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Attention deficit hyperactivity disorder ( ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inappropriate.

ADHD symptoms arise from executive dysfunction, and emotional dysregulation is often considered a core symptom. In children, problems paying attention may result in poor school performance. ADHD is associated with other neurodevelopmental and mental disorders as well as some non-psychiatric disorders, which can cause additional impairment, especially in modern society. Although people with ADHD struggle to focus on tasks they are not particularly interested in completing, they are often able to maintain an unusually prolonged and intense level of attention for tasks they do find interesting or rewarding; this is known as hyperfocus.

It affects about 5-7% of children when diagnosed via the DSM-IV criteria, and 1-2% when diagnosed via the ICD-10 criteria. Rates are similar between countries and differences in rates depend mostly on how it is diagnosed. ADHD is diagnosed approximately twice as often in boys than in girls, and 1.6 times more often in men than in women, although the disorder is overlooked in girls or diagnosed in later life because their symptoms sometimes differ from diagnostic criteria. About 30-50% of people diagnosed in childhood continue to have ADHD in adulthood, with 2.58% of adults estimated to have ADHD which began in childhood.[text-source integrity? ] In adults, hyperactivity is usually replaced by inner restlessness, and adults often develop coping skills to compensate for their impairments. The condition can be difficult to tell apart from other conditions, as well as from high levels of activity within the range of normal behavior. ADHD has a negative impact on patients' health related quality of life and that this may be further exacerbated by, or may increase the risk of, other psychiatric conditions such as anxiety and depression.

ADHD management recommendations vary and usually involve some combination of medications, counseling, and lifestyle changes. The British guideline emphasises environmental modifications and education for individuals and carers about ADHD as the first response. If symptoms persist, parent-training, medication, or psychotherapy (especially cognitive behavioral therapy) can be recommended based on age. Canadian and American guidelines recommend medications and behavioral therapy together, except in preschool-aged children for whom the first-line treatment is behavioral therapy alone. Stimulant medications are the most effective pharmaceutical treatment, although there may be side effects and any improvements will be reverted if medication is ceased.

ADHD, its diagnosis, and its treatment have been considered controversial since the 1970s. These controversies have involved doctors, teachers, policymakers, parents, and the media. Topics have included causes of ADHD and the use of stimulant medications in its treatment. Since the 2000s, ADHD has been a well-validated clinical diagnosis in children and adults, and the debate in the scientific community mainly centers now on how it is diagnosed and treated. ADHD was officially known as attention deficit disorder ( ADD) from 1980 to 1987; prior to the 1980s, it was known as hyperkinetic reaction of childhood. Symptoms similar to those of ADHD have been described in medical literature dating back to the 18th century.

Inattention, hyperactivity (restlessness in adults), disruptive behavior, and impulsivity are common in ADHD. Academic difficulties are frequent as are problems with relationships. The symptoms can be difficult to define, as it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin.

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and its text revision ( DSM-5-TR), symptoms must be present for six months or more to a degree that is much greater than others of the same age. This requires at least six symptoms of either inattention or hyperactivity/impulsivity for those under 17 and at least five symptoms for those 17 years or older. The symptoms must be present in at least two settings (e.g., social, school, work, or home), and must directly interfere with or reduce quality of functioning. Additionally, several symptoms must have been present before age twelve.

ADHD is divided into three primary presentations:

predominantly inattentive (ADHD-PI or ADHD-I)

predominantly hyperactive-impulsive (ADHD-PH or ADHD-HI)

combined type (ADHD-C).

The table "Symptoms" lists the symptoms for ADHD-I and ADHD-HI from two major classification systems. Symptoms which can be better explained by another psychiatric or medical condition which an individual has are not considered to be a symptom of ADHD for that person.

Inattention

Six or more of the following symptoms in children, and five or more in adults, excluding situations where these symptoms are better explained by another psychiatric or medical condition:

Frequently overlooks details or makes careless mistakes

Often has difficulty maintaining focus on one task or play activity

Often appears not to be listening when spoken to, including when there is no obvious distraction

Frequently does not finish following instructions, failing to complete tasks

Often struggles to organise tasks and activities, to meet deadlines, and to keep belongings in order

Is frequently reluctant to engage in tasks which require sustained attention

Frequently loses items required for tasks and activities

Is frequently easily distracted by extraneous stimuli, including thoughts in adults and older teenagers

Often forgets daily activities, or is forgetful while completing them.

Multiple symptoms of inattention that directly negatively impact occupational, academic or social functioning. Symptoms may not be present when engaged in highly stimulating tasks with frequent rewards. Symptoms are generally from the following clusters:

Struggles to maintain focus on tasks that aren't highly stimulating/rewarding or that require continuous effort; details are often missed, and careless mistakes are frequent in school and work tasks; tasks are often abandoned before they are completed.

Easily distracted (including by own thoughts); may not listen when spoken to; frequently appears to be lost in thought

Often loses things; is forgetful and disorganised in daily activities.

The individual may also meet the criteria for hyperactivity-impulsivity, but the inattentive symptoms are predominant.

Hyperactivity-Impulsivity

Six or more of the following symptoms in children, and five or more in adults, excluding situations where these symptoms are better explained by another psychiatric or medical condition:

Is often fidgeting or squirming in seat

Frequently has trouble sitting still during dinner, class, in meetings, etc.

Frequently runs around or climbs in inappropriate situations. In adults and teenagers, this may be present only as restlessness.

Often cannot quietly engage in leisure activities or play

Frequently seems to be "on the go" or appears uncomfortable when not in motion

Often talks excessively

Often answers a question before it is finished, or finishes people's sentences

Often struggles to wait their turn, including waiting in lines

Frequently interrupts or intrudes, including into others' conversations or activities, or by using people's things without asking.

Multiple symptoms of hyperactivity/impulsivity that directly negatively impact occupational, academic or social functioning. Typically, these tend to be most apparent in environments with structure or which require self-control. Symptoms are generally from the following clusters:

Excessive motor activity; struggles to sit still, often leaving their seat; prefers to run about; in younger children, will fidget when attempting to sit still; in adolescents and adults, a sense of physical restlessness or discomfort with being quiet and still.

Talks too much; struggles to quietly engage in activities.

Blurts out answers or comments; struggles to wait their turn in conversation, games, or activities; will interrupt or intrude on conversations or games.

A lack of forethought or consideration of consequences when making decisions or taking action, instead tending to act immediately (e.g., physically dangerous behaviours including reckless driving; impulsive decisions).

The individual may also meet the criteria for inattention, but the hyperactive-impulsive symptoms are predominant.

Combined

Meet the criteria for both inattentive and hyperactive-impulsive ADHD.

Criteria are met for both inattentive and hyperactive-impulsive ADHD, with neither clearly predominating.

Girls and women with ADHD tend to display fewer hyperactivity and impulsivity symptoms but more symptoms of inattention and distractibility.

Symptoms are expressed differently and more subtly as the individual ages. Hyperactivity tends to become less overt with age and turns into inner restlessness, difficulty relaxing or remaining still, talkativeness or constant mental activity in teens and adults with ADHD. Impulsivity in adulthood may appear as thoughtless behaviour, impatience, irresponsible spending and sensation-seeking behaviours, while inattention may appear as becoming easily bored, difficulty with organization, remaining on task and making decisions, and sensitivity to stress.

Although not listed as an official symptom for this condition, emotional dysregulation or mood lability is generally understood to be a common symptom of ADHD. People with ADHD of all ages are more likely to have problems with social skills, such as social interaction and forming and maintaining friendships. This is true for all presentations. About half of children and adolescents with ADHD experience social rejection by their peers compared to 10-15% of non-ADHD children and adolescents. People with attention deficits are prone to having difficulty processing verbal and nonverbal language which can negatively affect social interaction. They also may drift off during conversations, miss social cues, and have trouble learning social skills.

Difficulties managing anger are more common in children with ADHD as are delays in speech, language and motor development. Poorer handwriting is more common in children with ADHD. Poor handwriting in many situations can be a side effect of ADHD in itself due to decreased attentiveness but when it's a constant problem it may also be in part due to both Dyslexic and Dysgraphic individuals having higher rates of ADHD than the general population, with 3 in 10 people who have dyslexia also having ADHD. Although it causes significant difficulty, many children with ADHD have an attention span equal to or greater than that of other children for tasks and subjects they find interesting.

In children, ADHD occurs with other disorders about two-thirds of the time.

Other neurodevelopmental conditions are common comorbidities. Autism spectrum disorder (ASD), co-occurring at a rate of 21% in those with ADHD, affects social skills, ability to communicate, behaviour, and interests. Both ADHD and ASD can be diagnosed in the same person. Learning disabilities have been found to occur in about 20-30% of children with ADHD. Learning disabilities can include developmental speech and language disorders, and academic skills disorders. ADHD, however, is not considered a learning disability, but it very frequently causes academic difficulties. Intellectual disabilities and Tourette's syndrome are also common.

ADHD is often comorbid with disruptive, impulse control, and conduct disorders. Oppositional defiant disorder (ODD) occurs in about 25% of children with an inattentive presentation and 50% of those with a combined presentation. It is characterised by angry or irritable mood, argumentative or defiant behavior and vindictiveness which are age-inappropriate. Conduct disorder (CD) occurs in about 25% of adolescents with ADHD. It is characterised by aggression, destruction of property, deceitfulness, theft and violations of rules. Adolescents with ADHD who also have CD are more likely to develop antisocial personality disorder in adulthood. Brain imaging supports that CD and ADHD are separate conditions, wherein conduct disorder was shown to reduce the size of one's temporal lobe and limbic system, and increase the size of one's orbitofrontal cortex, whereas ADHD was shown to reduce connections in the cerebellum and prefrontal cortex more broadly. Conduct disorder involves more impairment in motivation control than ADHD. Intermittent explosive disorder is characterised by sudden and disproportionate outbursts of anger and co-occurs in individuals with ADHD more frequently than in the general population.

Anxiety and mood disorders are frequent comorbidities. Anxiety disorders have been found to occur more commonly in the ADHD population, as have mood disorders (especially bipolar disorder and major depressive disorder). Boys diagnosed with the combined ADHD subtype are more likely to have a mood disorder. Adults and children with ADHD sometimes also have bipolar disorder, which requires careful assessment to accurately diagnose and treat both conditions.

Sleep disorders and ADHD commonly co-exist. They can also occur as a side effect of medications used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder with behavioral therapy being the preferred treatment. Problems with sleep initiation are common among individuals with ADHD but often they will be deep sleepers and have significant difficulty getting up in the morning. Melatonin is sometimes used in children who have sleep onset insomnia. Specifically, the sleep disorder restless legs syndrome has been found to be more common in those with ADHD and is often due to iron deficiency anemia. However, restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders. Delayed sleep phase disorder is also a common comorbidity of those with ADHD.

There are other psychiatric conditions which are often co-morbid with ADHD, such as substance use disorders. Individuals with ADHD are at increased risk of substance abuse. This is most commonly seen with alcohol or cannabis. The reason for this may be an altered reward pathway in the brains of ADHD individuals, self-treatment and increased psychosocial risk factors. This makes the evaluation and treatment of ADHD more difficult, with serious substance misuse problems usually treated first due to their greater risks. Other psychiatric conditions include reactive attachment disorder, characterised by a severe inability to appropriately relate socially, and sluggish cognitive tempo, a cluster of symptoms that potentially comprises another attention disorder and may occur in 30-50% of ADHD cases, regardless of the subtype. Individuals with ADHD are 4x more likely to develop and be diagnosed with an eating disorder (Anorexia, Bulimia, Binge Eating, ARFID) compared to those without ADHD. Individuals with diagnosed eating disorders are 2.6x more likely to have ADHD than those without eating disorders, though these numbers are likely much lower than actual rates, due to limitations with screening and diagnosis in marginalized populations.

