Attention Deficit Hyperactivity Disorder (ADHD) Overview

Attention deficit hyperactivity disorder (ADHD) can cause difficulty maintaining attention, managing energy levels, and controlling impulses.

In the United States, around 8.4% of children and 2.5% of adults have ADHD. In some children, ADHD characteristics begin as early as 3 years of age.

Ways of treating ADHD include medication, behavioral management techniques, and other practical strategies.

What is ADHD?

Patients with ADHD have difficulty focusing on tasks and controlling their attention, which can make completing a project, for example, challenging. ADHD can limit a person’s ability to study or work, and it can lead to stress, anxiety and depression.

Some people with ADHD also find it hard to sit still. They may be quick to act on impulse and become easily distracted.

While children of any age can experience distraction and impulsiveness, these traits are more noticeable in those with ADHD.

Features of ADHD

ADHD may develop in one of three ways. A doctor may find that the disorder has:

• A predominantly hyperactive and impulsive presentation
• Predominantly inattentive presentation
• Combined presentation

Patients with ADHD experience hyperactivity, impulsivity, and inattention in varying degrees.

Inattention

Below are some behaviors related to inattention that a person might notice in someone with ADHD:

• Avoiding tasks that need prolonged focus and thought 
• Appearing to not listen while others are talking
• Becoming distracted and having difficulty focusing on tasks 
• Daydreaming 
• Frequently losing everyday items 
• Having difficulty following instructions
• Making careless mistakes
• Having difficulty with time management and organization

Hyperactivity and Impulsivity

Some or all of the following may be apparent in someone with ADHD:

• Fidgeting or tapping the hands or feet 
• Running or climbing at inappropriate times 
• Seeming constantly “on-the-go” and unable to sit still 
• Taking unnecessary risks
• Having difficulty taking turns in conversations and activities
• Talking and making noises excessively

In Adults

Adults and children tend to experience the same symptoms of ADHD, and these can create difficulties in relationships and at work.

The effects of these features vary widely from person to person, and a person may find that their experience of ADHD changes over time.

Not everyone with ADHD is noisy and disruptive. A child may be quiet in class, for example, while facing severe challenges that they do not express.

In Females

Females with ADHD may be more likely to have difficulty paying attention, while males may be more likely to experience hyperactivity and impulsivity.

This may be one reason why more males than females receive diagnoses of ADHD. Hyperactivity can be easier to spot than inattention.

Diagnosis of ADHD

Most children with ADHD receive a diagnosis while they are in elementary school, but some may not do so until adolescence or adulthood.

No single test can identify ADHD, and the symptoms can overlap with those of other conditions. This can make it difficult to diagnose.

A doctor will conduct examinations to rule out other potential causes, such as hearing or vision problems.

Other conditions that can lead to similar behaviors include:

• Anxiety
• Depression 
• Sleep disorders
• Trouble hearing or seeing
• Learning disabilities

A doctor will often ask questions to learn more about the person’s behavioral patterns. They may speak with the individual, members of their family, and any other caregivers, such as teachers.

Many children experience hyperactivity and inattention. For a diagnosis of ADHD, the symptoms must meet specific criteria, including having a significant impact on daily life and schoolwork.

Treatments of ADHD

A range of approaches can help a person manage ADHD. A doctor should work with the individual to develop a treatment plan that suits them best.

The plan may include:

Behavioral Therapy and Counseling

A therapist or counselor can help a person develop or enhance a wide range of skills, such as:

• Building and maintaining relationships 
• Developing and following a schedule
• Establishing and following rules 
• Monitoring ADHD symptoms
• Planning and completing tasks

Therapists can also help parents develop constructive ways to respond to the behaviors that can result from ADHD.

A person with ADHD may specifically benefit from:

• Classroom behavior management techniques
• Family therapy
• Stress management
• Cognitive behavioral therapy

Cognitive behavioral therapy, commonly called CBT, aims to help a person find new ways to approach and react to everyday situations.

Tips for Supporting Children

Parents, teachers, and other caregivers can help children navigate the challenges of ADHD.

