(Attention deficiency hyperactivity disorder)

Attention deficit hyperactivity disorder (ADHD) is a condition that affects people's behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse.

Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school.

Most cases are diagnosed when children are under 12 years old, but sometimes it's diagnosed later in childhood.

Sometimes ADHD was not recognised when someone was a child, and they are diagnosed later as an adult.

The symptoms of ADHD usually improve with age, but many adults who were diagnosed with the condition at a
young age continue to experience problems.

People with ADHD may also have additional problems, such as sleep and anxiety disorders.

Getting help

Many children go through phases where they're restless or inattentive. This is often completely normal and does not necessarily mean they have ADHD.

But you should discuss your concerns with your child's teacher, their school's special educational needs co-ordinator (SENCO) or a GP if you think their behaviour may be different from most children their age.

It's also a good idea to speak to a GP if you're an adult and think you may have ADHD, but were not diagnosed with the condition as a child.

What causes attention deficit hyperactivity disorder (ADHD)?

The exact cause of ADHD is unknown, but the condition has been shown to run in families.

Research has also identified a number of possible differences in the brains of people with ADHD when compared with those without the condition.

Other factors suggested as potentially having a role in ADHD include:

being born prematurely (before the 37th week of pregnancy)

having a low birthweight

smoking or alcohol or drug abuse during pregnancy

ADHD can occur in people of any intellectual ability, although it's more common in people with learning difficulties.

How attention deficit hyperactivity disorder (ADHD) is treated

For children with ADHD, although there's no cure, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medicine, if necessary.

For adults with ADHD, medicine is often the first treatment offered, although psychological therapies such as cognitive behavioural therapy (CBT) may also help.

Living with attention deficit hyperactivity disorder (ADHD)

Parents of children with ADHD

Looking after a child with ADHD can be challenging, but it's important to remember that they cannot help their behaviour.

Some day-to-day activities might be more difficult for you and your child, including:

getting your child to sleep at night

getting ready for school on time

listening to and carrying out instructions

being organised

social occasions

shopping

Adults with ADHD

Adults with ADHD may find they have problems with:

organisation and time management

following instructions

focusing and completing tasks

coping with stress

feeling restless or impatient

impulsiveness and risk taking

Some adults may also have issues with relationships or social interaction.

Symptoms of attention deficit hyperactivity disorder (ADHD)

The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into 2 types of behavioural problems:

inattentiveness (difficulty concentrating and focusing)

hyperactivity and impulsiveness

Many people with ADHD have problems that fall into both these categories, but this is not always the case.

For example, around 2 to 3 in 10 people with the condition have problems with concentrating and focusing, but not with hyperactivity or impulsiveness.

This form of ADHD is also known as attention deficit disorder (ADD).
ADD can sometimes go unnoticed because the symptoms may be less obvious.

ADHD is more often diagnosed in boys than girls. Girls are more likely to have symptoms of inattentiveness only, and are less likely to show disruptive behaviour that makes ADHD symptoms more obvious.
This means girls who have ADHD may not always be diagnosed.

Symptoms in children and teenagers

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of 6.

They occur in more than 1 situation, such as at home and at school.

Children may have symptoms of both inattentiveness and hyperactivity and impulsiveness, or they may have symptoms of just 1 of these types of behaviour.

Inattentiveness (difficulty concentrating and focusing)

The main signs of inattentiveness are:

having a short attention span and being easily distracted

making careless mistakes - for example, in schoolwork

appearing forgetful or losing things

being unable to stick to tasks that are tedious or time-consuming

appearing to be unable to listen to or carry out instructions

constantly changing activity or task

having difficulty organising tasks

H

yperactivity and impulsiveness

The main signs of hyperactivity and impulsiveness are:

being unable to sit still, especially in calm or quiet surroundings

constantly fidgeting

being unable to concentrate on tasks

excessive physical movement

excessive talking

being unable to wait their turn

acting without thinking

interrupting conversations

little or no sense of danger

These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

Related conditions in children and teenagers with ADHD

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:

anxiety disorder - which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness

oppositional defiant disorder (ODD) - this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers

conduct disorder - this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals

depression

sleep problems - finding it difficult to get to sleep at night, and having irregular sleeping patterns

autistic spectrum disorder (ASD) - this affects social interaction, communication, interests and behaviour

dyspraxia - a condition that affects physical co-ordination

epilepsy - a condition that affects the brain and causes repeated fits or seizures

Tourette's syndrome - a condition of the nervous system, characterised by a combination of involuntary noises and movements (tics)

learning difficulties - such as dyslexia

Symptoms in adults

In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.

As ADHD is a developmental disorder, it's believed it cannot develop in adults without it first appearing during childhood.
But symptoms of ADHD in children and teenagers often continue into adulthood.

The way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children.

For example, hyperactivity tends to decrease in adults, while inattentiveness tends to remain as the pressures of adult life increase.

Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.