ADHD, trauma, and Adverse Childhood Experiences are also comorbid, which could in part be potentially explained by the similarity in presentation between different diagnoses. The symptoms of ADHD and PTSD can have significant behavioral overlap with ADHD-in particular, motor restlessness, difficulty concentrating, distractibility, irritability/anger, emotional constriction or dysregulation, poor impulse control, and forgetfulness are common in both. This could result in trauma-related disorders or ADHD being mis-identified as the other. Additionally, traumatic events in childhood are a risk factor for ADHD - it can lead to structural brain changes and the development of ADHD behaviors. Finally, the behavioral consequences of ADHD symptoms cause a higher chance of the individual experiencing trauma (and therefore ADHD leads to a concrete diagnosis of a trauma-related disorder).

Some non-psychiatric conditions are also comorbidities of ADHD. This includes epilepsy, a neurological condition characterised by recurrent seizures. There are well established associations between ADHD and obesity, asthma and sleep disorders, and an association with celiac disease. Children with ADHD have a higher risk for migraine headaches, but have no increased risk of tension-type headaches. In addition, children with ADHD may also experience headaches as a result of medication.

A 2021 review reported that several neurometabolic disorders caused by inborn errors of metabolism converge on common neurochemical mechanisms that interfere with biological mechanisms also considered central in ADHD pathophysiology and treatment. This highlights the importance of close collaboration between health services to avoid clinical overshadowing.

Systematic reviews conducted in 2017 and 2020 found strong evidence that ADHD is associated with increased suicide risk across all age groups, as well as growing evidence that an ADHD diagnosis in childhood or adolescence represents a significant future suicidal risk factor. Potential causes include ADHD's association with functional impairment, negative social, educational and occupational outcomes, and financial distress. A 2019 meta-analysis indicated a significant association between ADHD and suicidal spectrum behaviors (suicidal attempts, ideations, plans, and completed suicides); across the studies examined, the prevalence of suicide attempts in individuals with ADHD was 18.9%, compared to 9.3% in individuals without ADHD, and the findings were substantially replicated among studies which adjusted for other variables. However, the relationship between ADHD and suicidal spectrum behaviors remains unclear due to mixed findings across individual studies and the complicating impact of comorbid psychiatric disorders. There is no clear data on whether there is a direct relationship between ADHD and suicidality, or whether ADHD increases suicide risk through comorbidities.

Certain studies have found that people with ADHD tend to have lower scores on intelligence quotient (IQ) tests. The significance of this is controversial due to the differences between people with ADHD and the difficulty determining the influence of symptoms, such as distractibility, on lower scores rather than intellectual capacity. In studies of ADHD, higher IQs may be over-represented because many studies exclude individuals who have lower IQs despite those with ADHD scoring on average nine points lower on standardized intelligence measures. In individuals with high intelligence, there is increased risk of a missed ADHD diagnosis, possibly because of compensatory strategies in highly intelligent individuals.

Studies of adults suggest that negative differences in intelligence are not meaningful and may be explained by associated health problems.

ADHD is generally claimed to be the result of neurological dysfunction in processes associated with the production or use of dopamine and norepinephrine in various brain structures, but there are no confirmed causes. It may involve interactions between genetics and the environment.

ADHD has a high heritability of 74%, meaning that 74% of the presence of ADHD in the population is due to genetic factors. There are multiple gene variants which each slightly increase the likelihood of a person having ADHD; it is polygenic and arises through the combination of many gene variants which each have a small effect. The siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the disorder.

Arousal is related to dopaminergic functioning, and ADHD presents with low dopaminergic functioning. Typically, a number of genes are involved, many of which directly affect dopamine neurotransmission. Those involved with dopamine include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. A common variant of a gene called latrophilin 3 is estimated to be responsible for about 9% of cases and when this variant is present, people are particularly responsive to stimulant medication. The 7 repeat variant of dopamine receptor D4 (DRD4-7R) causes increased inhibitory effects induced by dopamine and is associated with ADHD. The DRD4 receptor is a G protein-coupled receptor that inhibits adenylyl cyclase. The DRD4-7R mutation results in a wide range of behavioral phenotypes, including ADHD symptoms reflecting split attention. The DRD4 gene is both linked to novelty seeking and ADHD. The genes GFOD1 and CDH13 show strong genetic associations with ADHD. CHD13's association with ASD, schizophrenia, bipolar disorder, and depression make it an interesting candidate causative gene. Another candidate causative gene that has been identified is ADGRL3. In zebrafish, knockout of this gene causes a loss of dopaminergic function in the ventral diencephalon and the fish display a hyperactive/impulsive phenotype.

For genetic variation to be used as a tool for diagnosis, more validating studies need to be performed. However, smaller studies have shown that genetic polymorphisms in genes related to catecholaminergic neurotransmission or the SNARE complex of the synapse can reliably predict a person's response to stimulant medication. Rare genetic variants show more relevant clinical significance as their penetrance (the chance of developing the disorder) tends to be much higher. However their usefulness as tools for diagnosis is limited as no single gene predicts ADHD. ASD shows genetic overlap with ADHD at both common and rare levels of genetic variation.

In addition to genetics, some environmental factors might play a role in causing ADHD. Alcohol intake during pregnancy can cause fetal alcohol spectrum disorders which can include ADHD or symptoms like it. Children exposed to certain toxic substances, such as lead or polychlorinated biphenyls, may develop problems which resemble ADHD. Exposure to the organophosphate insecticides chlorpyrifos and dialkyl phosphate is associated with an increased risk; however, the evidence is not conclusive. Exposure to tobacco smoke during pregnancy can cause problems with central nervous system development and can increase the risk of ADHD. Nicotine exposure during pregnancy may be an environmental risk.

Extreme premature birth, very low birth weight, and extreme neglect, abuse, or social deprivation also increase the risk as do certain infections during pregnancy, at birth, and in early childhood. These infections include, among others, various viruses ( measles, varicella zoster encephalitis, rubella, enterovirus 71). At least 30% of children with a traumatic brain injury later develop ADHD and about 5% of cases are due to brain damage.

Some studies suggest that in a small number of children, artificial food dyes or preservatives may be associated with an increased prevalence of ADHD or ADHD-like symptoms, but the evidence is weak and may only apply to children with food sensitivities. The European Union has put in place regulatory measures based on these concerns. In a minority of children, intolerances or allergies to certain foods may worsen ADHD symptoms.

Individuals with hypokalemic sensory overstimulation are sometimes diagnosed as having attention deficit hyperactivity disorder (ADHD), raising the possibility that a subtype of ADHD has a cause that can be understood mechanistically and treated in a novel way. The sensory overload is treatable with oral potassium gluconate.

Research does not support popular beliefs that ADHD is caused by eating too much refined sugar, watching too much television, parenting, poverty or family chaos; however, they might worsen ADHD symptoms in certain people.

In some cases, an inappropriate diagnosis of ADHD may reflect a dysfunctional family or a poor educational system, rather than any true presence of ADHD in the individual.[better source needed ] In other cases, it may be explained by increasing academic expectations, with a diagnosis being a method for parents in some countries to get extra financial and educational support for their child. Behaviors typical of ADHD occur more commonly in children who have experienced violence and emotional abuse.

Current models of ADHD suggest that it is associated with functional impairments in some of the brain's neurotransmitter systems, particularly those involving dopamine and norepinephrine. The dopamine and norepinephrine pathways that originate in the ventral tegmental area and locus coeruleus project to diverse regions of the brain and govern a variety of cognitive processes. The dopamine pathways and norepinephrine pathways which project to the prefrontal cortex and striatum are directly responsible for modulating executive function (cognitive control of behavior), motivation, reward perception, and motor function; these pathways are known to play a central role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed.

In children with ADHD, there is a general reduction of volume in certain brain structures, with a proportionally greater decrease in the volume in the left-sided prefrontal cortex. The posterior parietal cortex also shows thinning in individuals with ADHD compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits have also been found to differ between people with and without ADHD.

The subcortical volumes of the accumbens, amygdala, caudate, hippocampus, and putamen appears smaller in individuals with ADHD compared with controls. Structural MRI studies have also revealed differences in white matter, with marked differences in inter-hemispheric asymmetry between ADHD and typically developing youths

Functional MRI fMRI studies have revealed a number of differences between ADHD and control brains. Independent component analysis performed on resting-state fMRI data have revealed that individuals with the inattentive type of ADHD have significantly more independent components are required to describe the variance of this data.

Previously, it had been suggested that the elevated number of dopamine transporters in people with ADHD was part of the pathophysiology, but it appears the elevated numbers may be due to adaptation following exposure to stimulant medication. Current models involve the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. ADHD psychostimulants possess treatment efficacy because they increase neurotransmitter activity in these systems. There may additionally be abnormalities in serotonergic, glutamatergic, or cholinergic pathways.

The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., attentional control, inhibitory control, and working memory). Executive functions are a set of cognitive processes that are required to successfully select and monitor behaviors that facilitate the attainment of one's chosen goals. The executive function impairments that occur in ADHD individuals result in problems with staying organised, time keeping, excessive procrastination, maintaining concentration, paying attention, ignoring distractions, regulating emotions, and remembering details. People with ADHD appear to have unimpaired long-term memory, and deficits in long-term recall appear to be attributed to impairments in working memory. Due to the rates of brain maturation and the increasing demands for executive control as a person gets older, ADHD impairments may not fully manifest themselves until adolescence or even early adulthood.

ADHD has also been associated with motivational deficits in children. Children with ADHD often find it difficult to focus on long-term over short-term rewards, and exhibit impulsive behavior for short-term rewards.

Another sign of the structurally altered signal processing in the central nervous system in this group of people is the conspicuously common Paradoxical reaction (ca. 10-20 % of patients). These are unexpected reactions in the opposite direction as with a normal effect, or otherwise significant different reactions. These are reactions to neuroactive substances such as local anesthetic at the dentist, sedative, caffeine, antihistamine, weak neuroleptics and central and peripheral painkillers. Since the causes of paradoxical reactions are at least partly genetic, it may be useful in critical situations, for example before operations, to ask whether such abnormalities may also exist in family members.

ADHD is diagnosed by an assessment of a person's behavioral and mental development, including ruling out the effects of drugs, medications, and other medical or psychiatric problems as explanations for the symptoms. ADHD diagnosis often takes into account feedback from parents and teachers with most diagnoses begun after a teacher raises concerns. It may be viewed as the extreme end of one or more continuous human traits found in all people. Imaging studies of the brain do not give consistent results between individuals; thus, they are only used for research purposes and not a diagnosis.

In North America and Australia, DSM-5 criteria are used for diagnosis, while European countries usually use the ICD-10. The DSM-IV criteria for diagnosis of ADHD is 3-4 times more likely to diagnose ADHD than is the ICD-10 criteria. ADHD is alternately classified as neurodevelopmental disorder or a disruptive behavior disorder along with ODD, CD, and antisocial personality disorder. A diagnosis does not imply a neurological disorder.

Associated conditions that should be screened for include anxiety, depression, ODD, CD, and learning and language disorders. Other conditions that should be considered are other neurodevelopmental disorders, tics, and sleep apnea.