Schools often have educational plans for children with ADHD, including specific teaching approaches, classroom accommodations, and school-based counseling.

At home and at school, the following strategies can help:

• Breaking down larger tasks into smaller, more manageable ones
• Establishing clear and consistent rules 
• Having a written schedule of all tasks
• Keeping school items and toys organized
• Rewarding or praising the child when they accomplish tasks
• Using a planner that teachers and caregivers check regularly

Also, encourage children to engage in activities that they enjoy and do well in to boost their self-esteem. Sports and other forms of exercise can provide outlets for high energy levels and enhance the child’s overall well-being.

Tips for Adults

Reminder notes and alarms, calendars, and planners can help adults with ADHD manage their schedules.

It is also a good idea to keep keys and other important everyday items in specific spots.

Medications

Medications, such as stimulants, can help improve attention and focus. Here are some examples:

• Amphetamine/dextroamphetamine (Adderall) 
• Dexamphetamine (Dexedrine)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Ritalin)

However, they can have adverse effects, such as:

• Abdominal pain 
• Headaches
• Increased anxiety and irritability 
• Raised blood pressure and heart rate 
• Personality changes
• Sleep problems
• Reduced appetite

To avoid side effects, let the doctor know about any ongoing medications and health issues.

If stimulants are ineffective or unsuitable, a doctor may prescribe nonstimulant medications, such as:

• Atguanfacine (Intuniv)
• Atomoxetine (Strattera)
• Clonidine (Catapres)

For some people, a doctor may prescribe one of the above alongside a stimulant.

Causes and Risk Factors

Doctors do not know what causes ADHD, but they have identified some risk factors, including:

• A family history of ADHD
• Brain injury
• Exposure to  stress, alcohol, or tobacco during pregnancy 
• A low birth weight, according to a 2018 meta-analysis
• Exposure to environmental toxins during pregnancy or from a young age
• Possibly preterm birth, according to a 2018 study

Inattentive ADHD

Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children. It occurs in around 8.4 percent of children and 2.5 percent of adults.

A diagnosis of attention deficit hyperactivity disorder will include one of three specifiers. These are terms that provide more detail about a person’s experience. The specifier “inattentive” describes challenges concentrating and paying attention to detail.

A person with inattentive ADHD likely has difficulties concentrating and paying attention to detail, in the classroom, for example.

Another specifier of ADHD is “hyperactive/impulsive.” This describes a person who likely fidgets, has difficulties sitting still, and has very high levels of energy.

If a person experiences some characteristics of both inattentive and hyperactive/impulsive ADHD, a doctor may diagnose them with combined ADHD.

A specifier does not represent a different diagnosis, it is an extension added to a diagnosis. Specifiers help psychological practitioners to better describe a person’s symptoms and make treatment decisions.

Inattentive ADHD is not a type of ADHD. It is just a more specific way of describing an individual’s symptoms.

It is important to remember that a child may not have ADHD just because they show some symptoms. Many life events, medical conditions, and psychological disorders can result in challenges and behavior similar to those associated with ADHD.

Symptoms and Diagnosis

Many children display symptoms of inattentive ADHD, such as having a limited attention span and difficulties following instructions.

However, children with inattentive ADHD have more significant challenges focusing and paying attention than the medical community would expect for most children in the age range.

A psychologist or psychiatrist will diagnose ADHD with “inattentive” as a specifier if a child has at least six of the nine symptoms below:

• Appearing not to listen when spoken to
• Being easliy distracted 
• Forgetting to perform daily tasks and go to appointments
• Seeming unable to pay close attention or regularly making careless mistakes in tasks
• Having difficulties staying focused on tasks or activities
• Unable to complete tasks or duties as instructed
• Having trouble organizing tasks and managing time
• Avoiding or disliking tasks that require extended periods of thinking
• Regularly losing items needed for daily life

A doctor can diagnose a person over 17 years of age if they demonstrate five of the symptoms above.