Some specialists have suggested the following as a list of symptoms associated with ADHD in adults:

carelessness and lack of attention to detail

continually starting new tasks before finishing old ones

poor organisational skills

inability to focus or prioritise

continually losing or misplacing things

forgetfulness

restlessness and edginess

difficulty keeping quiet, and speaking out of turn

blurting out responses and often interrupting others

mood swings, irritability and a quick temper

inability to deal with stress

extreme impatience

taking risks in activities, often with little or no regard for personal safety or the safety of others - for example, driving dangerously

Related conditions in adults with ADHD

As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions.

One of the most common is depression. Other conditions that adults may have alongside ADHD include:

personality disorders - conditions in which an individual differs significantly from the average person in terms of how they think, perceive, feel or relate to others

bipolar disorder - a condition affecting your mood, which can swing from one extreme to another

obsessive compulsive disorder (OCD) - a condition that causes obsessive thoughts and compulsive behaviour

The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships and social interaction

The exact cause of attention deficit hyperactivity disorder (ADHD) is not fully understood, although a combination of factors is thought to be responsible.

Genetics

ADHD tends to run in families and, in most cases, it's thought the genes you inherit from your parents are a significant factor in developing the condition.

Research shows that parents and siblings of someone with ADHD are more likely to have ADHD themselves.

However, the way ADHD is inherited is likely to be complex and is not thought to be related to a single genetic fault.

Brain function and structure

Research has identified a number of possible differences in the brains of people with ADHD from those without the condition, although the exact significance of these is not clear.

For example, studies involving brain scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger.

Other studies have suggested that people with ADHD may have an imbalance in the level of neurotransmitters in the brain, or that these chemicals may not work properly.

Groups at risk

Certain people are also believed to be more at risk of ADHD, including people:

who were born prematurely (before the 37th week of pregnancy) or with a low birthweight

with epilepsy

with brain damage - which happened either in the womb or after a severe head injury later in life

I

f you think you or your child may have attention deficit hyperactivity disorder (ADHD), speak to a GP.
If you're worried about your child, it may help to speak to their teachers, before seeing a GP, to find out if they have any concerns about your child's behaviour.
The GP cannot formally diagnose ADHD, but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.
When you see a GP, they may ask you:

about your symptoms or those of your child

when these symptoms started

where the symptoms occur - for example, at home, in school, college or university, or at work

whether the symptoms affect your or your child's day-to-day life - for example, if they make socialising difficult

if there have been any recent significant events in your or your child's life, such as a death or divorce in the family

if there's a family history of ADHD

about any other problems or symptoms of different health conditions you or your child may have

Next steps

Children and teenagers

If the GP thinks your child may have ADHD, they may first suggest a period of "watchful waiting" - lasting around 10 weeks - to see if your child's symptoms improve, stay the same or get worse.
They may also suggest starting a group-based, ADHD-focused parent training or education programme. Being offered a parent training and education programme does not mean you have been a bad parent - it aims to teach you ways of helping yourself and your child.
See treating ADHD for more information.
If your child's behaviour does not improve, and both you and the GP believe it's affecting their day-to-day life, the GP should refer you and your child to a specialist for a formal assessment.

Adults

For adults with possible ADHD, the GP will assess your symptoms and may refer you for an assessment if:

you were not diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since

your symptoms cannot be explained by a mental health condition

your symptoms significantly affect your day-to-day life - for example, if you're underachieving at work or find intimate relationships difficult

You may also be referred to a specialist if you had ADHD as a child or young person and your symptoms are now causing moderate or severe functional impairment.

Assessment

You or your child may be referred to 1 of the following types of specialist for a formal assessment:

a specialist child or adult psychiatrist

a paediatrician - a specialist in children's health

an appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD

Who you're referred to depends on your age and what's available in your local area.
There's no simple test to determine whether you or your child has ADHD, but your specialist can make an accurate diagnosis after a detailed assessment. The assessment may include:

a physical examination, which can help rule out other possible causes for the symptoms

a series of interviews with you or your child

interviews or reports from other significant people, such as partners, parents and teachers

Diagnosis in children and teenagers

Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have 6 or more symptoms of inattentiveness, or 6 or more symptoms of hyperactivity and impulsiveness.

To be diagnosed with ADHD, your child must also have:

been displaying symptoms continuously for at least 6 months

started to show symptoms before the age of 12

been showing symptoms in at least 2 different settings - for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or to parental control

symptoms that make their lives considerably more difficult on a social, academic or occupational level

symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition

Diagnosis in adults

Diagnosing ADHD in adults is more difficult because there's some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults.
In some cases, an adult may be diagnosed with ADHD if they have 5 or more of the symptoms of inattentiveness, or 5 or more of hyperactivity and impulsiveness, listed in diagnostic criteria for children with ADHD.
As part of your assessment, the specialist will ask about your present symptoms. However, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot be confirmed unless your symptoms have been present from childhood.
If you find it difficult to remember whether you had problems as a child, your specialist may wish to see your old school records, or talk to your parents, teachers or anyone else who knew you well when you were a child.
For an adult to be diagnosed with ADHD, their symptoms should also have a moderate effect on different areas of their life, such as:

underachieving at work or in education

driving dangerously

difficulty making or keeping friends

difficulty in relationships with partners

If your problems are recent and did not occur regularly in the past, you're not considered to have ADHD. This is because it's currently thought that ADHD cannot develop for the first time in adults.