Self-rating scales, such as the ADHD rating scale and the Vanderbilt ADHD diagnostic rating scale, are used in the screening and evaluation of ADHD. Electroencephalography is not accurate enough to make an ADHD diagnosis.

As with many other psychiatric disorders, a formal diagnosis should be made by a qualified professional based on a set number of criteria. In the United States, these criteria are defined by the American Psychiatric Association in the DSM. Based on the DSM-5 criteria published in 2013 and the DSM-5-TR criteria published in 2022, there are three presentations of ADHD:

1. ADHD, predominantly inattentive type, presents with symptoms including being easily distracted, forgetful, daydreaming, disorganization, poor concentration, and difficulty completing tasks.

2. ADHD, predominantly hyperactive-impulsive type, presents with excessive fidgeting and restlessness, hyperactivity, and difficulty waiting and remaining seated.

3. ADHD, combined type, is a combination of the first two presentations.

This subdivision is based on presence of at least six (in children) or five (in older teenagers and adults) out of nine long-term (lasting at least six months) symptoms of inattention, hyperactivity-impulsivity, or both. To be considered, several symptoms must have appeared by the age of six to twelve and occur in more than one environment (e.g. at home and at school or work). The symptoms must be inappropriate for a child of that age and there must be clear evidence that they are causing social, school or work related problems.

The DSM-5 and the DSM-5-TR also provide two diagnoses for individuals who have symptoms of ADHD but do not entirely meet the requirements. Other Specified ADHD allows the clinician to describe why the individual does not meet the criteria, whereas Unspecified ADHD is used where the clinician chooses not to describe the reason.

In the eleventh revision of the International Statistical Classification of Diseases and Related Health Problems ( ICD-11) by the World Health Organization, the disorder is classified as Attention deficit hyperactivity disorder (with the code 6A05). The defined subtypes are similar to those of the DSM-5: predominantly inattentive presentation (6A05.0); predominantly hyperactive-impulsive presentation(6A05.1); combined presentation (6A05.2). However, the ICD-11 includes two residual categories for individuals who do not entirely match any of the defined subtypes: other specified presentation (6A05.Y) where the clinician includes detail on the individual's presentation; and presentation unspecified (6A05.Z) where the clinician does not provide detail.

In the tenth revision ( ICD-10), the symptoms of hyperkinetic disorder were analogous to ADHD in the ICD-11. When a conduct disorder (as defined by ICD-10) is present, the condition was referred to as hyperkinetic conduct disorder. Otherwise, the disorder was classified as disturbance of activity and attention, other hyperkinetic disorders or hyperkinetic disorders, unspecified. The latter was sometimes referred to as hyperkinetic syndrome.

The social construct theory of ADHD suggests that, because the boundaries between normal and abnormal behavior are socially constructed (i.e. jointly created and validated by all members of society, and in particular by physicians, parents, teachers, and others), it then follows that subjective valuations and judgements determine which diagnostic criteria are used and thus, the number of people affected. This difference means using DSM-IV criteria could diagnose ADHD at rates three to four times higher than ICD-10 criteria. Thomas Szasz, a supporter of this theory, has argued that ADHD was "invented and then given a name".

Adults with ADHD are diagnosed under the same criteria, including that their signs must have been present by the age of six to twelve. The individual is the best source for information in diagnosis, however others may provide useful information about the individual's symptoms currently and in childhood; a family history of ADHD also adds weight to a diagnosis. While the core symptoms of ADHD are similar in children and adults, they often present differently in adults than in children: for example, excessive physical activity seen in children may present as feelings of restlessness and constant mental activity in adults.

Worldwide, it is estimated that 2.58% of adults have persistent ADHD (where the individual currently meets the criteria and there is evidence of childhood onset), and 6.76% of adults have symptomatic ADHD (meaning that they currently meet the criteria for ADHD, regardless of childhood onset). In 2020, this was 139.84 million and 366.33 million affected adults respectively. Around 15% of children with ADHD continue to meet full DSM-IV-TR criteria at 25 years of age, and 50% still experience some symptoms. As of 2010, most adults remain untreated. Many adults with ADHD without diagnosis and treatment have a disorganised life, and some use non-prescribed drugs or alcohol as a coping mechanism. Other problems may include relationship and job difficulties, and an increased risk of criminal activities. Associated mental health problems include depression, anxiety disorders, and learning disabilities.

Some ADHD symptoms in adults differ from those seen in children. While children with ADHD may climb and run about excessively, adults may experience an inability to relax, or may talk excessively in social situations. Adults with ADHD may start relationships impulsively, display sensation-seeking behavior, and be short-tempered. Addictive behavior such as substance abuse and gambling are common. This led to those who presented differently as they aged having outgrown the DSM-IV criteria. The DSM-5 criteria do specifically deal with adults unlike those in DSM-IV, which does not fully take into account the differences in impairments seen in adulthood compared to childhood.

For diagnosis in an adult, having symptoms since childhood is required. Nevertheless, a proportion of adults who meet the criteria for ADHD in adulthood would not have been diagnosed with ADHD as children. Most cases of late-onset ADHD develop the disorder between the ages of 12-16 and may therefore be considered early adult or adolescent-onset ADHD.

Depression disorder

Anxiety disorder

Bipolar disorder

persistent feeling of anxiety

irritability

occasional feelings of panic or fear

being hyperalert

inability to pay attention

tire easily

low tolerance for stress

difficulty maintaining attention

in manic state

in depressive state

same symptoms as in depression section

The DSM provides potential differential diagnoses - potential alternate explanations for specific symptoms. Assessment and investigation of clinical history determines which is the most appropriate diagnosis. The DSM-5 suggests ODD, intermittent explosive disorder, other neurodevelopmental disorders (such as stereotypic movement disorder and Tourette's disorder), specific learning disorder, intellectual developmental disorder, ASD, reactive attachment disorder, anxiety disorders, depressive disorders, bipolar disorder, disruptive mood dysregulation disorder, substance use disorder, personality disorders, psychotic disorders, medication-induced symptoms, and neurocognitive disorders. Many but not all of these are also common comorbidities of ADHD. The DSM-5-TR also suggests post-traumatic stress disorder.

Symptoms of ADHD, such as low mood and poor self-image, mood swings, and irritability, can be confused with dysthymia, cyclothymia or bipolar disorder as well as with borderline personality disorder. Some symptoms that are due to anxiety disorders, personality disorder, developmental disabilities or intellectual disability or the effects of substance abuse such as intoxication and withdrawal can overlap with ADHD. These disorders can also sometimes occur along with ADHD. Medical conditions which can cause ADHD-type symptoms include: hyperthyroidism, seizure disorder, lead toxicity, hearing deficits, hepatic disease, sleep apnea, drug interactions, untreated celiac disease, and head injury.[better source needed ]

Primary sleep disorders may affect attention and behavior and the symptoms of ADHD may affect sleep. It is thus recommended that children with ADHD be regularly assessed for sleep problems. Sleepiness in children may result in symptoms ranging from the classic ones of yawning and rubbing the eyes, to hyperactivity and inattentiveness. Obstructive sleep apnea can also cause ADHD-type symptoms.

The management of ADHD typically involves counseling or medications, either alone or in combination. While treatment may improve long-term outcomes, it does not get rid of negative outcomes entirely. Medications used include stimulants, atomoxetine, alpha-2 adrenergic receptor agonists, and sometimes antidepressants. In those who have trouble focusing on long-term rewards, a large amount of positive reinforcement improves task performance. ADHD stimulants also improve persistence and task performance in children with ADHD. Recent evidence from observational and registry studies indicates that pharmacological treatment of ADHD is associated with increased achievement and decreased absenteeism at school, a reduced risk of trauma-related emergency hospital visits, reduced risks of suicide and attempted suicide, and decreased rates of substance abuse and criminality.

There is good evidence for the use of behavioral therapies in ADHD. They are the recommended first-line treatment in those who have mild symptoms or who are preschool-aged. Psychological therapies used include: psychoeducational input, behavior therapy, cognitive behavioral therapy, interpersonal psychotherapy, family therapy, school-based interventions, social skills training, behavioral peer intervention, organization training, and parent management training. Neurofeedback has greater treatment effects than non-active controls for up to 6 months and possibly a year following treatment, and may have treatment effects comparable to active controls (controls proven to have a clinical effect) over that time period. Despite efficacy in research, there is insufficient regulation of neurofeedback practice, leading to ineffective applications and false claims regarding innovations. Parent training may improve a number of behavioral problems including oppositional and non-compliant behaviors.

There is little high-quality research on the effectiveness of family therapy for ADHD-but the existing evidence shows that it is similar to community care, and better than placebo. ADHD-specific support groups can provide information and may help families cope with ADHD.

Social skills training, behavioral modification, and medication may have some limited beneficial effects in peer relationships. Stable, high-quality friendships with non-deviant peers protect against later psychological problems.

Methylphenidate and amphetamine or its derivatives are first-line treatments for ADHD as they are considered the most effective pharmaceutical treatments. About 70 percent respond to the first stimulant tried and as few as 10 percent respond to neither amphetamines nor methylphenidate. Stimulants may also reduce the risk of unintentional injuries in children with ADHD. Magnetic resonance imaging studies suggest that long-term treatment with amphetamine or methylphenidate decreases abnormalities in brain structure and function found in subjects with ADHD. A 2018 review found the greatest short-term benefit with methylphenidate in children, and amphetamines in adults.

The likelihood of developing insomnia for ADHD patients taking stimulants has been measured at between 11 and 45 percent for different medications, and may be a main reason for discontinuation. Other side effects, such as tics, decreased appetite and weight loss, or emotional lability, may also lead to discontinuation. Stimulant psychosis and mania are rare at therapeutic doses, appearing to occur in approximately 0.1% of individuals, within the first several weeks after starting amphetamine therapy. The safety of these medications in pregnancy is unclear. Symptom improvement is not sustained if medication is ceased.

The long-term effects of ADHD medication have yet to be fully determined, although stimulants are generally beneficial and safe for up to two years for children and adolescents. Regular monitoring has been recommended in those on long-term treatment. There are indications suggesting that stimulant therapy for children and adolescents should be stopped periodically to assess continuing need for medication, decrease possible growth delay, and reduce tolerance. Although potentially addictive at high doses, stimulants used to treat ADHD have low potential for abuse. Treatment with stimulants is either protective against substance abuse or has no effect.

The majority of studies on nicotine and other nicotinic agonists as treatments for ADHD have shown favorable results; however, no nicotinic drug has been approved for ADHD treatment. Caffeine was formerly used as a second-line treatment for ADHD. It is considered less effective than methylphenidate or amphetamine but more so than placebo for children with ADHD. Pseudoephedrine and ephedrine do not affect ADHD symptoms.

Modafinil has shown some efficacy in reducing the severity of ADHD in children and adolescents. It may be prescribed off-label to treat ADHD.

There are a number of non-stimulant medications, such as Viloxazine, atomoxetine, bupropion, guanfacine, amantadine (effective in children and adolescents but still not been seen for adults), and clonidine, that may be used as alternatives, or added to stimulant therapy. There are no good studies comparing the various medications; however, they appear more or less equal with respect to side effects. For children, stimulants appear to improve academic performance while atomoxetine does not.

Atomoxetine, due to its lack of addiction liability, may be preferred in those who are at risk of recreational or compulsive stimulant use, although evidence is lacking to support its use over stimulants for this reason. Evidence supports its ability to improve symptoms when compared to placebo.

Amantadine was shown to induce similar improvements in children treated methylphenidate, with less frequent side effects. A 2021 retrospective study showed showed that amantadine may serve as an effective adjunct to stimulants for ADHD-related symptoms and appears to be a safer alternative to second- or third-generation antipsychotics.