However, a person has to demonstrate these symptoms frequently over a 6-month period to meet the doctor’s criteria.

There is no blood test or physical examination for inattentive ADHD. The doctor will reach a diagnosis by gathering information from parents and teachers, determining if the child shows the behavior that meets the criteria, and ruling out other issues.

Differences Between Specifiers

A doctor will diagnose ADHD with “inattentive” as a specifier if distraction is a key characteristic.

In a child, this may involve spending a lot of time looking through a window, rather than focusing on the teacher’s words.

If a person has ADHD with”hyperactive/impulsive” as a specifier, the symptoms are different. They involve high levels of energy.

For a diagnosis of hyperactive/impulsive ADHD, a child or adolescent will display at least of six of the following nine symptoms. Anyone older than 17 years will display at least five:

• Blurting out answers 
• Being constantly “on the go” or seeming motorized
• Fidgeting with or tapping the hands or feet, or squirming while sitting 
• Finding it difficult to wait in turn
• Seeming unable to stay seated
• Running and climbing at inappropriate times and places
• Talking an unusual amount
• Interrupting or intruding on others, such as by cutting into or taking over games, activities or conversations 
• Unable to play or participate in activities quietly

While many children have high levels of energy and may display some of the symptoms above, for a doctor to diagnose hyperactive/impulsive ADHD, the symptoms would have to be on the extreme side and cause problems in everyday life. The symptoms would also have to occur frequently for more than 6 months.

A person may have six or more of the above symptoms, some of which characterize inattentive ADHD and others which characterize hyperactive/impulsive ADHD.

If these symptoms are all present for more than 6 months, a doctor will likely diagnose combined ADHD.

According to research published in 1997, definitive symptoms of hyperactive/impulsive ADHD are likely to show by the time a child is 7 years old.

The findings suggest that a doctor can usually diagnose combined ADHD by the same age.

The researchers also found that fewer than half of the children later diagnosed with inattentive ADHD showed definitive symptoms in the first 7 years of life.

Overall, more males have ADHD than females, but females are more likely than males to have the inattentive specifier.

Before doctor diagnoses ADHD, they need to rule out other possible causes of symptoms. These can include:

• Learning difficulties 
• Medical conditions
• Other psychological or behavioral disorders
• Responses to life events

Causes and Risk Factors of Inattentive ADHD

The specific causes of inattentive ADHD are unclear. However, some research suggests that the following factors may play a role in developing ADHD:

Genetics: Around 3 out of 4 children with ADHD have a relative with the condition.

Premature birth: Infants born even 1 month prematurely may face an increased risk of developing ADHD.

Low birth weight: Results of one meta-analysis suggest a small but significant link between low birth weight and the development of ADHD.

Stress and other lifestyle factors during pregnancy: Findings of a study from 2012 support a previously established connection between maternal stress during pregnancy and the development of ADHD. The authors of this study conclude that smoking tobacco and drinking alcohol during pregnancy may also increase the child’s risk of developing the disorder.

Traumatic brain injury: In 2015, researchers found a possible link between mild traumatic brain injury and ADHD in student athletes. However, the causal relationship was unclear.

No research supports claims that the following can cause ADHD:

• Certain type of parenting styles
• Environmental or social factors, such as poverty or a stressful home life 
• Watching too much TV

However, these and similar factors may worsen symptoms of ADHD.

Treatment of Inattentive ADHD

While there is no cure for inattentive ADHD, medications and therapies can help to reduce symptoms and manage behavior.

Treatment for ADHD is similar, regardless of the specifier. A healthcare professional will often recommend a combination of medication and educational, behavioral, and psychological therapies.

Therapies and interventions

• Behavioral therapy: This aims to identify and change behaviors that are not healthful and may harm the individual or people around them.
• Family therapy: This involves a therapist speaking with each member of the family and encouraging discussion. The goal is to provide collective support for a child with ADHD. 
• Psychotherapy: There are many approaches to psychotherapy, but the main goals are for the individual to talk about the emotional impact of their condition and for the therapist to help them find healthful ways of handling it.
• Parent training: When a child shows regular signs of ADHD, family members usually have to adapt. Trained professionals can provide guidance and support for parents.
• Social skills training: This can help an individual with inattentive ADHD to adapt to social situations. The goal is to reduce some of the social and emotional effects of the condition.

