD from time to time, the child with ADHD has symptom “clusters”—six symptoms of inattention and/or six symptoms of hyperactivity/impulsivity. Before a diagnosis of ADHD can be made, however, it is not enough for the child to have these symptoms—he or she must also meet these conditions:
If a child shows symptom clusters and also meets these conditions, the doctor may diagnose the following types of ADHD:
It is very important to follow three steps when diagnosing ADHD:
A child who has symptoms of ADHD may be able to pay attention in a focused way to activities that he or she finds interesting. For example, children can spend hours in front of a screen playing video games, but they may have trouble finishing even simple homework assignments, or they may throw tantrums and refuse to do chores or school work at home. This affects parent behavior as well, causing parents to yell more often or have to give repeated reminders to prompt the child to do simple tasks (like get ready for school). At such times, parents may know the child is not being oppositional—they just do not follow directions immediately.
Fascination or automatic attention (the kind of attention one uses when doing something interesting) is not a problem for children with ADHD; in fact, it may be very strong in some cases. However, “directed attention” (also known as effortful attention or top-down attention) is far more difficult for a child with ADHD. Tasks that require directed attention are harder to do and require much more effort. This kind of attention is much more readily used up. Because of these conditions, the caregiver must carefully observe the child in a number of different situations to make sure the evaluation is thorough.
If you think your child has a problem with attention, hyperactivity, or impulsivity, and it seems that his or her behavior at home and performance at school are being affected, the next step is to have an examination and evaluation.
If the symptoms are affecting your child’s school work, you should request that the school evaluate him or her. When making this request, be as specific as possible about the type of educational or behavioral difficulties your child is having.
Schools are required to evaluate children (age 3 to 21) if they are believed to have a disability that affects their learning. This evaluation is free and must, by law, include appropriate standardized tests.School testing can lead to accommodations in the classroom. The school will not diagnose ADHD, but will take note of the symptoms and will often assign a designation of “Other Health Impaired” (OHI).
If your child is not yet school age, or if his or her problems occur mostly at home, make an appointment with your family doctor or pediatrician (or a caregiver who is familiar with diagnosing ADHD) to discuss the possibility of ADHD. Be sure to give the caregiver or doctor background information about your concerns and the concerns of school personnel or other caregivers. If necessary, the family doctor may suggest you take your child to a professional who specializes in ADHD and other developmental, behavioral, or mental health concerns.
Before the ADHD appointment, parents should fill out and return all the rating scales or medical information forms they received, both broad band (which cover a variety of conditions) and narrow band (which include symptoms associated with ADHD alone). Because there is no one single test for ADHD, information about family history, the child’s medical history, and behavior concerns are important for the doctor or specialist to know in order to complete a full evaluation.
If your child already receives school services from an IEP or 504 Accommodations plan, bring a copy of the IEP/504 to your appointment. This will let the physician or specialist know about the child’s difficulties at school and any testing the school has completed, and will give a picture of the strategies the school already has in place for your child.
The diagnosis of ADHD will probably be made by a pediatric psychologist or physician (a pediatrician, psychiatrist, or neurologist), with the help of standard guidelines from the American Academy of Pediatrics.
A comprehensive ADHD evaluation includes the following:
If a child is diagnosed with ADHD, it means that not only is he or she easily distracted, but that the distraction is much more noticeable than it is in other children of the same age. Specialists will consider the following when diagnosing ADHD:
The specialists will also check to see if other things might be causing behavior that is similar to ADHD. This behavior can often show up in other disorders and situations, such as the following:
After the first appointment, your child’s healthcare provider will collect all the information from the evaluation process, make a diagnosis, and complete a report. The report will sum up the results and give treatment recommendations, including general guidelines for managing your child’s ADHD, and specific strategies and resources tailored to your family’s needs and your child’s strengths and weaknesses.
After diagnosis, recommendations for both behavior therapy and pharmacotherapy (medication) should be discussed with the healthcare provider.