There is little evidence on the effects of medication on social behaviors. Antipsychotics may also be used to treat aggression in ADHD.

Guidelines on when to use medications vary by country. The United Kingdom's National Institute for Health and Care Excellence recommends use for children only in severe cases, though for adults medication is a first-line treatment. Conversely, most United States guidelines recommend medications in most age groups. Medications are especially not recommended for preschool children. Underdosing of stimulants can occur, and can result in a lack of response or later loss of effectiveness. This is particularly common in adolescents and adults as approved dosing is based on school-aged children, causing some practitioners to use weight-based or benefit-based off-label dosing instead.

Regular physical exercise, particularly aerobic exercise, is an effective add-on treatment for ADHD in children and adults, particularly when combined with stimulant medication (although the best intensity and type of aerobic exercise for improving symptoms are not currently known). The long-term effects of regular aerobic exercise in ADHD individuals include better behavior and motor abilities, improved executive functions (including attention, inhibitory control, and planning, among other cognitive domains), faster information processing speed, and better memory. Parent-teacher ratings of behavioral and socio-emotional outcomes in response to regular aerobic exercise include: better overall function, reduced ADHD symptoms, better self-esteem, reduced levels of anxiety and depression, fewer somatic complaints, better academic and classroom behavior, and improved social behavior. Exercising while on stimulant medication augments the effect of stimulant medication on executive function. It is believed that these short-term effects of exercise are mediated by an increased abundance of synaptic dopamine and norepinephrine in the brain.

Dietary modifications are not recommended as of 2019 by the American Academy of Pediatrics, the National Institute for Health and Care Excellence, or the Agency for Healthcare Research and Quality due to insufficient evidence. A 2013 meta-analysis found less than a third of children with ADHD see some improvement in symptoms with free fatty acid supplementation or decreased eating of artificial food coloring. These benefits may be limited to children with food sensitivities or those who are simultaneously being treated with ADHD medications. This review also found that evidence does not support removing other foods from the diet to treat ADHD. A 2014 review found that an elimination diet results in a small overall benefit in a minority of children, such as those with allergies. A 2016 review stated that the use of a gluten-free diet as standard ADHD treatment is not advised. A 2017 review showed that a few-foods elimination diet may help children too young to be medicated or not responding to medication, while free fatty acid supplementation or decreased eating of artificial food coloring as standard ADHD treatment is not advised. Chronic deficiencies of iron, magnesium and iodine may have a negative impact on ADHD symptoms. There is a small amount of evidence that lower tissue zinc levels may be associated with ADHD. In the absence of a demonstrated zinc deficiency (which is rare outside of developing countries), zinc supplementation is not recommended as treatment for ADHD. However, zinc supplementation may reduce the minimum effective dose of amphetamine when it is used with amphetamine for the treatment of ADHD.

ADHD persists into adulthood in about 30-50% of cases. Those affected are likely to develop coping mechanisms as they mature, thus compensating to some extent for their previous symptoms. Children with ADHD have a higher risk of unintentional injuries. Effects of medication on functional impairment and quality of life (e.g. reduced risk of accidents) have been found across multiple domains. Rates of smoking among those with ADHD are higher than in the general population at about 40%.

ADHD is estimated to affect about 6-7% of people aged 18 and under when diagnosed via the DSM-IV criteria. When diagnosed via the ICD-10 criteria, rates in this age group are estimated around 1-2%. Children in North America appear to have a higher rate of ADHD than children in Africa and the Middle East; this is believed to be due to differing methods of diagnosis rather than a difference in underlying frequency.[verification needed ] As of 2019, it was estimated to affect 84.7 million people globally. If the same diagnostic methods are used, the rates are similar between countries. ADHD is diagnosed approximately three times more often in boys than in girls. This may reflect either a true difference in underlying rate, or that women and girls with ADHD are less likely to be diagnosed.

Rates of diagnosis and treatment have increased in both the United Kingdom and the United States since the 1970s. Prior to 1970, it was rare for children to be diagnosed with ADHD, while in the 1970s rates were about 1%. This is believed to be primarily due to changes in how the condition is diagnosed and how readily people are willing to treat it with medications rather than a true change in how common the condition is. It was believed changes to the diagnostic criteria in 2013 with the release of the DSM-5 would increase the percentage of people diagnosed with ADHD, especially among adults.

Due to disparities in the treatment and understanding of ADHD between caucasian and non-caucasian populations, many non-caucasian children go undiagnosed and unmedicated. It was found that within the US that there was often a disparity between caucasian and non-caucasian understandings of ADHD. This led to a difference in the classification of the symptoms of ADHD, and therefore, its misdiagnosis. It was also found that it was common in non-caucasian families and teachers to understand the symptoms of ADHD as behavioral issues, rather than mental illness.

Hyperactivity has long been part of the human condition. Sir Alexander Crichton describes "mental restlessness" in his book An inquiry into the nature and origin of mental derangement written in 1798. He made observations about children showing signs of being inattentive and having the "fidgets". The first clear description of ADHD is credited to George Still in 1902 during a series of lectures he gave to the Royal College of Physicians of London. He noted both nature and nurture could be influencing this disorder.

Alfred Tredgold proposed an association between brain damage and behavioral or learning problems which was able to be validated by the encephalitis lethargica epidemic from 1917 through 1928.

The terminology used to describe the condition has changed over time and has included: minimal brain dysfunction in the DSM-I (1952), hyperkinetic reaction of childhood in the DSM-II (1968), and attention-deficit disorder with or without hyperactivity in the DSM-III (1980). In 1987, this was changed to ADHD in the DSM-III-R, and in 1994 the DSM-IV in split the diagnosis into three subtypes: ADHD inattentive type, ADHD hyperactive-impulsive type, and ADHD combined type. These terms were kept in the DSM-5 in 2013 and in the DSM-5-TR in 2022. Prior to the DSM, terms included minimal brain damage in the 1930s.

In 1934, Benzedrine became the first amphetamine medication approved for use in the United States. Methylphenidate was introduced in the 1950s, and enantiopure dextroamphetamine in the 1970s. The use of stimulants to treat ADHD was first described in 1937. Charles Bradley gave the children with behavioral disorders Benzedrine and found it improved academic performance and behavior.

Once neuroimaging studies were possible, studies conducted in the 1990s provided support for the pre-existing theory that neurological differences - particularly in the frontal lobes - were involved in ADHD. During this same period, a genetic component was identified and ADHD was acknowledged to be a persistent, long-term disorder which lasted from childhood into adulthood.

ADHD was split into the current three sub-types because of a field trial completed by Lahey and colleagues.

ADHD, its diagnosis, and its treatment have been controversial since the 1970s. The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature. In 2014, Keith Conners, one of the early advocates for recognition of the disorder, spoke out against overdiagnosis in a The New York Times article. In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.

With widely differing rates of diagnosis across countries, states within countries, races, and ethnicities, some suspect factors other than the presence of the symptoms of ADHD are playing a role in diagnosis, such as cultural norms. Some sociologists consider ADHD to be an example of the medicalization of deviant behavior, that is, the turning of the previously non-medical issue of school performance into a medical one. Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms. Among healthcare providers the debate mainly centers on diagnosis and treatment in the much greater number of people with mild symptoms.

There have been notable differences in the diagnosis patterns of birthdays in school-age children. Those born relatively younger to the school starting age than others in a classroom environment are shown to be more likely diagnosed with ADHD. Boys who were born in December in which the school age cut-off was December 31 were shown to be 30% more likely to be diagnosed and 41% to be treated than others born in January. Girls born in December had a diagnosis percentage of 70% and 77% treatment more than ones born the following month. Children who were born at the last 3 days of a calendar year were reported to have significantly higher levels of diagnosis and treatment for ADHD than children born at the first 3 days of a calendar year. The studies suggest that ADHD diagnosis is prone to subjective analysis.

Possible positive traits of ADHD are a new avenue of research, and therefore limited.

A 2020 review found that creativity may be associated with ADHD symptoms, particularly divergent thinking and quantity of creative achievements, but not with the disorder of ADHD itself - i.e. it has not been found to be increased in people diagnosed with the disorder, only in people with subclinical symptoms or those that possess traits associated with the disorder. Divergent thinking is the ability to produce creative solutions which differ significantly from each other and consider the issue from multiple perspectives. Those with ADHD symptoms could be advantaged in this form of creativity as they tend to have diffuse attention, allowing rapid switching between aspects of the task under consideration; flexible associative memory, allowing them to remember and use more distantly-related ideas which is associated with creativity; and impulsivity, which causes people with ADHD symptoms to consider ideas which others may not have. However, people with ADHD may struggle with convergent thinking, which is a cognitive process through which a set of obviously relevant knowledge is utilized in a focused effort to arrive at a single perceived best solution to a problem.

Reviews of ADHD biomarkers have noted that platelet monoamine oxidase expression, urinary norepinephrine, urinary MHPG, and urinary phenethylamine levels consistently differ between ADHD individuals and non-ADHD controls. These measurements could potentially serve as diagnostic biomarkers for ADHD, but more research is needed to establish their diagnostic utility. Urinary and blood plasma phenethylamine concentrations are lower in ADHD individuals relative to controls and the two most commonly prescribed drugs for ADHD, amphetamine and methylphenidate, increase phenethylamine biosynthesis in treatment-responsive individuals with ADHD. Lower urinary phenethylamine concentrations are also associated with symptoms of inattentiveness in ADHD individuals.

Hinshaw SP, Scheffler RM (2014). The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance. Oxford University Press. ISBN 978-0199790555.

Reaser A, Prevatt F, Petscher Y, Proctor B (2007). "The learning and study strategies of college students with ADHD". Psychology in the Schools. Wiley-Blackwell. 44 (6): 627-638. doi:10.1002/pits.20252. eISSN 1520-6807. ISSN 0033-3085. LCCN 64009353. OCLC 1763062.

Schwarz A (2016). ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic. Scribner. ISBN 978-1501105913. OCLC 951612166.

Pliszka S (July 2007). "Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 46 (7): 894-921. doi:10.1097/chi.0b013e318054e724. PMID 17581453. S2CID 602465.

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Attention deficit hyperactivity disorder - Wikipedia

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Attention deficit hyperactivity disorder ( ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inappropriate. ADHD symptoms arise from executive dysfunction, and emotional dysregulation is often considered a core symptom. In children, problems paying attention may result in poor school performance.

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ADHD is a condition that can make it hard to focus, stay still, think before acting, and much more. We have resources that explain the ins and outs of ADHD, from diagnosis to strategies.

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Attention Deficit Hyperactivity Disorder (ADHD)

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Attention Deficit Hyperactivity Disorder (ADHD)

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According to a 2016 article, there are 5.4 million children with ADHD in the United States. Despite this large number, there still seem to be unknowns and mistruths about the disorder. Those diagnosed, as well as parents and guardians, can feel lost, confused, and alone. And research can feel overwhelming.

Here are four common questions to get you started on the ADHD journey.

What Is ADHD?
Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder typically, but not always, diagnosed during childhood. Early signs can include excessive daydreaming, forgetfulness, fidgeting, talking too much, and difficulty taking turns. Although it is typical for children to have trouble with these things sometimes, a child with ADHD exhibits these symptoms more frequently than their peers. These symptoms can create difficulties at home, in school, and in their personal lives.

There are three different types of ADHD.