Having a specifier attached to the diagnosis of ADHD can help therapists and other professionals to personalize treatment plans.

Medicines

Medicinal treatments for inattentive ADHD include:

• Antidepressants, which are medications developed to treat anxiety and depression.
• Stimulants which are medicines that increase levels of chemicals in some areas of the brain 
• Atomoxetine, a medication that helps to control the processing of noradrenaline, a hormone similar to adrenaline 
• Clonidine, which doctors also prescribe to treat high blood pressure and anxiety
• Guanfacine, a prescribed non-stimulant drug

Stimulants are the most widely used medications for ADHD. Between 70 and 80 percent of children with ADHD experience fewer symptoms when they take stimulants.

However, every individual responds to medication differently, especially children.

It is important that parents and caregivers work with healthcare professionals to find the medication and dosage that is best for the child.

Living with inattentive ADHD

Any combination of ADHD symptoms can sometimes be distressing, [MOU18] for both the person with the disorder and those close to them.

However, a wide range of strategies can make life easier for young people and adults with ADHD.

Tips for Parents and Caregivers

Parents and caregivers may find that making the following types of changes helps children with inattentive ADHD to adjust:

• Effective Discipline: Use time-outs and remove privileges, such as video game time, as a consequence of inappropriate behavior.
• Clear conversation: Give clear, brief instructions, and repeat the child’s statements back to them, to show that they have been understood.
• Goals and rewards: List goals, track positive behaviors and reward the child when they have acted in line with their goals.
• Healthful lifestyle: Provide a nutritious diet, encourage physical activity, and help to ensure that the child is getting enough sleep. 
• Identify and manage distractions: For some children with ADHD, listening to music or moving helps them to learn, but for others, these activities have the opposite effect.
• Limit choices: Avoid overstimulation by presenting a few concrete options. For example, let a child with inattentive ADHD choose between only two meal plans or weekend activities.
• Organization: Always keeping clothing, toys, and school bags in the same place can help the child to remember what they need and avoid losing things.
• Planning: Break down complicated tasks into smaller, more straightforward steps, and make sure to take breaks during longer activities to limit stress.
• Positive opportunities: Encourage the child to participate in activities in which they show skill and are more likely to have positive experiences. 
• Routine: Aim to follow the same schedule each day.
• School: Maintain regular communication with the child’s teachers.
• Supervision: Children with ADHD may need more supervision than other children.

Parents and caregivers should experiment and learn what works for each child. As a general rule, however, it is best to limit noise, clutter, and time spent watching TV.

Tips for Managing Inattentive ADHD in Adulthood

An adult with inattentive ADHD may find it challenging to perform some everyday tasks, such as staying organized, keeping appointments, paying bills on time, and maintaining relationships with friends and family.

However, several strategies and can help a person with ADHD to maintain focus and regain control over their daily tasks.

Some helpful techniques include the following:

Getting organized: This can compensate for any symptomatic forgetfulness. Make to-do lists, use calendars and planners, and try to avoid procrastination.

Also, it can help to designate specific areas for important items, to reduce the risk of losing them.

It may help to avoid clutter by paying bills online and opting for paperless transactions.

When a collection of paperwork is unavoidable, it can help to set up and maintain a clearly labeled or color-coded filing system.

Outlook

ADHD is a mental health condition that can create challenges to a person’s work, study, and home life. It usually appears during childhood.

A person does not “grow out of” ADHD, but learning management strategies can help them enjoy a full life.

Without treatment, which may include medication, a person may experience low self-esteem, depression, and problems with school, work, and relationships.

Anyone who believes that a child may have ADHD should seek medical advice.

Counselors, teachers, and other members of a child’s support network can help the child manage their symptoms and maximize their opportunities.

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