A group of drugs called psychostimulants has been found to be the most effective treatment for childhood ADHD. The two most commonly used medicines in this class are methylphenidate (Ritalin®, Concerta®, Focalin XR®, Ritalin LA®, Daytrana®, Quillivant XRTM, Metadate CD) and dextroamphetamine (Adderall XR®, Vyvanse®). These medicines help children to focus their thoughts and ignore distractions. Stimulant medicines are effective in 70% to 80% of patients.
Non-stimulant medicines include atomoxetine (Strattera®,) guanfacine (Intuniv®), and clonidine (Kapvay®). They are often used as additional therapy, or can be used on their own if the doctor decides.
Here is a current list of ADHD medications:
ADHD medicines are available in short-acting (immediate-release), intermediate-acting, and long-acting forms. It might take some time for a doctor to find the most effective medicine, dosage, and schedule for a person who has ADHD.
There is no reliable way to predict which medicine(s) will work. The only way to know that a medication will be helpful for a child with ADHD is to prescribe it.
ADHD drugs sometimes have side effects, including appetite suppression, trouble sleeping, or irritability. Side effects are often mild and short-lived, and usually happen early in treatment. If side effects continue or interfere with the child’s life, the doctor will probably change the medication or lower the dose of the medicine used. A good rule is to compare the benefit of medicine to the side effect—if the benefit outweighs the side effect, it is often helpful to manage the side effect.
Behavioral treatments for ADHD include the following:
Parents should use caution when considering alternative treatments. Very few alternative or complementary treatments have been shown to be helpful for ADHD.
The program Cogmed® is effective in training working memory, which is often a problem with children who have ADHD. Other studies have shown mild benefits for omega-3 supplements, massage therapy, and mindfulness training. Mindfulness training is proving to be a real asset in many therapies, including ADHD.
Other alternative treatments for ADHD that have not been proven useful in controlled scientific studies, or may even be harmful, are:
Though many claims are made for other complementary and alternative treatments for ADHD, such as Brain Gym® and Lumosity®, few have been found to be effective.
Families must understand that children will adapt their behavior to their parents’ behavior. Children can learn rules, follow them, cooperate with siblings, and complete homework and chores more often when effective family strategies are put to use in the home.
Such positive changes don’t come easily—changes in behavior often take time and focused effort. Excellent behavior management strategies for the home can be found in the book 1-2-3 Magic by Dr. Thomas Phelan.
Parents may find the following strategies helpful for managing ADHD in the home:
Teaching a child with ADHD: Tips for the classroom
Teachers may want to use these strategies for managing a child with ADHD in school:
For more than 60% of children with ADHD, troublesome symptoms continue through adolescence and into adulthood. The following behaviors and problems might stem directly from ADHD, or might be caused by problems with adjustment:
If these issues are not managed appropriately, they may cause emotional, social, work, and educational difficulties for adults with ADHD. However, with the right combination of resources, family support, social support, and treatment programs, problems related to ADHD can be effectively managed.
ADHD and its difficulties may be treated or managed with the help of these strategies:
In addition, some adults with ADHD may benefit from medication to address symptoms and difficulties with inattention, distractibility, hyperactivity, and impulsive behavior.
Helpful information for adults living with ADHD can be found at the following websites:
Additional information about ADHD and its management can be found at the following websites:
American Psychological Association
750 First Street NE
Washington, DC 20002
Attention Deficit Disorder Association (ADDA)
15000 Commerce Pkwy, Ste C
Mount Laurel, NJ 08054
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
4601 Presidents Drive, Suite 300
Lanham, MD 20706
Learning Disabilities Association of America
4156 Library Road
Pittsburgh, PA 15234-1349
National Center for Learning Disabilities
32 Laight Street, 2nd Floor
New York, NY 10013
National Institute of Mental Health
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard, Room 6200, MSC 9663
Bethesda, MD 20892-9663
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 10/18/2016