Often, children with hyperactive/impulsive ADHD are described as "driven by a motor." Being seen as "on the go," they struggle to stay seated. Individuals with hyperactive/impulsive ADHD may talk excessively, interrupt others, and struggle with impulsivity.

Individuals with inattentive ADHD have a hard time maintaining attention. Activities like following complex instructions and organizing tasks can be challenging. External stimuli can distract the person, and they tend to misplace things.

Individuals with combined ADHD have symptoms of both hyperactive/impulsive and inattentive ADHD.

How is ADHD Diagnosed?
There is no simple or one test that can diagnose ADHD. Doctors typically do an assessment, which includes a medical examination that can help rule out other causes that may present themselves as ADHD. In addition, a physician will typically review family history, evaluate a checklist for rating ADHD symptoms, and gather input from others (i.e., parents and teachers).

What is the Treatment for ADHD?
ADHD is not curable; however, individuals can manage their symptoms successfully. Treatment options include medication and behavior therapy. Most people recommend a combination of both for best results; however, what works well varies by person. Any treatment plan requires monitoring, follow-up, and making necessary changes as needed.
Is ADHD Considered a Disability?
Although not considered a learning disability, ADHD may be labeled a disability under the Individuals with Disabilities Education Act (IDEA). If qualified, the child can receive services and accommodations as identified through their Individualized Education Plan (IEP). Scheduled breaks, longer time to finish assignments, and the ability to use tools such as calculators are examples of accommodations in the classroom.

The Americans with Disabilities Act (ADA) protects individuals with disabilities. The civil rights law defines a disability as "a physical or mental impairment that substantially limits one or more of the major life activities of such individual." Specified as a physical or mental impairment, ADHD has protection under the act. Companies with 15 employees or more must make reasonable accommodations for those qualifying under the act. These accommodations may include providing a quiet workspace, allowing noise-canceling headphones, and allowing assistive technology.

References:
https://pubmed.ncbi.nlm.nih.gov/29363986/
https://www.cdc.gov/ncbddd/adhd/facts.html
https://www.additudemag.com/3-types-of-adhd/
https://chadd.org/for-parents/individuals-with-disabilities-education-act/
https://www.additudemag.com/workplace-legal-protection/
https://www.law.cornell.edu/cfr/text/28/35.108

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Attention Deficit Hyperactivity Disorder (ADHD)

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Attention Deficit Hyperactivity Disorder (ADHD) According to a 2016 article, there are 5.4 million children with ADHD in the United States. Despite this large number, there still seem to be [...]

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Everybody can have difficulty sitting still, paying attention or controlling impulsive behavior once in a while. For some people, however, the problems are so pervasive and persistent that they interfere with every aspect of their life: home, academic, social and work.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting 11 percent of school-age children. Symptoms continue into adulthood in more than three-quarters of cases. ADHD is characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity.

Individuals with ADHD can be very successful in life. However, without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, accidental injuries and job failure. Early identification and treatment are extremely important.

Medical science first documented children exhibiting inattentiveness, impulsivity and hyperactivity in 1902. Since that time, the disorder has been given numerous names, including minimal brain dysfunction, hyperkinetic reaction of childhood, and attention-deficit disorder with or without hyperactivity. With the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) classification system, the disorder has been renamed attention-deficit/hyperactivity disorder or ADHD. The current name reflects the importance of the inattention aspect of the disorder as well as the other characteristics of the disorder such as hyperactivity and impulsivity.
Symptoms
Typically, ADHD symptoms arise in early childhood. According to the DSM-5, several symptoms are required to be present before the age of 12. Many parents report excessive motor activity during the toddler years, but ADHD symptoms can be hard to distinguish from the impulsivity, inattentiveness and active behavior that is typical for kids under the age of four. In making the diagnosis, children should have six or more symptoms of the disorder present; adolescents 17 and older and adults should have at least five of the symptoms present. The DSM-5 lists three presentations of ADHD-Predominantly Inattentive, Hyperactive-Impulsive and Combined. The symptoms for each are adapted and summarized below.
ADHD predominantly inattentive presentation

Fails to give close attention to details or makes careless mistakes

Has difficulty sustaining attention

Does not appear to listen

Struggles to follow through with instructions

Has difficulty with organization

Avoids or dislikes tasks requiring sustained mental effort

Loses things

Is easily distracted

Is forgetful in daily activities

ADHD predominantly hyperactive-impulsive presentation

Fidgets with hands or feet or squirms in chair

Has difficulty remaining seated

Runs about or climbs excessively in children; extreme restlessness in adults

Difficulty engaging in activities quietly

Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor

Talks excessively

Blurts out answers before questions have been completed

Difficulty waiting or taking turns

Interrupts or intrudes upon others

ADHD combined presentation

The individual meets the criteria for both inattention and hyperactive-impulsive ADHD presentations.

These symptoms can change over time, so children may fit different presentations as they get older.
Confusing labels for ADHD
In 1994, the name of the disorder was changed in a way that is confusing for many people. Since that time all forms of attention deficit disorder are officially called "Attention-Deficit/Hyperactivity Disorder," regardless of whether the individual has symptoms of hyperactivity or not. Even though these are the official labels, a lot of professionals and lay people still use both terms: ADD and ADHD. Some use those terms to designate the old subtypes; others use ADD just as a shorter way to refer to any presentation.
Severity of symptoms
As ADHD symptoms affect each person to varying degrees, the DSM-5 now requires professionals diagnosing ADHD to include the severity of the disorder. How severe the disorder is can change with the presentation during a person's lifetime. Clinicians can designate the severity of ADHD as "mild," "moderate" or "severe" under the criteria in the DSM-5.

Mild: Few symptoms beyond the required number for diagnosis are present, and symptoms result in minor impairment in social, school or work settings.
Moderate: Symptoms or functional impairment between "mild" and "severe" are present.
Severe: Many symptoms are present beyond the number needed to make a diagnosis; several symptoms are particularly severe; or symptoms result in marked impairment in social, school or work settings.

As individuals age, their symptoms may lessen, change or take different forms. Adults who retain some of the symptoms of childhood ADHD, but not all, can be diagnosed as having ADHD in partial remission.
ADHD throughout the lifespan
Children with ADHD often experience delays in independent functioning and may behave younger than their peers. Many children affected by ADHD can also have mild delays in language, motor skills or social development that are not part of ADHD but often co-occur. They tend to have low frustration tolerance, difficulty controlling their emotions and often experience mood swings.

Children with ADHD are at risk for potentially serious problems in adolescence and adulthood: academic failure or delays, driving problems, difficulties with peers and social situations, risky sexual behavior, and substance abuse. There may be more severe negative behaviors with co-existing conditions such as oppositional defiant disorder or conduct disorder. Adolescent girls with ADHD are also more prone to eating disorders than boys. As noted above, ADHD persists from childhood to adolescence in the vast majority of cases (50-80 percent), although the hyperactivity may lessen over time.

Teens with ADHD present a special challenge. During these years, academic and life demands increase. At the same time, these kids face typical adolescent issues such as emerging sexuality, establishing independence, dealing with peer pressure and the challenges of driving.

More than 75 percent of children with ADHD continue to experience significant symptoms in adulthood. In early adulthood, ADHD may be associated with depression, mood or conduct disorders and substance abuse. Adults with ADHD often cope with difficulties at work and in their personal and family lives related to ADHD symptoms. Many have inconsistent performance at work or in their careers; have difficulties with day-to-day responsibilities; experience relationship problems; and may have chronic feelings of frustration, guilt or blame.

Individuals with ADHD may also have difficulties with maintaining attention, executive function and working memory. Recently, deficits in executive function have emerged as key factors affecting academic and career success. Executive function is the brain's ability to prioritize and manage thoughts and actions. This ability permits individuals to consider the long-term consequences of their actions and guide their behavior across time more effectively. Individuals who have issues with executive functioning may have difficulties completing tasks or may forget important things.
Co-occurring Disorders
More than two-thirds of children with ADHD have at least one other co-existing condition. Any disorder can co-exist with ADHD, but certain disorders seem to occur more often. These disorders include oppositional defiant and conduct disorders, anxiety, depression, tic disorders or Tourette syndrome, substance abuse, sleep disorders and learning disabilities. When co-existing conditions are present, academic and behavioral problems, as well as emotional issues, may be more complex.

These co-occurring disorders can continue throughout a person's life. A thorough diagnosis and treatment plan that takes into account all of the symptoms present is essential.
Causes
Despite multiple studies, researchers have yet to determine the exact causes of ADHD. However, scientists have discovered a strong genetic link since ADHD can run in families. More than 20 genetic studies have shown evidence that ADHD is strongly inherited. Yet ADHD is a complex disorder, which is the result of multiple interacting genes.

Other factors in the environment may increase the likelihood of having ADHD:

exposure to lead or pesticides in early childhood

premature birth or low birth weight

brain injury

Scientists continue to study the exact relationship of ADHD to environmental factors, but point out that there is no single cause that explains all cases of ADHD and that many factors may play a part.

Previously, scientists believed that maternal stress and smoking during pregnancy could increase the risk for ADHD, but emerging evidence is starting to question this belief. However, further research is needed to determine if there is a link or not.

The following factors are NOT known causes, but can make ADHD symptoms worse for some children:

watching too much television

eating sugar

family stress (poverty, family conflict)

traumatic experiences

ADHD symptoms, themselves, may contribute to family conflict. Even though family stress does not cause ADHD, it can change the way the ADHD presents itself and result in additional problems such as antisocial behavior.

Problems in parenting or parenting styles may make ADHD better or worse, but these do not cause the disorder. ADHD is clearly a brain-based disorder. Currently research is underway to better define the areas and pathways that are involved.

For more information on the following topics:

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About ADHD - Symptoms, Causes and Treatment - CHADD

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Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting up to 11 percent of school-age children and many adults.

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ADHD Awareness Month: Free Resources for Parents/Caregivers & Providers

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ADHD Awareness Month: Free Resources for Parents/Caregivers & Providers

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For ADHD Awareness Month, we are committed to supporting primary care providers, mental health professionals, parents/caregivers and those who have been diagnosed with ADHD. Together, we can increase awareness! Below is a list of REACH-recommended resources on ADHD, including the future of ADHD, common comorbidities, treatment & management of ADHD, and strategies for both clinicians and parents/caregivers. To learn more about REACH training programs, additional free mental health resources and to read our recent blog posts, click on one of the tabs above.
What is ADHD?
Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral health disorders, affecting approximately 9% of all children and adolescents.ADHD challenges a child's ability to focus, follow directions, stay organized, manage time. ADHD can also affect academics, relationship, mental health and substance issues later in life. Early intervention and prevention are key.
What are the common signs & symptoms?
When it comes to ADHD signs and symptoms, every case is different. Some symptoms are more prevalent in boys. And, often the signs present differently for girls. Children may be inattentive, hyperactive, and/or impulsive. Common symptoms include the inability to sit still, difficulty concentrating or following directions, excessive talking and/or interrupting, impulsive behavior, fidgeting, having a short attention span, difficulty staying organized, completing tasks, managing time.
The Future of ADHD, What's New: ADHD & Common Comorbidities: Strategies for PCPs: Strategies for Parents:
ADHD Rating Scales:

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ADHD Awareness Month: Free Resources for Parents/Caregivers & Providers - The Reach Institute

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The Reach Institute is Proud to Support ADHD Awareness Month. View our FREE ADHD Resources for Parents/Caregivers & Providers.

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Students will be allotted extra time on same-day timed assignments to allow students an equal chance to succeed.

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Students may be allowed a paraproffesional to assist them on assignments and work one-on-one in subjects they struggle to focus on.

