Here's everything you need to know about attention-deficit/hyperactivity disorder (ADHD).
What is attention-deficit/hyperactivity disorder (ADHD)?
Attention-deficit/hyperactivity disorder (ADHD) is a diagnosis given to children and adolescents who have difficulty controlling their attention, their activity level and/or their impulses. The diagnosis of ADHD is only made when these difficulties get in the way of everyday functioning, such as school performance, making and keeping friends, and staying out of trouble.
What are symptoms of ADHD?
Attention problems
Symptoms of inattention include difficulty focusing on things that are boring or challenging, like homework, brushing teeth or a difficult puzzle.
Often, children with attention problems are easily distracted. For example, they may stop working on an assignment because they hear another student talking, they see their pet dog walk by or they begin thinking about what they want to do later.
Attention problems can include making careless mistakes, like adding instead of subtracting, or being forgetful.
Additionally, some kids have trouble shifting their attention away from things they really enjoy. For example, they may not hear the smoke alarm go off if they are playing video games, or they may refuse to get ready to go to lunch until they have finished their math worksheet at school.
Hyperactivity
Children with hyperactivity are often described as “always on the go.” They are up and out of their seats at meal times and in the classroom. Parents may avoid going to places like restaurants or theaters where the child will need to sit properly for extended periods of time.
Sometimes hyperactive symptoms in children cause safety concerns, such as when a child is likely to run away in public spaces or climb on things when it is not appropriate.
Adolescents with ADHD are generally able to control their activity level better than young children. Hyperactive adolescents tend to fidget with things in their hands, squirm in their seats and jiggle their legs. They may prefer to stand while working.
Across ages, extreme talkativeness and noisiness is also a symptom of hyperactivity. Hyperactive youth often talk, sing, make repetitive noises and tap on things more than their same-age peers.
Impulsivity
Impulsivity often shows up in social situations with peers. Preschool-age children have trouble keeping their hands to themselves at circle time or while waiting in line. School-age children with ADHD are more likely to grab things out of others’ hands without asking first. Adolescents with ADHD are likely to say something unkind or post something on social media that they later regret.
Impulsivity can also lead to safety concerns at all ages. In young children, impulsive behaviors include running into a street without checking for cars or grabbing at something hot on the stove. In adolescence, impulsivity can lead to risky behaviors such as trying drugs and alcohol.
What causes ADHD?
ADHD is caused by differences in the organization of the brain. ADHD is largely genetic, meaning it is inherited through families or related to spontaneous changes in the DNA.
Some non-genetic causes of ADHD include prenatal exposure to alcohol and brain injury (e.g., stroke, seizures, severe concussion).
Is ADHD genetic?
ADHD is about 75% heritable, meaning that in the whole population, about 75% of individual differences in ADHD symptoms can be accounted for by genetic factors.
How is ADHD diagnosed?
ADHD is diagnosed by a child’s pediatrician or primary care provider, or a specialist like a pediatric psychologist, psychiatrist or developmental behavioral pediatrician, which can be found at places like Boston Children's Hospital.
The doctor will gather information about the child’s symptoms and how they are affecting daily functioning. This will include talking to and collecting surveys from parents, caregivers and teachers. Older children and adolescents may also be able to provide helpful firsthand information about their symptoms.
There may be some cases where alternative or additional diagnoses should be considered. For example, it may be unclear whether a learning disorder is causing your child to appear inattentive, or whether your child has ADHD as well as a learning disorder. When the diagnosis of ADHD is not clear, it is important to have your child evaluated by a specialist who can help differentiate between symptoms so that your child receives the most appropriate treatments.
How to treat ADHD
Evidence-based treatments for ADHD include behavioral therapy, school-based supports and medications.
For young and school-aged children, the most appropriate behavioral therapy is focused on providing parents and caregivers with tools to support their child. This therapy is called “parent management training” (PMT) or sometimes “parent behavioral training” (PBT). PMT/PBT is often delivered in a group setting, but can also be done 1:1 with a therapist and the family.
Adolescents with ADHD may benefit from behavioral therapy in which they, rather than their parents, are the primary patients. The recommended therapy for older individuals with ADHD is cognitive behavioral therapy, or CBT. Even with adolescents, it’s recommended parents be involved in some aspect of the therapy so that they can support their child’s use of new strategies at home.
Children and adolescents with ADHD who are struggling with friendships may benefit from social skills groups. Social skills training should always happen in a group setting with other children so they can practice what they are learning in a real-life setting with peers.
School-based supports
School-based interventions for ADHD can be formalized in a Section 504 Plan or an Individualized Education Plan (IEP).
Some common accommodations for youth with ADHD include preferential seating, extra time on tests and opportunities to take breaks and move around.
For young children, the use of behavioral plans, like a daily report card, is strongly recommended to create goals for and reinforce desired behaviors in the classroom.
Older children and adolescents may benefit from support from a counselor or homeroom teacher to stay organized and to ensure they understand their assignments. As students get older, it is important that they learn how to break down large assignments into smaller pieces so that they do not get overwhelmed and/or wait until the last minute to complete their work.
Medications
Medications for ADHD include stimulants and non-stimulants.
Stimulant medications are often not prescribed until children are at least 6 years old because they can cause side effects prior to then. At any age, determining the best medication for a child with ADHD requires the caregivers and the medication provider to work closely together. Sometimes a child will need to try multiple medications and multiple doses before finding the right fit.
Is ADHD a disability?
The Americans with Disabilities Act (ADA) defines a disability broadly as, “a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.”
ADHD is diagnosed based on a combination of symptoms and resulting functional impairment. Thus, by this definition, ADHD is considered a disability.
What’s the difference between ADD and ADHD?
There is no difference between ADD and ADHD. ADD is the term used in old diagnostic guidelines. In 2013, the term was updated to ADHD in the diagnostic manual, with the option to specify if a child presents with predominantly inattentive or hyperactive/impulsive symptoms. Most children are diagnosed with ADHD, combined presentation, meaning they have some symptoms of inattention as well as hyperactivity/impulsivity.
Living with ADHD
Living with ADHD has its pros and cons. Children with ADHD are enthusiastic, loving, creative and funny. Most of the time, children with ADHD know how they should behave, but they have trouble acting on it in the moment. This can leave children feeling regretful, embarrassed or down on themselves after they make a mistake. Caregivers and teachers can help children with ADHD maintain positive self-esteem by setting them up for success. For example:
If a child struggles to be patient in the car or at a restaurant, keep a special set of toys that they can only use in that setting.
If an older child is having trouble fitting in with peers at school, help them build at least one strong friendship by setting up 1:1 playdates.
For adolescents who may be struggling academically, invite the adolescent into discussions with teachers to identify the challenges and brainstorm solutions.