Treatment for attention deficit hyperactivity disorder (ADHD) can help relieve the symptoms and make the condition much less of a problem in day-to-day life.
ADHD can be treated using medicine or therapy, but a combination of both is often best.
Treatment is usually arranged by a specialist, such as a paediatrician or psychiatrist, although the condition may be monitored by a GP.

Medicine

There are 5 types of medicine licensed for the treatment of ADHD:

methylphenidate

lisdexamfetamine

dexamfetamine

atomoxetine

guanfacine

These medicines are not a permanent cure for ADHD but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.
Some medicines need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended to assess whether the medicine is still needed.
If you were not diagnosed with ADHD until adulthood, a GP and specialist can discuss which medicines and therapies are suitable for you.
If you or your child is prescribed one of these medicines, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to see a GP for regular check-ups to ensure the treatment is working effectively and check for signs of any side effects or problems.
It's important to let the GP know about any side effects and talk to them if you feel you need to stop or change treatment.
Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.

Methylphenidate

Methylphenidate is the most commonly used medicine for ADHD. It belongs to a group of medicines called stimulants, which work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.
Methylphenidate may be offered to adults, teenagers and children over the age of 5 with ADHD.
The medicine can be taken as either immediate-release tablets (small doses taken 2 to 3 times a day) or as modified-release tablets (taken once a day in the morning, with the dose released throughout the day).
Common side effects of methylphenidate include:

a small increase in blood pressure and heart rate

loss of appetite, which can lead to weight loss or poor weight gain

trouble sleeping

headaches

stomach aches

feeling aggressive, irritable, depressed, anxious or tense

Diet

People with ADHD should eat a healthy, balanced diet. Do not cut out foods before seeking medical advice.
Some people may notice a link between types of food and worsening ADHD symptoms. If this is the case, keep a diary of what you eat and drink, and what behaviour follows. Discuss this with a GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).

Supplements

Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial for people with ADHD, although the evidence supporting this is very limited.
It's advisable to talk to a GP before using any supplements, because some can react unpredictably with medicine or make it less effective.
You should also remember that some supplements should not be taken long term, as they can reach dangerous levels in your body.

Tips for parents

If you're the parent of a child with ADHD:

be sure your GP or specialist helps you understand the difference between ADHD and any other problems your child may have

think about who else needs to know about your child's ADHD, such as their school or nursery

find out the side effects of any medicine your child takes and what you need to look out for

getting to know people at local support groups can stop you feeling isolated and help you to cope

to play, but keep playtimes short so your child does not lose self-control. Do not aim to do this when your child is feeling tired or hungry, such as after a day at school.

Exercise

Make sure your child gets lots of physical activity during the day. Walking, skipping and playing sport can help your child wear themselves out and improve their quality of sleep.
Make sure they're not doing anything too strenuous or exciting near to bedtime.
Read our physical activity guidelines for children and young people, which includes information on getting active, and how much activity you and your child should be doing.

Eating

Keep an eye on what your child eats. If your child is hyperactive after eating certain foods, which may contain additives or caffeine, keep a diary of these and discuss them with a GP.

Bedtime

Stick to a routine. Make sure your child goes to bed at the same time each night and gets up at the same time in the morning.
Avoid overstimulating activities in the hours before bedtime, such as computer games or watching TV.

Night time

Sleep problems and ADHD can be a vicious circle. ADHD can lead to sleep problems, which in turn can make symptoms worse.
Many children with ADHD will repeatedly get up after being put to bed and have interrupted sleep patterns. Trying a sleep-friendly routine can help your child and make bedtime less of a battleground.

Help at school

Children with ADHD often have problems with their behaviour at school, and the condition can negatively affect a child's academic progress.
Speak to your child's teachers or their school's special educational needs co-ordinator (SENCO) about any extra support your child may need.

Adults with ADHD

If you're an adult living with ADHD, you may find the following advice useful:

if you find it hard to stay organised, then make lists, keep diaries, stick up reminders and set aside some time to plan what you need to do

let off steam by exercising regularly

find ways to help you relax, such as listening to music or learning breathing exercises for stress

if you have a job, speak to your employer about your condition, and discuss anything they can do to help you work better

if you're at college or university, ask about what adjustments can be made to support you, such as extra time to complete exams and coursework

talk to a doctor about your suitability to drive, as you'll need to tell the Driver and Vehicle Licensing Agency (DVLA) if your ADHD affects your driving

contact or join a local or national support group - these organisations can put you in touch with other people in a similar situation, and can be a good source of support, information and advice

Read about living with ADHD on the AADD-UK website. AADD-UK is a charity specifically for adults with ADHD.
AADD-UK also has a list of support groups across the UK, including groups for adults, parents and carers.

Authors note:

Hey guys this is my first chapter of my mental disorder book I hope you like it I spent 2 hours writing it all
Been!