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Students may have their projects broken down into smaller steps by the teacher to help students feel less overwhelmed with larger assignments to ensure success.

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Students may take time with their paraproffesional away from the class to reduce distractions during the students individual classwork.

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ADHD in the Classroom: Helping Children Succeed in School

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ADHD in the Classroom: Helping Children Succeed in School

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Children with attention-deficit/hyperactivity disorder (ADHD) experience more obstacles in their path to success than the average student. The symptoms of ADHD, such as inability to pay attention, difficulty sitting still, and difficulty controlling impulses, can make it hard for children with this diagnosis to do well in school.

Classroom treatment strategies for ADHD students

There are some school-based management strategies shown to be effective for ADHD students:

Behavioral classroom management

The behavioral classroom management approach encourages a student's positive behaviors in the classroom, through a reward system or a daily report card, and discourages their negative behaviors. This teacher-led approach has been shown to influence student behavior in a constructive manner, increasing academic engagement. Although tested mostly in elementary schools, behavioral classroom management has been shown to work for students of all ages.

Organizational training

Organizational training teaches children time management, planning skills, and ways to keep school materials organized in order to optimize student learning and reduce distractions. This management strategy has been tested with children and adolescents.

Teaching and supporting positive behavior‎

These two management strategies require trained staff-including teachers, counselors, or school psychologists-to follow a specific plan to teach and support positive behavior.

Special education services and accommodations

Most children with ADHD receive some school services, such as special education services and accommodations. There are two laws that govern special services and accommodations for children with disabilities:

The Individuals with Disabilities Education Act (IDEA)

Section 504 of the Rehabilitation Act of 1973

Learn more about IDEA vs Section 504
The support a child with ADHD receives at school will depend on if they meet the eligibility requirements for one of two federal plans funded by IDEA and Section 504:

What are the main differences between an IEP and a 504 Plan?‎

* IEPs: Provide individualized special education services to meet the unique needs of the child and is governed under the Federal law known as the Individuals with Disabilities Education Act (IDEA).

* 504 Plan: Provides services and changes to the learning environment to meet the needs of the child as adequately as other students and is part of Section 504 of the Rehabilitation Act.

Accommodations

IEPs and 504 Plans can offer accommodations for students to help them manage their ADHD, including the following:

Extra time on tests

Instruction and assignments tailored to the child

Positive reinforcement and feedback

Using technology to assist with tasks

Allowing breaks or time to move around

Changes to the environment to limit distraction

Extra help with staying organized

Did you know?‎

Parents of children with ADHD report receiving more services through an IEP than through a 504 plan.

There is limited information about which types of accommodations are effective for children with ADHD. However, there is evidence that setting clear expectations, providing immediate positive feedback, and communicating daily with parents through a daily report card can help.

What teachers can do to help

For teachers, helping children manage their ADHD symptoms can present a challenge. Most children with ADHD are not enrolled in special education classes but do need extra assistance on a daily basis.

Helping students with ADHD‎

CHADD's National Resource Center on ADHD provides information for teachers from experts on how to help students with ADHD.

Close collaboration between the school, parents, and healthcare providers will help ensure the child gets the right support. Here are some tips for classroom success:

Communication

Give frequent feedback and attention to positive behavior.

Be sensitive to the influence of ADHD on emotions, such as self-esteem issues or difficulty regulating feelings.

Provide extra warnings before transitions and changes in routines.

Understand that children with ADHD may become deeply absorbed in activities that interest them (hyper-focus) and may need extra assistance shifting their attention.

Assignments and tasks

Make assignments clear-check with the student to see if they understand what they need to do.

Provide choices to show mastery (for example, let the student choose among written essay, oral report, online quiz, or hands-on project.

Make sure assignments are not long and repetitive. Shorter assignments that provide a little challenge without being too hard may work well.

Allow breaks-for children with ADHD, paying attention takes extra effort and can be very tiring.

Allow time to move and exercise.

Minimize distractions in the classroom.

Use organizational tools, such as a homework folder, to limit the number of things the child has to track.

Develop a plan that fits the child

Observe and talk with the student about what helps or distracts them (for example, fidget tools, limiting eye contact when listening, background music, or moving while learning can be beneficial or distracting, depending on the child).

Communicate with parents on a regular basis.

Involve the school counselor or psychologist.

Parent education and support

How to best advocate for your child‎

What every parent should know

School support and services are regulated by laws. The U.S. Department of Education has developed a "Know your rights" letter for parents and a resource guide for educators to help educators, families, students, and other interested groups better understand how these laws apply to students with ADHD so that they can get the services and education they need to be successful.

Healthcare providers also play an important part in collaborating with schools to help children get the special services they need.

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ADHD in the Classroom: Helping Children Succeed in School

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Resources for parents, teachers, and healthcare providers to help children with ADHD succeed in the school.

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ADHD and School: How to Help a Child with ADHD in School

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ADHD and School: How to Help a Child with ADHD in School

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Practical tips for helping a child with ADHD thrive in school and enjoy learning.

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How Can ADHD Affect Kids at School?

ADHD can affect a student's ability to focus, pay attention, listen, or put effort into schoolwork. ADHD also can make a student fidgety, restless, talk too much, or disrupt the class. Kids with ADHD might also have learning disabilities that cause them to have problems in school.

Most kids with ADHD start school before their ADHD is diagnosed. Teachers are sometimes the first to notice possible signs of ADHD. They may talk it over with the child's parent. The parent can then have the child evaluated by a health provider to see if it's ADHD.

How Can Teachers Help Kids With ADHD?

Let all teachers know if your child has ADHD.
Teachers can help you find out if your child needs an IEP (individual education program) or 504 plan:

An IEP is a written plan that provides individualized special education and related services. Your child's teacher might suggest an evaluation to see if your child could benefit from an IEP.

A 504 plan provides services and changes to the learning environment to meet the child's needs.

Teachers can talk with you about your child's progress. Ask the teacher to let you know how your child is doing. Using a folder that goes back and forth between you and your child's teacher is one way to share notes about progress.

Teachers can focus on your child's needs. Every student with ADHD is different. Some need help paying attention and managing distractions. Some need help staying organized. Others need help getting started with their work, or finishing work they start. Some students with ADHD have trouble staying seated or working quietly. Ask the teacher how ADHD affects your child in the classroom and what you can do to help your child with schoolwork.

Teachers can help your child succeed. Depending on what a student needs, a teacher can do things like:

Seat a student where there are fewer distractions.

Give instructions that are clear and brief.

Have simple classroom routines and rules.

Be warm, encouraging, and positive.

Praise efforts.

Help with organization.

Guide kids to slow down and take their time.

Give prompts to stay on task.

Give breaks to move around in the classroom.

Give extra time to complete work.

Teach students how to check their work and catch careless mistakes.

For older students, teachers can also:

Teach study skills such as taking notes, reading aloud, and prepping for tests.

Break down multi-step projects and assignments into smaller parts.

Teachers can bring out the best in your child. When teachers see the best in their students, students see the best in themselves. Teachers can convey that every student can grow, learn, and succeed - whether or not they have ADHD.

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ADHD can affect a child's ability to do well in school and even make friends. This article for parents has tips on working with teachers to help your child succeed.

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ADHD: How to Help Your Child Succeed at School

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ADHD: How to Help Your Child Succeed at School

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Attention deficit hyperactivity disorder (ADHD) can make you less able to pay attention, concentrate, and remember. Children who have it also can have a tough time connecting with other kids their age.

These things can make school especially hard. But there are ways to help your child have an easier time in class.

It helps to be familiar with laws, regulations, and policies that can support your child:

Your child's rights. Two federal laws are in place to make sure children with disabilities get a "free and appropriate education." The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 require schools to offer services and other things to help children learn.

Your state may have other laws about this, too.

Individualized education program (IEP). If your child needs specialized instruction to meet their learning needs, they should have an IEP. It will:

Detail those needs

Explain the services the school will give them

Note how their progress will be measured

504 plan. If your child doesn't need an IEP, this document outlines other ways the school will support them. The plans are tailored for each child's needs. They don't change what's being taught in class. But your child may:

Get extra time on tests and schoolwork

Have the option to listen to audiobooks instead of reading

Give verbal answers to a test instead of written ones

Take tests in a different room with fewer distractions or in a smaller group of students

Get speech therapy, occupational therapy, or counseling

The law doesn't outline a standard way to get a 504 plan. It's up to each school. If you think a plan would help your child, contact your school district and find out what's involved.

The policies and support available at your child's school. Make a written request to your child's principal for an evaluation for services. On its website, an organization called Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) offers an example of a letter you might send.

Many public schools also offer social skills groups. These are small gatherings - usually between two and eight kids - that are led by a school psychologist or speech therapist. They can help kids learn how to connect with their peers and handle certain social situations.

ADHD in children can cause problems with learning and behavior at school. To help your child succeed, educate yourself about their rights and stay in touch with teachers and administrators. (Photo Credit: DigitalVision/Getty Images)

Is your child starting middle or high school? Did you move over the summer? A big change like that can be hard for a child or teen with ADHD.

Make it easier by reaching out to the school before classes start. Help the new school match your child with the classes and teachers that fit their abilities and learning style.

Call the school and arrange to share report cards, test scores, and notes from last year. Meet with the guidance counselor and your child's teachers. You may need to update their 504 plan or IEP, or make a new one.

Ask the guidance counselor to take you and your child on a tour of the new school. Meet with teachers, the principal, the nurse, and anyone else your child will see daily. Walk through the whole school day with your child so they know where they need to go and when. If possible, try to arrange a playdate or hangout with another student from your child's new class.

Advance planning and practice, along with familiar routines at home, will help you both get used to this change and maybe feel more confident on the first day of school.

Meet with teachers to talk about your child's needs and goals, and see what the teacher can do to help them in class.

This might include letting them sit in the front row and away from doors and windows. That can help them avoid distractions and stay focused. It also promotes accountability, since the teacher can better see when your child needs help to stay on task.

Ask for access to the schedule. You may want to get a second set of books to keep at home. Also, discuss varied teaching methods that could help keep your child interested. You might ask the teacher about helpful technologies, like recording apps that let your child play back discussions and instructions they may have missed in class.

Working as a team helps. It shows your child that the most important adults in their life have their back. Here's how to build a winning parent-teacher team:

Have face-to-face talks. Set up meetings early in the school year to talk about how ADHD affects your child. It's different for everyone, and your kid's situation is unique. Stay positive. Instead of talking about their problems, focus on what helps them. So avoid saying, "My child never listens." Replace that with something like, "I find that my child pays more attention when we're in a quiet space and they look me in the eye."

If you have any educational reports or plans, share copies with the teachers.

Keep in touch. Check in regularly in person, by email, or by phone and ask about your child's behavior and how they're doing with schoolwork. Find out how much homework the teacher plans to assign each night. You may want to ask for extra help to make sure your child can finish all of their assignments, or for extra time on tests.

Check teacher websites for upcoming tests or big projects. Ask for the teacher's advice on how best to help your child organize and prepare well ahead of the due dates. This can head off a last-minute meltdown for you and your child.

Be tactful. Choose your words carefully so you don't put a teacher on the defensive. Instead of: "Why aren't you helping my child finish their class assignments in school?" Try this: "I'm concerned that my child needs to finish classwork at home. Is there anything we can do to help them work more quickly at school?"

Don't take things personally. You may get calls saying your child's disrupting class or not paying attention. Don't lash out at the messenger. Instead, say that you know your child often is a handful, and talk about solutions to the problems. Simple things like changing where they sit or giving them directions one task at a time may help.

Keep teachers in the loop. If you start or change ADHD medication, tell the teachers and administrators. They can watch for side effects and let you know if medication seems to be helping. Also, let them know if there's a big change at home - like a divorce or death - since these kinds of things can affect any child's behavior.

Set shared goals. Many ADHD symptoms affect your child inside and outside school. If following directions is a problem, brainstorm with the teacher about ways to help them stay on track that you can use both at home and in the classroom. Using the same tools creates a link between school and home.

Be organized at meetings. Parent-teacher conferences are usually short, so come with a list of questions so you don't forget to ask something important. Organize report cards, test results, and teacher notes in a binder so they're at your fingertips.

Pitch in. Attend back-to-school nights and volunteer to chaperone a field trip or help in the library. That will show the teacher and your child that you're plugged into the school. And you'll get a first-hand look at how your child interacts there.

Say thank you. When a teacher goes the extra mile to understand and help your child, write a simple note showing your appreciation.

It's also a good idea for your child to have a schedule for the day, and a written behavior plan - which encourages positive actions - posted on a nearby wall or on their desk.

How do you know if the teacher or school isn't a good fit?

A teacher who is critical and lacks patience will make most kids resist learning, but those children might get by. For a child with ADHD, it could derail an entire school year.

A school that encourages a values-based learning process and prides itself on teachers who are excellent role models will most likely be a better fit. You'll want your child to be taught by people who are firm but kind and create a safe and comfortable learning environment.

The best schools for kids with ADHD are ones that encourage and maintain an open dialogue among parents, teachers, and staff, so everyone is on the same page as to what's working well and where there are opportunities for improvement.

A good way to support your child is to create a routine for when they're home:

Ease into a new schedule. If your child slept late during summer vacation, start waking them up a little earlier each day. That way, they won't be groggy when school starts. Make bedtime a little earlier each night so they get enough sleep.

Start them back on any ADHD medicines if you took a break for the summer.

Post a routine. Put a list of the daily morning activities on the fridge or somewhere your child will see it. Write down everything they need to do before walking out the door, such as:

Get dressed.

Make the bed.

Eat breakfast.

Pack homework.

Take your backpack, shoes, jacket, and lunch.

Learn More: Sample Morning and Nighttime Schedules for Your Child With ADHD.

Get organized. Help your child stay on top of homework. Great tools for organizing include:

A calendar or daily planner

A dry-erase or bulletin board to post due dates and reminders

A desk organizer and storage bins for school supplies to keep their study space neat and free from distractions

Color-coded folders or a multipocket binder to keep assignments straight

Let them help make a shopping list for supplies for the coming year.
Read More: Your Guide to Solving Disorganization at School.
Set up a homework station. Choose one spot where your child can do their homework every day. Make sure it's away from distractions like noisy siblings and the TV. (The kitchen table works well for some kids, since you can easily check in on them.) The seat should face a wall, not a window.

Try to give siblings their own space, though this may be hard if you have to monitor more than one. Remember that different kids may have different needs.

Have them do their homework as close to the same time every day as possible. Let them take a break every 10 to 20 minutes so they can move around. Make sure these breaks don't involve screens like those on a TV or phone. Have them tackle three 20-minute sessions with playtime or a snack in between. Or switch subjects: math for 20 minutes, English for another 20, and then back to math. They'll struggle less, and their work may improve.

Make a calendar to keep track of assignments and activities. Set up a way for them to know which assignments are most important. For example, you might color-code things to show priorities. Include things like after-school clubs, sports, music lessons, and regular play dates. Add projects and tests as they come up. Leave room in each day for homework, plus some time to relax and have fun.

Let them help set up their schedule so they feel a sense of control and ownership. Go over the schedule each day until they understand the routine. Your kid can even use an app to help organize tasks and manage time.

For older kids, listing assignments, deadlines, and upcoming events on a digital calendar can be especially helpful. They can have notifications sent to their phone, and share their calendars with parents and teachers.

Plan studying around medication. A child who takes ADHD medication may study better earlier in the afternoon, when the drugs are still in effect. They may have a hard time later in the evening, after they wear off.

Motivate with rewards. They're not bribes. It's OK to reward your child when they do a good job. A little encouragement can go a long way. Some parents set up a currency - poker chips, for example - in return for getting homework done. Your kid can turn the chips in later for rewards they like, such as time to watch TV or play a video game.

Make sure homework is handed in. Your child might spend hours on their homework but then lose it or forget to hand it in. An organized binder or folder system, with pockets for new assignments and finished homework, can help get the papers across the finish line.

They can also use online tools such as Google Docs or OneDrive, which autosave work and let them retrieve it at home or in school.

Keep on top of assignments. It's not uncommon for a kid with ADHD to miss a due date or misunderstand instructions. Create a backup plan. Talk to your child's teacher - weekly or even daily - about upcoming assignments.

Some teachers post homework on the internet. Others may email copies of assignments directly to you. Ask the teacher to let you know about any late or missing homework.

Use concentration aids. White noise machines or apps that feature soothing sounds like rain or ocean waves can block distractions while your child does homework. A loud fan can work, too.

Have backup items. Avoid a rough start to your child's day by keeping multiples of easily lost items. Have an extra set of keys, hats and gloves, transit passes, or anything else that tends to go missing on hand to avoid panic and get your child on their way promptly.

Plan playdates to improve social skills. If your child struggles withmaking friends, set up a playdate that includes a structured activity in a setting that's comfortable for them.

Talk to them ahead of time about what they can expect and what they should do.

To get an idea of your child's social life at school, ask their teacher about classmates who might be a good fit for a playdate.

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ADHD: How to Help Your Child Succeed at School

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School can be especially hard for children with ADHD. There are ways you can help make things a bit easier for a child in your life. Find out more from WebMD.

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Understanding and Supporting Your Student With ADHD

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Understanding and Supporting Your Student With ADHD

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Understanding and Supporting Your Student With ADHD

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School Takes Unique Approach to Teaching Kids With ADHD

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School Takes Unique Approach to Teaching Kids With ADHD

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School takes unique approach to teaching kids with ADHD

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"I Hate School, It's Stupid!": How to Respond to Your Child with ADHD Seminar 

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"I Hate School, It's Stupid!": How to Respond to Your Child with ADHD Seminar 

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"I Hate School, It's Stupid!": How to Respond to Your Child with ADHD

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6 Ways to Help Your Child With ADHD Prepare for Back to School

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6 Ways to Help Your Child With ADHD Prepare for Back to School

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Sarah was a pro at getting her daughter Alisa and son Luke ready for the school year. A month before school would begin, they'd start adjusting bedtimes and morning routines. As the first day of school drew closer, there might be a few changes they would have to get used to, such as a new teacher or a best friend assigned to another class, but it was easy for Alisa and Luke to take these things in stride.

It was more challenging for Sarah's son William, however. After William was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), Sarah and her husband Ben were relieved to understand why he struggled with things his siblings didn't. Sarah read everything about ADHD she could find and sought advice from William's pediatrician. With some trial and error, Sarah developed some routines and habits that helped relieve everyone's stress in the family - not just at the start of the school year, but all year long.

Develop a Healthy Eating Plan

Like many kids with ADHD, William was concerned about the texture of his food. He was also of the "grab and go" school of eating, and Sarah wasn't always happy about what he chose to eat. She put together a plan for lunch and snacks that incorporated a variety of his favorites that were healthy too, and made sure something was always available to him.

Create an Easy-To-Follow Family Calendar

Developing a master family calendar is a great visual aid and organizational tool for any family. Sarah set up time to sit down with William every week to preview the next seven days. At first, William would bring items to Sarah to have her add; when he was able to add things on his own, he was proud and excited. "Isn't our calendar cool?" Sarah heard him say to a friend.

Establish Open Communication With Teachers

Next, Sarah and William developed a school-to-home communication system with his teacher. They agreed on how verbal information would arrive at home, and how Sarah could receive a snapshot of William's day: his positive and not-so-positive experiences, daily work completion, homework assignments. Sarah wanted to keep things calm and predictable, so she placed particular emphasis on how she would receive notice about changes to their routines, such as a shortened school day or substitute teacher.

Simplify Tasks To Make Them Feel Less Overwhelming

Because children with ADHD often find multi-step directions overwhelming, Sarah broke down tasks into bite-sized pieces, making it easier for William to complete them. When he was young, she put together visual charts with pictures; he could draw a line through each picture as he completed the task, and bring it to her when it was completed or even after every step. As he got older, a written checklist worked much the same way.

Create a Designated Place for Everything of Importance

Having a special place for William's things also made life easier. His backpack belonged on a peg on his bedroom door (William helped paint the peg red, his favorite color). Ongoing projects were on the desk in his room. Library books were stacked on a shelf by the back door. Permission slips were pinned to a bulletin board in the kitchen.

Adhere to a Bedtime Routine That Works for Your Child

A bedtime routine helped set William up for success. Each night, Sarah watched him organize his backpack for the next day (where occasionally, they discovered some important information on papers he brought home). While Sarah sometimes had to bite her tongue, she let William take the lead. She sat with William while he picked out the next day's clothes, making only an occasional suggestion about gloves or a coat.

"It's great to have that time together," Sarah told her husband Ben one day. "If I'm quiet and just listen, sometimes William will talk about things without me having to bring them up, because he's relaxed and comfortable. Other times he doesn't have much to say, and that's okay, too."

"It just feels like a special time," she continued, "and that's great, because William is a special kid. All of our kids are special - just the way they are."

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6 Ways To Help Your Child With ADHD Prepare for Back To School

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Here are some tips for helping to prepare your child with ADHD for a new school year.

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Parental Involvement in Your Child's Education

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Parental Involvement in Your Child's Education

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This article is beneficial to all parents!

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If you could wave a magic wand that would improve the chances of school success for your children as well as their classmates, would you take up that challenge?

For decades, researchers have pointed to one key success factor that transcends nearly all others, such as socioeconomic status, student background or the kind of school a student attends: parental involvement.

The extent to which schools nurture positive relationships with families - and vice versa - makes all the difference, research shows. Students whose parents stay involved in school have better attendance and behavior, get better grades, demonstrate better social skills and adapt better to school.

Parental involvement also more securely sets these students up to develop a lifelong love of learning, which researchers say is key to long-term success.

A generation ago, the National PTA found that three key parent behaviors are the most accurate predictors of student achievement, transcending both family income and social status:

1. creating a home environment that encourages learning;

2. communicating high, yet reasonable, expectations for achievement; and

3. staying involved in a child's education at school.

What's more, researchers say when this happens, the motivation, behavior and academic performance of all children at a particular school improve. Simply put, the better the partnership between school and home, the better the school and the higher the student achievement across the board.
Download Our Parental Involvement in Education Report
What Is Parental Involvement, and How Is It Different From Parental Engagement?

Parental involvement is the active, ongoing participation of a parent or primary caregiver in the education of a child. Parents can demonstrate involvement at home by:

reading with children;

helping with homework;

discussing school events;

attending school functions, including parent-teacher meetings; and

volunteering in classrooms.

While both parental involvement and parental engagement in school support student success, they have important differences.

Involvement is the first step towards engagement. It includes participation in school events or activities, with teachers providing learning resources and information about their student's grades. With involvement, teachers hold the primary responsibility to set educational goals.

But while teachers can offer advice, families and caregivers have important information about their children that teachers may not know. So a student's learning experience is enriched when both bring their perspectives to the table.

With engagement, home and school come together as a team. Schools empower parents and caregivers by providing them with ways to actively participate, promoting them as important voices in the school and removing barriers to engagement. Examples include encouraging families to join the family-teacher association or arranging virtual family-teacher meetings for families with transportation issues.

Research has found that the earlier educators establish family engagement, the more effective they are in raising student performance.

Why Is It Important to Involve Parents in School?

It Benefits Students

Children whose families are engaged in their education are more likely to:

earn higher grades and score higher on tests;

graduate from high school and college;

develop self-confidence and motivation in the classroom; and

have better social skills and classroom behavior.

In one study, researchers looked at longitudinal data on math achievement and found that effectively encouraging families to support students' math learning at home was associated with higher percentages of students who scored at or above proficiency on standardized math achievement tests.

Students whose parents are involved in school are also less likely to suffer from low self-esteem or develop behavioral issues, researchers say.

And classrooms with engaged families perform better as a whole, meaning that the benefits affect virtually all students in a classroom.

It Positively Influences Children's Behavior

Decades of research have made one thing clear: parental involvement in education improves student attendance, social skills and behavior. It also helps children adapt better to school.

In one instance, researchers looking at children's academic and social development across first, third and fifth grade found that improvements in parental involvement are associated with fewer ​"problem behaviors" in students and improvements in social skills. Researchers also found that children with highly involved parents had ​"enhanced social functioning" and fewer behavior problems.

It Benefits Teachers

Because it improves classroom culture and conditions, parent involvement also benefits teachers. Knowing more about a student helps teachers prepare better and knowing that they have parents' support ensures that teachers feel equipped to take academic risks and push for students to learn more.

How Can Parents Get Involved in Their Child's Education?

1. Make learning a priority in your home, establishing routines and schedules that enable children to complete homework, read independently, get enough sleep and have opportunities to get help from you. Talk about what's going on in school.

2. Read to and with your children: Even 10-20 minutes daily makes a difference. And parents can go further by ensuring that they read more each day as well, either as a family or private reading time that sets a good example.

3. Ask teachers how they would like to communicate. Many are comfortable with text messages or phone calls, and all teachers want parents to stay up to date, especially if problems arise.

4. Attend school events, including parent-teacher conferences, back-to-school nights and others - even if your child is not involved in extracurricular activities.

5. Use your commute to connect with your kids; ask them to read to you while you drive and encourage conversations about school.

6. Eat meals together: It's the perfect opportunity to find out more about what's going on in school.

7. Prioritize communication with teachers, especially if demanding work schedules, cultural or language barriers are an issue. Find out what resources are available to help get parents involved.

Parental Involvement Outside the Classroom

Outside of the classroom, engaged parents more often see themselves as advocates for their child's school - and are more likely to volunteer or take an active role in governance.

Researchers have noted that parent involvement in school governance, for instance, helps parents understand educators' and other parents' motivations, attitudes and abilities. It gives them a greater opportunity to serve as resources for their children, often increasing their own skills and confidence. In a few cases, these parents actually further their own education and upgrade their job.

While providing improved role models for their children, these parents also ensure that the larger community views the school positively and supports it. They also provide role models for future parent leaders.

Reading and Homework

Very early in their school career - by fourth grade - children are expected to be able to read to learn other subjects. But recent research shows that about two-thirds of the nation's public school fourth graders aren't proficient readers.

To make children successful in reading, and in school more generally, the single most important thing you can do is to read aloud with them.

Youth Sports and Other Extracurricular Activities

Parents can make or break their child's relationship with sports and other extracurricular activities, so they should think deeply about how to show children the fun of mastering a new skill, working toward a group or individual goal, weathering adversity, being a good sport and winning or losing gracefully.

Beyond this, parents with coaching skills should consider volunteering to get involved. The National Alliance for Youth Sports notes that only about 5% to 10% of youth sports coaches have received any relevant training before coaching, with most coaches stepping up because their child is on the team and no one else volunteered.

Parental Involvement in Juvenile Justice

Parents finding themselves involved in the juvenile justice system on behalf of their kids face a system that offers many challenges and few resources.

The Annie E. Casey Foundation's Juvenile Detention Alternatives Initiative has long sought to sharply reduce reliance on detention, with the aim of decreasing reliance on juvenile incarceration nationwide.

But parents whose children face the judicial system can make a difference. Surveys of corrections officials note that family involvement is one of the most important issues facing the juvenile system, and it is also the most operationally challenging.

One well-respected framework outlines the importance of five ​"dimensions" that measure parental involvement, including receptivity to receiving help, a belief in positive change, investment in planning and obtaining services and a good working relationship between the parent and the justice system.

What Successful Parental Involvement Looks Like

Experts urge parents to be present at school as much as possible and to show interest in children's schoolwork.

As noted in the Annie E. Casey Foundation ​"Parental Involvement in Education Policy" brief, the National PTA lists six key standards for good parent/​family involvement programs:

1. Schools engage in regular, two-way, meaningful communication with parents.

2. Parenting skills are promoted and supported.

3. Parents play an integral role in assisting student learning.

4. Parents are welcome in the school as volunteers, and their support and assistance are sought.

5. Parents are full partners in the decisions that affect children and families.

6. Community resources are used to strengthen schools, families and student learning.

How To Avoid Negative Parental Involvement

Teachers may, on occasion, complain of ​"helicopter parents" whose involvement - sometimes called ​"hovering" - does more harm than good. One veteran educator recently told the story of an award-winning colleague who quit the profession because of the growing influence of ​"a group of usually well-intentioned, but over-involved, overprotective and controlling parents who bubble-wrap their children."

What these parents fail to understand, he said, is that their good intentions ​"often backfire," impeding their children's coping skills and capacity to problem-solve. Such over-involvement can actually increase children's anxiety and reduce self-esteem.

The colleague's plea: ​"Please partner with us rather than persecute us. That will always be in your children's best interests."

Resources for Parents, Teachers, School Administrators and Advocates

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Parental Involvement in Your Child's Education

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Parental involvement makes better students, more relaxed teachers and more confident parents. Learn how to get involved in your child's education and life.

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It's a story we hear regularly: A child is diagnosed with ADHD and one of his parents, recognizing the symptoms, realizes that he (or she) has the disorder, too.

It's often a surprise to the mom or dad, but to clinicians it's not surprising. "We know ADHD is highly familial," explains Mark Stein, a clinical psychologist and director of the ADHD and Related Disorders Program (PEARL Clinic) at Seattle Children's Hospital. "That means 25 percent of the parents of kids we diagnose are going to have it."

It also comes as no surprise to Dr. Stein that many parents who meet the criteria for ADHD don't know it, and haven't been diagnosed. There's still a good deal of stigma and lack of understanding surrounding adults with ADHD.

Moms and dads with undiagnosed ADHD often find themselves overwhelmed by the demands of parenting and struggling to meet their children's needs. Lacking organizational skills, they may find keeping up with their kids' schedules and managing their behavior very stressful. But in the case of moms, they are more likely to be treated for depression than ADHD, notes Dr. Stein, who is also a professor of psychiatry and behavioral science at the University of Washington.

This oversight is unfortunate, Dr. Stein adds, because treating the ADHD that's underlying their problems would benefit both them and their children.

Studies show that intervention for kids with ADHD tends to be less effective when a caregiving parent has ADHD, too. Medication treatment requires a lot of parental organization to make appointments, deal with insurance, fill prescriptions, make sure kids take their meds and monitor side effects, and the child's treatment is less effective if compliance with the treatment regimen isn't consistent.

Behavioral treatment for kids with ADHD is also less effective when parents have ADHD. "There are a number of studies that look at behavioral parent training," notes Dr. Stein, "and the biggest predictor of not responding is if a parent has ADHD."

It is especially common for mothers to discover that they have ADHD that was not diagnosed when they were children. That's because ADHD presents in the two genders differently. Women tend to have the inattentive type of ADHD, rather than the hyperactive/impulsive or combined types. These women may have been chronically disorganized and underachieving back in school, but since they're not as likely to be disruptive, they were more often overlooked.

"When we see moms who are seriously stressed out, being pulled between all kinds of things in their work and their family life, we tend to think of anxiety or depression," adds David Anderson, a clinical psychologist, and director of the ADHD and Behavior Disorders Center at the Child Mind Institute. "That's because we associate depression and anxiety more with their gender, rather than seeing the underlying deficit, the ADHD, that's making it so it's difficult to manage all of those things."

"We hear parents all the time say that they feel like a failure because they know what they have to do, but then carrying it out is so difficult," notes Dr. Anderson. "Managing the logistics, remembering everything - they're feeling really bad about themselves."

For a parent who has ADHD, getting a diagnosis itself can help reduce guilt and alleviate stress. "A lot of adults with ADHD don't realize they have ADHD," says Dr. Stein. "They don't know why they've struggled in school, and perhaps at work and maybe in their marriage, and raising their kids. They're demoralized and frustrated." With a diagnosis, he adds," rather than blaming themselves and thinking that it's a moral failing, they understand they have this genetic disorder, like their child does."

Getting treatment for a parent with ADHD can improve that person's parenting skills and reduce stress on the whole family, Dr. Stein notes. Treatment for ADHD often involves stimulant medication, but might also include behavioral therapy. "You're able to be better organized and give kids more focused attention," explains Dr. Stein. "Patients report that they all of a sudden feel less overwhelmed, and they can be more relaxed and comfortable with their children."

When his team works with families in which both a parent and a child have ADHD, Dr. Anderson explains, the team does an inventory with the parent, to talk about strengths and weaknesses. "We want to be allies with them from the get-go, to figure out how to support both them and their child." Parents assessing their own capabilities helps the team craft strategies to help them succeed.

One of the challenges of parenting children with ADHD is that these kids often have serious behavior problems. They have low frustration tolerance and are prone to tantrums and outbursts when things don't go their way. Responding effectively to this kind of behavior is difficult for all parents, but more so for someone with ADHD.

Managing a child's behavior successfully requires parents to be consistent and calm, and keep their own emotions out of the equation. Parents need to pay close attention to and respond positively to behaviors they want to encourage. And they need to avoid reacting emotionally to behaviors that are problematic. None of these things is easy if you have ADHD.

But when parents get treatment for their own ADHD, research shows that their behavior management skills improve, leading to an increase in positive parent-child interactions and more effective direction for their children. Hence treating the caregiver's ADHD may be a vitally important part of helping the child overcome behavior problems.

Dr. Stein sees a shortage of professionals who are comfortable diagnosing and treating adults with ADHD. "I think ADHD is where depression was 15 years ago, where it used to be something that only psychiatrists treated. Then it became primary care, and now primary care doctors routinely screen for it. ADHD is very common, but seldom screened for in adults."

Dr. Stein notes that physicians get much more training in diagnosing depression and prescribing antidepressants than they do diagnosing and treating ADHD. On top of that, they may be uncomfortable prescribing stimulant medications because they worry about potential abuse.

And organizations that treat children with ADHD are leery about including parents in their coverage. "Family medicine should be a place that should work for it," Dr. Stein argues, "but, again, there's this discomfort with using stimulants, and so they're more likely to be tried with an antidepressant."

This gap in the medical system, he adds, demonstrates why, for lifelong developmental disorders like autism and ADHD, "we need lifespan clinics."

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When Parent and Child Both Have ADHD - Child Mind Institute

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It's a story we hear regularly: A child is diagnosed with ADHD and one of his parents, recognizing the symptoms, realizes that he (or she) has the disorder, too. It's often a surprise to the mom or dad, but to clinicians it's not surprising.